The International Journal of Psychosocial Rehabilitation
 

The Effects of Professional Experiences on Recovery Knowledge and Expectations amongst Department of Veterans Affairs Mental Health Providers

Leonardo J Caraballo
Jason D Netland


Phoenix VA Health Care System, Psychology Service, 650 E. Indian School Road, Phoenix, Arizona, United States
Email: Leonardo.Caraballo@va.gov

 

Citation:
Caraballo LJ (2020)  The Effects of Professional Experiences on Recovery Knowledge and Expectations amongst Department of Veterans Affairs Mental Health Providers.
International Journal of Psychosocial Rehabilitation. Vol 23 (1)



Abstract

Training in psychosocial recovery has been disseminated across various health care systems and health care disciplines. The present study examined the impact mental health provider experiences have on a provider’s knowledge of and expectations for recovery. Online surveys were completed by 172 mental health providers across three Veterans Health Administration healthcare systems. Survey measures included items assessing demographic information, professional experiences, recovery knowledge, and recovery expectations. All mental health disciplines across treatment settings were encouraged to participate. Regression analyses demonstrated a positive predictive relationship between highest educational degree and a provider’s recovery knowledge and expectations for recovery. No other variable demonstrated the predictive ability of highest educational degree for either recovery knowledge or recovery expectations. Educational attainment appears to be the best predictor of a mental health provider’s knowledge of recovery and their expectations of recovery by their clients. Improving educational opportunities for all mental health providers may also positively affect their recovery oriented practices.

Key words: Veterans, Recovery knowledge, Recovery expectations, Education



 


Introduction

Recovery oriented practices have been implemented in various healthcare settings and have been disseminated across a variety of healthcare disciplines. An impetus for this change was the President’s New Freedom Commission that stipulated the importance of recovery-oriented mental health services (United States Department of Health and Human Services, 2003). This is particularly true for mental health services provided by Veterans Health Administration (VHA) facilities through the guidance of the Uniformed Mental Health Services Handbook (2008) and the efforts of Local Recovery Coordinators. VHA facilities initiated the transformation to recovery oriented practices by educating staff on the definition and principles of recovery. One such definition is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (Substance Abuse and Mental Health Services Administration, 2012). Of note, research has found that provider recovery knowledge can improve following recovery focused training (Feeney, Jordan, & McCarron, 2013; Chen, Krupa, Lysaght, McCay. & Piat, 2014). Researchers have also found that provider expectations for recovery may differ based on the provider’s professional setting and that VA providers have demonstrated the highest expectations for their client’s recovery (Salyers & Brennan, 2013). It has also been found that length of professional experience and type of mental health discipline may impact knowledge of recovery (Cleary & Dowling, 2009).

Veterans Health Administration (VHA) providers have also undergone training to utilize evidence-based practices that align with a recovery model of care. These efforts by VHA to develop recovery focused psychosocial rehabilitation models of care have been found to improve veteran health outcomes (Kova et al., 2016; & Zuehlke, Kotecki, Kern, Sholty, & Hauser, 2016) and help reduce mental health stigma (Leddy-Stacy, Stefanovics, & Rosenheck, 2016). However, the change to a recovery model of care often requires a cultural change that can be met with challenges. Advocating for recovery oriented practices can result in negative reactions by staff that may be resistant to change (McGuire et al., 2015). Furthermore, the impact that professional development and experiences may have on recovery perspectives has yet to be fully understood.

The purpose of this study was to examine the knowledge and expectations of VHA mental health providers with regard to psychosocial recovery. First, we sought to understand the impact professional experiences can have on recovery knowledge and expectations. We predicted that education level and confidence in providing recovery oriented services would be positively associated with recovery knowledge and expectations. We also predicted that the overall amount of mental health experience would be positively associated with both recovery knowledge and expectations. Second, we sought to identify healthcare experiences that could enhance mental health provider’s understanding of recovery. We predicted that experience with inpatient mental health settings would be positively associated with recovery knowledge and expectations.

Method

Participants and Procedure

Following appropriate institutional review board approval, Veterans Health Administration (VHA) mental health providers (N = 172) from three VHA healthcare systems from the southwest and the northeast were recruited through email announcements with links to online research participation information and survey measures. Informed consent was obtained via online informed consent document acknowledgment. The online survey measures included demographics, professional experiences, recovery knowledge, and recovery expectations. To ensure participation from a variety of mental health providers, any provider that self-identified as a mental health provider was asked to participate. Furthermore, providers that offered any mental health clinical services were included. Only mental health providers that functioned strictly in an administrative role with no clinical services in VHA were excluded. Participant ages ranged from 27 to 69 (M = 47.46, SD = 11.28, Mdn = 48.00).  Racial/ethnic composition of the sample included 78.7% White, 4.3% African-American, 4.9% Hispanic, 4.3% Asian, 1.2% Native American/Alaska Native and 6.6% from other racial/ethnic backgrounds. Participants were 72.8% female and reported that their highest academic degrees were 4.1% 2-year college degree, 14.7% 4-year college degree, 41.2% master’s degree, 17.1% professional degree, and 17.6% doctoral degree. Additionally, 5.3% reported some college with no degree completion.

Measures

Confidence providing SMI services. Participant’s confidence in providing recovery oriented services for clients with serious mental illnesses was assessed using a one-item measure of overall confidence. This time asked, “How confident do you feel that you can provide effective recovery oriented services to clients with a serious mental illness?” Response options ranged from 1 = not at all confident to 5 = completely confident.

Recovery Knowledge Inventory. Recovery knowledge (α = .84) was measured utilizing the Recovery Knowledge Inventory (Bedregal, O'Connell, & Davidson, 2006). The Recovery Knowledge Inventory is a 20-item measure developed to assess provider knowledge and attitudes towards recovery. It has been found to assess four domains associated with recovery including roles and responsibilities, non-linearity, self-definition and peers, and expectations (Bedregal, O'Connell, & Davidson, 2006). Item responses range from 1 = strongly disagree to 5 = strongly agree.

Provider Expectations for Recovery Scale. Expectations for recovery (α = .94) was measured utilizing the Provider Expectations for Recovery Scale (Salyers, Brennan, & Kean, 2013). The Provider Expectations for Recovery Scale is a 10-item measure developed to assess provider’s expectations for recovery regarding the clients with which they work. Of note, the development of this measure included mental health provider samples from a VHA setting. Item responses range from 1 = none to 5 = almost all.

Data Analysis

All analyses were conducted using SPSS version 24. Hierarchical linear regressions were utilized to determine the impact education level, self-reported confidence in providing recover services, amount of professional experience, and inpatient mental health experience had on recovery knowledge and expectations. Control variables of age and gender were included in Step 1 of the regression followed by the predictor variables.

Results

Means, standard deviations, and zero-order correlations for recovery knowledge and expectations are displayed in Table 1. At the bivariate level, recovery knowledge demonstrated a positive association with highest degree (r = .35) and a negative association with years of experience providing inpatient mental health services (r = -.20). Similarly, recovery expectations demonstrated a positive association with highest degree (r = .37).

Table 1: Means, SDs, and Bivariate Correlations.

Means, SDs, and Bivariate Correlations

 

 

 

 

 

Variable

M

SD

1

2

3

4

5

6

7

1. Age

47.46

11.28

 

 

 

 

 

 

 

2. Gender

3. Education

4. Confidence

5. Total experience

6. Inpatient experience

7. Knowledge

8. Expectation

1.67

4.15

3.30

4.01

5.38

72.99

41.43

.48

1.26

1.13

1.33

5.70

9.25

6.59

.22**

-.23**

.31**

.55**

.26**

-18*

-.05

 

-.13

.31**

.16*

.01

-.07

-.12

 

 

-.12

.06

-.26**

.35**

.37**

 

 

 

.26**

.08

.15

.08

 

 

 

 

.36**

.02

.08

 

 

 

 

 

-.20

-.13

 

 

 

 

 

 

.46**

Note. Gender: 1 = female, 2 = male, 3 = other.

*p < .05 (two-tailed). **p < .01.

However, neither recovery knowledge or expectations demonstrated a significant relationship with self-reported confidence (r = .15 and r = .08, respectively). Furthermore, total experience providing mental health services was also not significantly correlated with recovery knowledge or expectations (r = .02 and r = .08, respectively). Results from the two hierarchical multiple regression analyses are presented in Table 2. As hypothesized, highest educational degree significantly and positively predicted recovery knowledge (β = .36, p < .01) and recovery expectations (β = .38, p < .01). However, years of inpatient mental health experience did not predict recovery knowledge over and above highest educational degree (β = -.07, p > .05). The overall model explained 17% of the variance for recovery knowledge, R2 = .17, F(4, 104) = 5.07, p < .01. For recovery expectations, the overall model explained 15% of the variance, R2 = .15, F(3, 142) = 8.17, p < .01.

Table 2: Hierarchical Multiple Regression.

 

Recovery Knowledge

 

Recovery Expectations

 

β

t

 

β

t

Step 1

Age

Gender

 

Step 2

Highest degree

Inpatient experience

.09

1.96

 

 

.74

-.07

-1.48

-.18

 

 

3.73**

-.73

 

 

-.03

-.12

 

 

 

.38

 

 

-.36

-1.37

 

 

 

4.68**

 

**p < .01.

Discussion

Training and education in psychosocial recovery has been widely disseminated throughout various health care systems and has been particularly emphasized in VHA settings. The current study attempted to examine the impact various professional experiences may have on a VHA provider’s knowledge of and expectations for recovery. As found in previous studies (e.g., Bedregal, O'Connell, & Davidson, 2006), educational attainment, measured as highest educational degree in this study, was found to have a positive impact on recovery expectations. Furthermore, this study found a similar relationship between recovery knowledge and education. These findings may suggest that educational experiences may broaden a provider’s understanding of recovery through educational opportunities and possibly though exposure to diverse experiences in health care that are afforded by longer educational experiences.

The current finding also suggests that there may be a relationship between inpatient mental health experience and recovery knowledge. However, this relationship does not appear to be a better predictor of recovery knowledge than education. Additionally, counter to the hypothesized relationship there was a negative correlation between inpatient mental health experience and recovery knowledge. This may be due to the types of experiences inpatient mental health providers tend to have with their clients. These circumscribed experiences may result in a biased view of recovery.  Inpatient mental health providers, particularly in acute settings, tend to interact with their clients only during periods of increased symptoms and distress. These limited experiences may result in inpatient mental health provider’s believing that this acute presentation is typical and not the exception.

Of note, the current findings did not support the hypotheses that self-reported confidence in providing recovery services for clients with serious mental illness would be positively associated with recovery knowledge and expectations. This may be due to the limitations of using a single item to attempt to capture the complex construct of confidence. Additionally, self-perceived confidence providing recovery services does not equate competence in recovery. The current findings also did not support the hypotheses that amount of professional experience providing mental health services would be positively associated with recovery knowledge and expectations. This deviation from the expected relationship may be due to the diversity of experiences a provider may have throughout an entire career coupled with the variability of emphasizing recovery-oriented practice that health care systems have had over time.

Limitations and Future Directions

To our knowledge, the current study is the first to examine relationships between professional experiences, recovery knowledge, and recovery expectations. Several limitations must be considered with regard to the outcomes of this study. One important limitation is the limited measurement of confidence in providing recovery services to clients with serious mental illness. Future research may benefit from a more robust measure of confidence in applying recovery-oriented principles of care and comparing self-perceived confidence with competence in recovery. Also, while this study had a moderate sample size, the sample was limited to VHA employees that self-selected to participate and was not derived from a nationwide sample of mental health providers. As such, the sample’s gender, racial, and ethnic diversity was limited. Additional research using more diverse samples of providers may help improve the generalizability of these findings.  Lastly, the present study used a cross-sectional design, precluding any inferences regarding causality.  Longitudinal research would better assess for the impact professional experiences have on recovery knowledge and expectations over time. Future research may also wish to include mixed methods (e.g., focus groups, interviews, and observation) of collecting information about a provider’s recovery knowledge and expectations repeatedly throughout their professional development. Moreover, a study looking at the actual application of psychosocial recovery in daily practice would help elucidate the differences amongst the many mental health providers in VHA facilities.


References    
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