Portland State University PDXScholar Dissertations and Theses Dissertations and Theses Spring 5-24-2016 The Development and Validation of the Social Recovery Measure Casadi "Khaki" Marino Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the Social Work Commons Let us know how access to this document benefits ou.y Recommended Citation Marino, Casadi "Khaki", "The Development and Validation of the Social Recovery Measure" (2016). Dissertations and Theses. Paper 2925. https://doi.org/10.15760/etd.2921 This Dissertation is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. The Development and Validation of the Social Recovery Measure by Casadi Michelle Marino A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Social Work and Social Research Dissertation Committee: Maria Talbott, Chair Eileen Brennan Mary Oschwald Greg Townley Melissa Thompson Portland State University 2016 © 2016 Casadi Michelle Marino Abstract Mental health recovery is a complex phenomenon involving clinical, functional, physical, and social dimensions. The social dimension is understood to involve meaningful relationships and integration with supportive individuals and a wider community. While the recovery model developed from a movement led by consumers and survivors of the mental health system to promote hope, self-determination, and social inclusion, the clinical aspects of recovery have dominated mental health research and practice. The under-investigated area of social recovery calls for psychometrically sound measurement instruments. The purpose of the current study was to develop and validate the Social Recovery Measure (SRM). The study was grounded in disability and mad theories which locate disability at the intersection of the person and the environment. The SRM is a 19-item self-administered instrument scored on a 5-point Likert scale that consists of two domains: Self and Community. Items for the SRM were developed through focus groups and interviews with 41 individuals in recovery from mental health challenges and the preliminary measure was administered to a purposive, nonprobability sample of 228 individuals in recovery. A confirmatory factor analysis (CFA) was conducted and a re-specified model resulted in good model fit. The SRM exhibited excellent internal consistency with a Cronbach’s coefficient alpha of .951 and demonstrated excellent test-retest reliability, content validity, and construct validity. Social recovery is highly relevant for social work given the discipline’s commitment to disenfranchised populations and investment in creating enabling environments. The i SRM has utility for use in evidence based practice and evaluation. The SRM can be used to further research in social recovery, test underlying theory bases, and explore the differential effects of the multiple dimensions of recovery. There is a need to better understand social recovery which this measure can facilitate. ii Acknowledgments I would like to recognize the members of my dissertation committee: Dr. Maria Talbott, Chair, Dr. Eileen Brennan, Dr. Mary Oschwald, Dr. Greg Townley, and Dr. Melissa Thompson. I would like to acknowledge the members of my expert panel: Dr. Larry Davidson, Dr. Nev Jones, Stephania Hayes, and Candice Morgan. I extend my appreciation to the mad grrls in the academy who supported me over the years. I am grateful to Christina Aguilera for the song “Fighter” which I listened to repeatedly for motivation during the last stages of my PhD program. Y gracias a las señoras de La Casita para los tacos vegetarian. Adios. iii Table of Contents Abstract ................................................................................................................................ i Acknowledgments.............................................................................................................. iii List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1 Introduction ..........................................................................................................................1 Chapter 2 Review of a Theory Base for and the Literature on Recovery ..........................................13 Chapter 3 Methods ………………………………………………………………………………...115 Chapter 4 Results ………………………………………………………………………………….156 Chapter 5 Discussion ……………………………………………………………………………...177 References ……………………………………………………………………………...193 Appendices Appendix A. IRB Approval .................................................................................231 Appendix B. Qualtrics Survey .............................................................................232 Appendix C. Skew and Kurtosis of the Items on the Draft SRM .......................246 Appendix D. Total Variance Explained and Pattern Matrix…………………... 252 Appendix E. Final Version of the SRM ...............................................................262 iv List of Tables Table 1. Summary of Instrument Quality Ratings ..........................................................110 Table 2. Demographic Characteristics: Residency, Age, Gender, Race/Ethnicity, Sexual Orientation, Relationship Status, Living Situation ..........................................................157 Table 3. Demographic Characteristics: Education, Employment, Services Type, Diagnosis..........................................................................................................................159 Table 4. Draft SRM Distribution Data .............................................................................161 Table 5. Final SRM Distribution Data .............................................................................166 Table 6. Factor Loadings for Final SRM Items ...............................................................167 Table 7. Correlation, One-way ANOVAs, and T-Test of Non-significant Findings .......175 v List of Figures Figure 1: Scree Plot of Eigenvalues of Factors for Exploratory Factor Analysis ............164 Figure 2: 19-item Two Factor Model of the Social Recovery Measure (SRM) ..............168 vi Chapter 1 INTRODUCTION Mental health and illness have proven difficult to define. Concepts and values differ across social groups, cultures, and time periods. There is insufficient understanding of the etiology of mental illness. The difficulty with definitions has challenged the development of common approaches and effective interventions (Satcher, 2000). Mental health policy is fundamentally shaped by the prevailing definition of mental illness. Changing policies reflect changing definitions (Goldman & Grob, 2006). According to the Surgeon General, serious mental illnesses are understood as conditions that interfere with social functioning (U.S. Department of Health and Human Services, 1999). The Center for Psychiatric Rehabilitation defines “psychiatric disability” as mental illness which significantly interferes with performance of major life activities such as communicating with others and working (Center for Psychiatric Rehabilitation, 2012). Four percent or 9.6 million adults aged 18 or older in the U.S. have serious mental illnesses. Mental illness accounts for the largest proportion of disability in the United States as well as in other developing countries. The economic cost of mental illness in the United States is approximately 300 billion dollars a year (Centers for Disease Control and Prevention, 2011; National Institute of Mental Health, 2014). Individuals with mental health issues face significant financial issues and employment barriers. According to the General Accounting Office, major mental illness is found disproportionally among the poor and homeless. Approximately one-third of homeless adults in the United States are believed to have major mental illness (GAO, 2000). An estimated one-half of individuals 1 with serious mental illness live at or near the poverty level (Cook, 2006). Nationwide, 10% - 20% of individuals with mental illness are employed versus 70% of individuals without disabilities (Bureau of Labor Statistics, 2011; National Association of Mental Health Program Directors, 2007). Individuals with major mental illness are overrepresented in jails and prisons. Prevalence rates of serious mental illness are thought to be three to six times greater in the prison population than in the community (U.S. Department of Justice, 2007). Compared to the general U.S. population, public mental health clients die 25 years younger (Colton & Manderscheid, 2006; Manderscheid, et al., 2010). Stigma Mental illness has been described as “the ultimate stigma” and a “mark of shame” (Green, 2009). Stigma is founded on a discredited individual difference and is characterized by lack of knowledge and fear (Corrigan, Watson, Byrne, & Davis, 2005). Stigmatizing beliefs lead individuals with relative social power to restrict opportunities to individuals with a perceived difference (Corrigan, Bink, Fokuo, & Schmidt, 2015). Given the pain caused by exclusion and rejection, stigma has been characterized as a form of social death (Corbiere, Samson, Villotti, & Pelletier,