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The
Community
Psychologist

Volume 48 Number 3 
Summer 2015

Self Help and Mutual Support

Edited by Greg Townley (gtownley@pdx.edu) and Alicia Lucksted (Aluckste@psych.umaryland.edu)

An Evaluation of the Living Room: Members’ Experiences of Hopefulness

Written by Robin Robberson (Robin.Robberson@ccconcern.org), Living Room Coordinator Central City Concern, Portland, OR, and Kari Nilsen, Volunteer, Central City Concern (Kari.nilsen@ccconcern.org)

Acknowledgements: Erica Meadows, and Joan Ayala 

Overview and Purpose

Central City Concern (CCC) is a 501(c)(3) nonprofit agency serving single adults and families in the Portland metro area who are impacted by homelessness, poverty and addictions. Founded in 1979, the agency operates a comprehensive continuum of affordable housing options integrated with direct social services including healthcare, behavioral healthcare, recovery, employment and peer support.  The agency serves approximately 13,000 people annually. In 2008, Multnomah County asked Central City Concern to assume operations of a downtown outpatient mental health program, and the Living Room was created in 2009.  The Living Room currently reaches upwards of 400 people annually. The philosophy of the Living Room centers on the idea that we are all equally important, although each member may have a different role.

We use the term “member” to describe a person utilizing the Living Room programming, avoiding the word “client” to promote a more equal power dynamic. We do not know the diagnosis of those we work with as peers.  Further, discussion of medications is discouraged in the larger forum, and case management by clinical staff is not allowed within the space. The goal is to have a peer-guided, member-run center where rules are created by consensus in the community, and where transparency is critical.  Everyone has a voice and is encouraged to work to better their community.

As a program, the Living Room seeks to inspire hope and recovery through peer relationships, groups, and activities that support members in their development of a spiritual identity. Numerous studies have led to the endorsement of hope as an essential factor in recovery from mental illness (Bonney & Stickley, 2008; Mashiach-Eizenberg, Hasson-Ohayon, Yanos, Lysaker, & Roe, 2013; Waynor, Gao, Dolce, Haytas, & Reilly, 2012). Increased hope is related to a variety of positive outcomes in people with mental illness, including reduced symptoms, improved psychosocial functioning, and better treatment outcomes (Schrank, Stanghellini, & Slade, 2008).

Objectives

This preliminary evaluation aims to provide a snapshot to assist in determining our next steps toward program expansion. It will also provide a benchmark of comparison for further evaluation. 

Methods

Participants

A total of 27 participants were recruited during the operational hours of the Living Room.  All members were approached except those who were visibly experiencing psychotic symptoms.  

Materials and Procedures

We used the Integrative Hope Scale (IHS), first developed by Schrank and colleagues (2010) and then adjusted for use with participants experiencing psychosis (Schrank et. al., 2012).  The IHS comprehensively measures the multifaceted concept of hope: trust and confidence, perspective-taking, positive future orientation, and social relations and personal value.  We also wanted to capture the language and lived experiences of our members through a semi-structured interview.  This qualitative evaluation consisted of 10 questions, the majority adapted from The Recovery Interview (Heil & Johnson, 1998); and the remainder created to reflect the four components of hope identified by Schrank and colleagues (2008): affective, cognitive, behavioral and environmental.  Research assistants who had previously volunteered with the Living Room administered the informed consent, IHS, and qualitative interview with participants.  The interviews were audio recorded and destroyed after transcription. 

Results

Demographics    

Twenty-seven members completed the IHS and six members completed the interview.  Demographic information was obtained to gather a snapshot of the members of the Living Room.  The majority of the participants were male (81.5%), between the ages of 45-54 (40.7%), White (44.4%), and reported living in a house/apartment (81.5%). 

Quantitative: Integrative Hope Scale (IHS) Results

The mean total hope score was M=91.52 (SD=15.53; N=27) which was 69.33% (SD=11.77) of the total possible hopeful score.   Scores ranged from 57 to 118 (50% of the participants scored between 59%-79%, with 25% of the participants scoring above and below this range). Our population’s mean hope score of 69.33% (M=91.52, SD=15.53, N=27) was slightly higher than found in the general population of Austria (67.96% ; M=93.78, SD=12.83, N=489) (Schrank et. al., 2011) and in participants diagnosed with schizophrenia or schizoaffective disorder (68.64% ; M=94.72, SD=4.8, N=200) (Schrank et. al., 2012)

Qualitative Interview Results

A thematic analysis was conducted on the 7 open-ended responses contained in the semi-structured interviews with the goal of understanding participants’ experiences in the Living Room and how this relates to their overall experience of recovery.  The following thematic categories were identified:

Definitions of Recovery

Participants were asked to define what recovery meant to them.  Their definitions covered a diverse array of ideas, including an end to destructive actions (e.g., using drugs), a change in thinking and relating to the world (learning how to deal with trauma, unlearning negative thinking patterns), and an end to pain.

Social Support

Participants spoke often about the value of social support for their recovery, as well as the ability of the Living Room to provide them with that social support. One stated, “It helps me here because it’s a safe place for me to go…I’ve got buddies here.”  Another said, "Well, sometimes I feel alone, so it’s given me a place to go with a peer group [which] is really cool.”  More specifically, participants identified value in the Living Room's peer-support model. One participant said, “I know a few people… and it’s nice to talk to them. Having a relationship with them…kinda brightens up their lives and my life.”

Positive Feelings

Participants discussed having positive feelings when at the Living Room. “I feel better," said one. "When I leave the Living Room, I feel better than I was". Another said, "I feel good.  I feel like I can go home. I am adjusted better, and I feel like I’ve brightened up my day.” One participant also described the mechanism of these positive feelings:  “Because it gets me out of isolation, just staying home and contemplating my navel or twiddling my thumbs. I am more, I’m better. I function better, you know?”

Proactive Behaviors

Some participants mentioned how the Living Room has supported them in taking on more responsibilities and feeling empowered: "Well, like, they [the Living Room staff] put me on the committee to pick out the art for the clinic.  It makes me feel really good. They like my feedback.”  Additionally, participants mentioned appreciating the activities offered in the Living Room: “ I like the yoga and meditation. Cause meditation is much more powerful when it is in groups.”

Motivation

Participants spoke to the ways the Living Room helps them feel motivated. Several participants mentioned that simply showing up to the space gives them a sense of accomplishment. For example, one participant said, "Cause normally what gives me enough energy to get up and get dressed to do things in the morning, if I go through all of that work, it’s usually because I’m driven by something inside that I feel needs attention. And I come here for specific reasons sometimes."

Decision-making

Participants spoke about the ways that their experiences in the Living Room have helped them to make positive decisions in their lives. In the words of one participant, "It’s changed the way I think about past experiences, more so than it helps me make good choices around situations that come up in my life right now." Another participant, when asked how the Living Room has helped in their recovery process, responded, "I can find out better ways of doing, organizing my time…and more wise decisions".

Positive Environment

A number of participants described positive aspects of the environment at the Living Room, many focusing on how it is a safe space. One participant stated, “It helps me here because it’s a safe place for me to go." Another stated, "“I come back for the sanctity, for the safety". Other participants used words like "refuge" and "safe place" to describe the environment. Factors that they mentioned included the lack of drug use and violence in the space and the cleanliness of the space. Others discussed how they felt respected and “welcome” in the space. When asked if the Living Room has hindered their recovery in any way, a participant responded, "It hasn’t. Because there’s no pressure, nobody bothered me or nobody told me to shut up when I'm talking. It has not hindered me."

Negative Factors

Though the majority of comments about the Living Room were positive, a few participants mentioned negative experiences with the program. One participant stated that they did not like it, "when people argue" in the space. Another described a staff member who tells them 'no' a lot. These two negative examples indicate violations of the intended use of the space: the first, a lack of safety in the space and the second, a staff/client hierarchy that the Living Room works to eradicate.

Discussion

Quantitative

This evaluation was a point in time collection of data to provide a snap shot of the levels and experiences of hopefulness for the members of the Living Room.  It is promising that the amount of hopefulness represented by the IHS percentage score for members of the Living Room is comparable to, and in fact greater, than those among members of the general population.  Cultural differences may contribute to this difference in hopefulness.  For example, one important difference in Living Room participants compared to participants in Shrank’s (2012) study was that substance abuse disorder was an exclusion criterion for participation in Shrank’s study but not in our study.  No conclusive remarks can be made regarding this difference, but it would be interesting to see how another set of participants with co-morbidity of substance abuse disorder and another mental health disorder would score on the IHS scale, as well as how a population with only substance abuse disorder would score. 

Qualitative

Participants' responses reflected positively on the Living Room program. Participants spoke to the many ways that the program helps them in recovery. Additionally, these responses largely reflected the components of hope outlined by Schrank et al. (2008), including the importance of social support and personal motivation. Participants were able to articulate ways that their experiences in the Living Room reflect Schrank et al.’s model for fostering hope in recovery.

Future Directions

This evaluation brought to light areas for us to work on.  Although members who participated in the evaluation had a great deal of positive feedback, it was noted that Living Room participants do not differentiate between types of employees.  Everyone is considered to be a counselor, and they did not recognize, understand, or value the intention of having peer staff.  Since this evaluation was completed, we have worked to clarify what it means to be a “peer”, as the word may not be the best descriptor for our population.  Ultimately, staff members are required to wear a badge, and that may work against eliminating power differentials in the space; however, we will continue to work toward an egalitarian structure.  In addition, a Peer Leader program has been developed to recognize and encourage members who excel and wish to be of service to their community.

References

Bonney, S., & Stickley, T. (2008). Recovery and mental health: A review of the British literature. Journal

of Psychiatric & Mental Health Nursing, 15, 140-153.

Mashiach-Eizenberg, M., Hasson-Ohayon, I., Yanos, P., Lysaker, P., & Roe, D. (2013). Internalized stigma and

quality of life among persons with severe mental illness: The mediating roles of self-esteem and hope. Psychiatry

Research, 208, 15-20.

Schrank, B., Stanghellini, G., & Slade, M. (2008). Hope in psychiatry: A review of the literature. ACPS Acta

Psychiatrica Scandinavica, 118, 421-433.

Schrank, B., Woppmann, A., Sibitz, I., & Lauber, C. (2011). Development and validation of an integrative hope

scale to assess hope.  Health Expectations, 14(4), 417-428.

Schrank, B., Woppmann, A., Hay, A. G., Sibitz, I., Zehetmayer, S., & Lauber, C. (2012). Validation of the

integrative hope scale in people with psychosis.  Journal of Psychiatry Research, 198, 395-399.

Waynor, W. R., Gao, N., Dolce, J. N., Haytas, L. A., & Reilly, A. (2012). The relationship between hope and

symptoms. Psychiatric Rehabilitation Journal, 35, 345-348.

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