How to Measure Recovery

MeasuringRecoveryI have a new crush.

I get them. Big intellectual crushes. On people who are doing really innovative work in the field of measurement.

I have a long-standing crush on Michael Quinn Patton, originator of Developmental Evaluation.

My new crush is Dr Skye Barbic, who has created the Personal Recovery Outcome Measure (PROM). I spend a blissful hour and half this week learning all about it.

The PROM questionnaire is designed for people who are recovering from mental illness. But it can be used by everyone.

In fact, I think it should be used by everyone.

The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Clearly we don’t need to be recovering from a debilitating mental illness to be pursuing improved mental health. In fact, the WHO definition for mental health could be the definition for purpose in life.

The PROM questionnaire is designed to help anyone realize their potential and cope with stress.

It’s my new favourite tool!

How it Works

The questionnaire tells a story of recovery, from the very earliest stages of the process to total wellness.

That’s why all of us can use it: wellness is a goal we all share no matter where we are stating from.

This tool quantifies that which can otherwise feel amorphous. It enables a person to track their progress over time, and also enables comparison between people.

There are 30 multiple-choice questions in PROM and they are sequential.

The metaphor Dr Barbic uses to describe measurement of recovery using PROM is a 30-cm ruler. The whole ruler represents total wellness. For any of us.

Almost no one is at 30. All of us are somewhere on the ruler.


Each one of the questions, in order, represents another increment (a centimeter) on the ruler.

By completing the PROM questionnaire we end up with a score. Some number out of the highest possible total of 30 (for example, I got 24 and Matthew got 16.5).

This score enables you to track changes over time.

If you missed the link earlier in this post,  you can find the questionnaire here.

PROM questionsGoal Setting

After scoring, the questionnaire enables you to identify areas of strength as well as areas to work on.

Your score also refers you to an intervention opportunity as part of your story of recovery.

So, for example, my score of 24 refers me to statement #24, which is “I like the place that I live in.”

I could choose to work on something else, but something around 24 might be a good place for me to start.

PROM questions 2Dr Barbic suggested that we look at a range of options, three below and three above our score. If I go three below, I get to “I can manage stress”.

That’s definitely where I need to start!

Matthew’s score refers him to statement #16 “I have new interests”.

Are you feeling it?

I sure am.

Matthew and I have done our first questionnaires, and I’ve marked my calendar. In 2 months, we’ll do them again.

Implications for People with Chronic Health Conditions

Many people with autoimmune and other chronic health conditions report degenerating mental health, whether that takes the form of brain fog, depression, anxiety, or something even more disabling.

Given that, it makes sense to track mental health recovery as well as recovery of other symptoms when engaging in n=1 experimentation for healing.

PROM also focuses on the lifestyle components of healing protocols, like sleep, stress management and supportive relationships. Things that we know we need in our lives to improve our health and well-being.

So, our mental health can improve by using PROM as a measurement and intervention tool, and our physical health can, too.

The Mental Health Epidemic

In my professional role, I coordinate a large health network that is working to improve the mental health outcomes of children and youth.

I was curious about whether this questionnaire could be used with youth. Before I could put up my hand to ask, Dr Barbic told us that it can.

With one key difference.

Youth don’t care about sleep. But they care very much about intimate relationships. So those two statements (#5 & #29) need to be reversed when using PROM with youth.

I wrote a post awhile back called the child & youth mental health epidemic, but this ‘epidemic’ is not just confined to young people.

According to Dr Barbic, the “cost of mental illness to Canadian society is approximately $192 billion annually and evidence suggests that in the next two decades, mental illness will be the leading cause of disability in Canada.”

And that’s just one sparsely-populated country.

I think something like PROM, widely used, could reverse those trends. For us as individuals, and for entire societies.

Let’s try.

A clarifying note from Dr Barbic: ” I hypothesize that the ordering is not the same for youth. I use the example of sleep and intimate relationships. They are not necessarily flipped….but they do not fall in the same order as adults. I will have more on that coming in April! I will keep you posted on the Youth PROM. Thanks for the great summary. You have made my day.”

6 thoughts on “How to Measure Recovery

  1. I just did the test (came out 19) and both the specific question and the area around it really are the things I need to look at more closely. Thank you yet again, Petra!

  2. Hey this is pretty cool, Petra! And my score was pretty good with no BIG surprises – just have a renewed focus on the wobbly bits (so to speak!). You have the best blog posts!

  3. #NailedIt

    I’m so glad to have read this post!! Thank you for unearthing and publicizing such a valuable tool. It is very difficult to measure health outcomes across the gamut of health and wellbeing factors. This tool does it ingeniously!

  4. I have to say I was a bit apprehensive about the test, but after completing it I am very impressed.. and thinking this needs to be a new monthly addition to my life!
    My score and the questions three above and three below are exactly what I’m struggling with right now, I just hadn’t taken the time and realised it yet.
    Thanks for sharing this post Petra, and The Paleo PI who linked to the page.

  5. Pingback: Risk Management for Health | petra8paleo

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