Recovery College Research Articles

Reflections from a Mindfulness Based Cognitive Therapy (MBCT) group in a Recovery College setting: Working across primary and secondary care

The article describes an innovative and flexible approach to running a mindfulness group, open to primary and secondary care services. The group was run by a clinical psychologist and a trainee clinical psychologist, reflections on the process and outcomes are provided.

Instrumental measurements of recovery-oriented practice in psychiatric services.

A team of community and rehabilitation staff from a regional mental hospital in Hong Kong has been adopting recovery-oriented practices since 2010 to enhance its services through organizational transformation. The REFOCUS model of the Recovery College of Maudsley Hospital has adopted a tool called INSPIRE, which measures the level of support and relationship. In this study, service users were invited to rate the received support and their relationship with service providers to benchmark our current service before we fully implement the REFOCUS model of practice. INSPIRE was translated into traditional Chinese. Service users were invited to use C-INSPIRE to score one service provider with whom they had the most frequent contact or had the closest relationship. A total of 147 subjects were recruited from different service units at different phases of organizational transformation in recovery-oriented practice. Significantly higher scores in the Relationship Subscale (P= .028) were obtained by units that had introduced recovery-oriented practice for a longer period. However, the overall INSPIRE scores in the Support and Relationship Subscales achieved by Kwai Chung Hospital were 60 and 70, respectively, which were lower than those recorded (72 and 78, respectively) in a study conducted in the United Kingdom. This indicates that there is considerable room for improvement in the delivery of recovery-oriented practice at Kwai Chung Hospital. With further training and implementation of REFOCUS for all staff, service users' experience in their recovery can be more empowering and satisfying.

Recovery Colleges After a Decade of Research: A Literature Review.

Since the first recovery college (RC) opened in England in 2009, many more have begun operating around the world. The body of knowledge regarding the effects of RCs is growing, suggesting their benefit to recovery, well-being, goal achievement, knowledge, self-management, social support, reduced stigma, and service use. The objective of this review was to establish the state of knowledge about RCs from current empirical literature and to document the methods used to evaluate them. In consultation with an international expert panel, two independent evaluators performed a literature review with no date limits on publications in the Medline and Scopus electronic databases. A total of 460 articles were found, and 31 publications were retained. RC attendance was associated with high satisfaction among students, attainment of recovery goals, changes in service providers' practice, and reductions in service use and cost. To our knowledge, this is the first literature review of peer-reviewed publications about original studies evaluating the impacts of RCs, including studies pertaining to students, health service providers' practices, education and management practitioners, and citizens. Quantitative studies with a high level of evidence were underrepresented and should be considered as a future evaluation design. Furthermore, outcomes such as empowerment and reduced stigma should be assessed with standardized tools. The impact of RCs on attendees, family, friends, and caregivers and on the everyday practice of health service providers who attend RCs for continuing education or as tutors should also be assessed.

Recovery Colleges

Soziale Arbeit, founded in 1951, is an independent academic journal which addresses developments in the context of social work. It is one of the most important publication media in its field and is read by teachers, students and researchers in social work and social pedagogy as well as by professionals and managers from associations and institutions.

The role of recovery colleges in supporting personal goal achievement.

This study examined the types of goals set, the degree to which goals were achieved, and the factors influencing goal attainment for participants in a Recovery College, a recovery-based mental health education program that uses peer learning advisors to facilitate individual student learning plans. Students of the Recovery College set baseline goals that were rated in terms of importance and difficulty in line with the Goal Attainment Scale (GAS) framework and reviewed at follow-up points. Goals were reviewed to determine areas of priority and an analysis of goal attainment was conducted using multinomial logit regression analysis. Sixty-four students recorded their goals. The most common goal areas identified related to education, socialization, physical health, mental health, and employment. Seventy percent of goals were fully or partially achieved with goals rated as having a lower difficulty more likely to be achieved. Recovery College is a program model that can effectively support personal goal achievement, a recommended indicator of personal recovery and program success. The GAS proved to be a useful instrument for measuring goal setting and attainment in students' recovery journeys and peer learning advisors were effective in facilitating this process. The setting and achievement of physical health goals is of clinical significance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Recovery colleges and dementia courses – a scoping survey

PurposeThe purpose of this paper is to understand how dementia is represented within current UK Recovery College courses and how people with dementia are involved with such courses.Design/methodology/approachA scoping survey was developed with seven multiple choice questions. Information was collected to find out: How many Colleges are currently offering dementia courses; have previously offered courses or plan to start offering courses; how they have developed their courses; who delivers them; who can attend; and how long courses have been running. Individual Recovery Colleges could leave contact details if they were interested in collaborating on future research projects. UK Recovery Colleges were identified using a published list (Anfossi, 2017) supplemented with internet searching. 86 e-mail messages were sent to Recovery Colleges inviting Leads/Managers to complete the survey through an electronic link.FindingsOf the 28 (32.6 per cent) Recovery Colleges who completed the survey, 11 reported to be currently offering dementia courses, while eight planned to start doing so. Six Recovery Colleges stated they were not currently offering dementia courses, have not done so previously and have no current plans to.Research limitations/implicationsThe survey results indicate variability in provision of UK Recovery College courses for people with dementia, and raise further questions about the way the courses are used, their acceptability and usefulness.Originality/valueThis service evaluation highlights the variability in what is offered, which is an important step in understanding the current service provision.

Recovery college as a transition space in the journey towards recovery: An Australian qualitative study.

Recovery colleges are formal learning programs that aim to support people with a lived experience of mental illness. In this study, we aimed to explore the experiences of participants in a pilot recovery college that opened in Adelaide, South Australia, in 2016. A qualitative exploratory study was conducted involving interviews with learners (n = 8) and focus groups with lived experience facilitators (course facilitators with a lived experience of mental illness, n = 5), Clinician facilitators (mental health service staff facilitators, n = 4), and care coordinators (staff providing case management support, n = 5). Three main themes (hope, identity, and the recovery college as a transition space) and two subthemes (recovery college experience and outcomes) were identified. The results showed that the recovery college provided a transition space for shifting learners' identities from patient to student, facilitated by the experiences and outcomes of the recovery college, providing hope for the future. This study highlights the importance of providing mentally healthy and non-stigmatizing learning environments to promote and cement recovery for people with a lived experience of mental illness.

To what extent does Sussex Recovery College reflect its community? An equalities and diversity audit

PurposeThe purpose of this paper is to explore whether one Recovery College reflects its community.Design/methodology/approachRecovery College students’ demographics and protected characteristics were compared with the general population and the population of people using local mental health services.FindingsRecovery College students were representative of the local community in terms of ethnicity, religion or belief and sexual orientation. Fewer Recovery College students were over 60 years old or men.Practical implicationsRecovery Colleges may be more accessible to people who are often under-served and under-represented in mainstream mental health services, including people from BAME backgrounds and people who identify as LGBT. Recovery Colleges may need to engage more men and more older people. Recovery Colleges aim to be inclusive and open to all but need to ensure that this is a reality in practice.Originality/valueThis is the first study to explore who accesses Recovery Colleges and whether they are inclusive and open to all.

The crucible of co-production: Case study interviews with Recovery College practitioner trainers

Objectives: This study explored healthcare professionals’ accounts of being practitioner trainers in a mental health Recovery College, where they worked with peer trainers, who were people with lived experience of mental illness, to co-produce workshops for mental health service users and staff. The aim of this study was to understand the process of co-production in the Recovery College from the perspective of practitioner trainers. Design: Single-site case study. Setting: A Recovery College in the South of England, open to staff and service users from one mental health care provider organisation. Methods: Semi-structured interviews with eight mental healthcare professionals. Transcripts were thematically analysed. Results: A central image of ‘the workshop as crucible’ emerged from the three themes derived from the analysis. Co-facilitating the workshop was a ‘structured’ encounter, within which health professionals experienced ‘dynamism’ and change. For them, this involved experiences of ‘challenge and discomfort’. Conclusion: Findings from this study contribute to the evidence base for the evaluation of Recovery Colleges by focusing on the training impact on staff. Findings suggest that taking on a trainer role in Recovery College co-production is beneficial for healthcare professionals as well as mental health service users, especially if healthcare professionals are open to the dynamism and possible discomfort of these workshop encounters. Future research, however, should expand beyond single-site case studies to test the extent to which this metaphor and themes are appropriate to describing the ‘transformative’ element of co-production.

Survey identifying commonality across international Recovery Colleges

PurposeThe purpose of this paper is to provide a preliminary outline of the international presence, commonality and differences between Recovery Colleges.Design/methodology/approachThis study used a short e-mailed survey to create a map of Recovery Colleges internationally and review Recovery Colleges outside the UK. Questions gathered descriptive and qualitative data to gain an overview of the mode of delivery and aspects respondents felt were noteworthy.FindingsThis paper identifies Recovery Colleges in 22 countries in five continents (including the UK). Participants described wide variance in their context. Despite adaptations, the operational models and inherent principles of each were closely aligned to those developed in the UK.Originality/valueThis paper provides the first baseline of Recovery Colleges on an international scale. It provides evidence of a high degree of commonality despite variance in setting and highlights the internationally valued transformational power of this model.

A mixed-methods evaluation of a Recovery College in South East Essex for people with mental health difficulties.

Recovery Colleges aim to assist people with mental health difficulties in the journey to recovery through education. They bring together professional and lived experience of mental health challenges in a non-stigmatising college environment and operate on college principles. All courses are designed to contribute towards well-being and recovery. Despite the ever-growing number of Recovery Colleges (both in the UK and internationally), the evaluative evidence is limited; comprising mostly non-peer-reviewed evaluations, audits and case studies. The present article comprises a mixed-methods evaluation of a newly established Recovery College in South East Essex, UK. The evaluation comprised questionnaires of mental well-being and social inclusion at baseline and 3 and 6 month follow-up, in addition to three focus groups. There were significant improvements in both mental well-being and social inclusion from baseline to 6 month follow-up (25 participants completed the measure of well-being at both time points and 19 completed the measure of social inclusion). This was supported by additional free-text questionnaire comments and focus group findings (17 participants participated across the focus groups), with reports of increased confidence, reduced anxiety and increased social inclusion/reduced social isolation. Additionally, at 6 month follow-up a majority of respondents were planning on attending courses external to the Recovery College, volunteering and/or gaining paid employment. Challenges and recommendations identified through the focus groups indicate the importance for standardisation of processes (which is particularly important when multiple organisations are involved in the running of a Recovery College), as well as consideration of longer-running courses. Funders should continue to invest in the Recovery College movement as the growing evidence-base is demonstrating how these colleges can help address the high prevalence of mental health difficulties, by promoting mental well-being and social inclusion.

Starting from Scratch: Co-production with dramatherapy in a Recovery College

This piece of writing has focused on the first stage of creating a co-production arts wing of the Recovery College and is written with the intention of demonstrating the practical value of a dramatherapy and ‘experts by experience’ collaboration. It includes an introduction to ‘recovery’ and the contemporary NHS guidelines for a Recovery College. The first four classes of co-production in action with a dramatherapist are described with feedback from students. Followed by a sharing of the evolution of this process into three new courses leading to a workshop, performance and exhibition on World Mental Health Day. It also includes a BASIC Ph evaluation analysis of group work through the three courses run in collaboration with a dramatherapist at the Recovery College. The following questions are addressed by the evaluation – Can dramatherapy effectively support the co-production process? Can these co-production situations be creatively defined and described by their participants? The conclusions are that dramatherapy lends itself to collaborative work. Service users share languages of resilience and, through forming social networks, improve in confidence and self-esteem.

Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process.

Aims:A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format.Methods:A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover – a set of literature and app searches of wellbeing and health visualisation material; Define – an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop – a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver – to disseminate the learning from the exercise.Results:Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing.Discussion:While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal.Conclusion:The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.

Recovery College influences upon service users: a Recovery Academy exploration of employment and service use

PurposeThe purpose of this paper is to provide an exploration of Recovery Academy influences upon employment and service use amongst individuals with lived experience of mental health difficulties.Design/methodology/approachThe study utilised a questionnaire design over a nine-month period. Participants’ baseline and follow-up data were analysed to explore the influence of course attendance upon employment and service use.FindingsAt follow-up, there was a significant association between participants attending Recovery Academy courses and paid or self-employment (p<0.05). However, there were also no significant differences in service use over time between those who attended courses and those who did not attend any courses.Research limitations/implicationsFurther research is required to explore the cost-effectiveness of the Recovery Academy. As participants were all enroled onto the Recovery Academy findings may not be generalisable to other Recovery Colleges. There is a need for more robust research such as a randomised controlled trial (RCT) to evaluate multiple Recovery Colleges and establish definitive conclusions as to their economic implications.Social implicationsThere may be value in the Recovery Academy as a gateway to employment, speaking to the transformative powers of Recovery Colleges. The Recovery Academy may serve as a vehicle to support service users to obtain paid or self-employment, and thus promote community reintegration.Originality/valueThis paper offers an important contribution to the Recovery College literature, which remains limited in evaluative evidence, particularly regarding associated economic factors, such as employment and service use.

Challenges of measuring the influence of the Recovery Academy upon health professionals: considerations for quantitative research

PurposeThe purpose of this paper is to reflect upon experiences of measuring the influences of the Recovery Academy within Greater Manchester Mental Health (GMMH) NHS Foundation Trust amongst a student population of health professionals. This paper aims to present considerations for future quantitative research surrounding the efficacy of Recovery Colleges such as the Recovery Academy.Design/methodology/approachThis paper utilised baseline data collected from health professionals as part of a quantitative evaluation of the Recovery Academy. The paper discusses challenges experienced in measuring change amongst this student population within GMMH.FindingsHealth professionals reported positive attitudes towards recovery at baseline presenting challenges in measuring attitudinal change associated with the Recovery Academy. The experiences of conducting research amongst health professionals within GMMH offers insights into the selection and use of self-report measures in Recovery College research; the representativeness of health professional student populations; and models of course attendance within Recovery Colleges.Originality/valueThe existing literature specific to Recovery College influences upon health professionals remains predominantly qualitative and anecdotal. It is important to gather empirical evidence regarding Recovery Colleges to establish their ability to re-orientate health professionals around principles of recovery. This paper therefore offers considerations for future researchers aiming to gather empirical evidence which may facilitate quantitative evaluations of Recovery Colleges such as the Recovery Academy amongst staff populations.

Evaluation of a new recovery college: delivering health outcomes and cost efficiencies via an educational approach

Purpose The purpose of this paper is to evaluate cost efficiencies and health outcomes after one academic year of course delivery, in a recovery college. Design/methodology/approach The paper used service evaluation and review of data. Findings There is significant impact on health outcomes when standardised measures of Patient Activation Measure and Warwick–Edinburgh Mental Wellbeing Scale were completed pre- and post-intervention, with indications of possible financial efficiencies identified within secondary care mental health pathways. Research limitations/implications The current evaluation sample is only representative of community mental health populations rather than broader communities. However, indications are that the model is effective from a wider public health perspective (early intervention/prevention) in producing significant health outcomes in terms of improved wellbeing and increased levels of activation/self-management. More in-depth research collaboration with an academic institution is now required. Practical implications There is an implication that the recovery college needs to be fully embedded within the mental health pathway as part of the core offer. This would require significant service redesign and culture change within the organisation. Social implications There is a need to continue to work with other statutory service providers, key stakeholders, voluntary and community sectors to embed the college with wider public health services and ensure a holistic approach across local communities and the whole health pathway. Originality/value Although the model is based on the widely recognised national recovery college model, it has moved away from the usual boundaries of access only being for those attached to secondary care mental health services to a more holistic and integrative approach of offering access to the whole population. Social value is indicated in the ownership and co-production of the model by the collaboration of student expertise, experts by experience and experts by expertise. The co-produced integrated volunteering and work pathway offers positive and cost-efficient health outcomes from a co-designed and co-delivered educational approach.

The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change?

The content and organization of mental health care have been heavily influenced by the view that mental difficulties come as diagnosable disorders that can be treated by specialist practitioners who apply evidence-based practice (EBP) guidelines of symptom reduction at the group level. However, the EBP symptom-reduction model is under pressure, as it may be disconnected from what patients need, ignores evidence of the trans-syndromal nature of mental difficulties, overestimates the contribution of the technical aspects of treatment compared to the relational and ritual components of care, and underestimates the lack of EBP group-to-individual generalizability. A growing body of knowledge indicates that mental illnesses are seldom "cured" and are better framed as vulnerabilities. Important gains in well-being can be achieved when individuals learn to live with mental vulnerabilities through a slow process of strengthening resilience in the social and existential domains. In this paper, we examine what a mental health service would look like if the above factors were taken into account. The mental health service of the 21st century may be best conceived of as a small-scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability, complemented by a limited number of regional facilities. Peer support, organized at the level of a recovery college, may form the backbone of the community. Treatments should be aimed at trans-syndromal symptom reduction, tailored to serve the higher-order process of existential recovery and social participation, and applied by professionals who have been trained to collaborate, embrace idiography and maximize effects mediated by therapeutic relationship and the healing effects of ritualized care interactions. Finally, integration with a public mental health system of e-communities providing information, peer and citizen support and a range of user-rated self-management tools may help bridge the gap between the high prevalence of common mental disorder and the relatively low capacity of any mental health service.

Development and Evaluation of a Recovery College Fidelity Measure.

Recovery Colleges are widespread, with little empirical research on their key components. This study aimed to characterize key components of Recovery Colleges and to develop and evaluate a developmental checklist and a quantitative fidelity measure. Key components were identified through a systematized literature review, international expert consultation (n = 77), and semistructured interviews with Recovery College managers across England (n = 10). A checklist was developed and refined through semistructured interviews with Recovery College students, trainers, and managers (n = 44) in 3 sites. A fidelity measure was adapted from the checklist and evaluated with Recovery College managers (n = 39, 52%), clinicians providing psychoeducational courses (n = 11), and adult education lecturers (n = 10). Twelve components were identified, comprising 7 nonmodifiable components (Valuing Equality, Learning, Tailored to the Student, Coproduction of the Recovery College, Social Connectedness, Community Focus, and Commitment to Recovery) and 5 modifiable components (Available to All, Location, Distinctiveness of Course Content, Strengths Based, and Progressive). The checklist has service user student, peer trainer, and manager versions. The fidelity measure meets scaling assumptions and demonstrates adequate internal consistency (0.72), test-retest reliability (0.60), content validity, and discriminant validity. Coproduction and an orientation to adult learning should be the highest priority in developing Recovery Colleges. The creation of the first theory-based empirically evaluated developmental checklist and fidelity measure (both downloadable at researchintorecovery.com/recollect ) for Recovery Colleges will help service users understand what Recovery Colleges offer, will inform decision making by clinicians and commissioners about Recovery Colleges, and will enable formal evaluation of their impact on students.

The impact of Recovery Colleges on mental health staff, services and society.

Recovery Colleges are opening internationally. The evaluation focus has been on outcomes for Recovery College students who use mental health services. However, benefits may also arise for: staff who attend or co-deliver courses; the mental health and social care service hosting the Recovery College; and wider society. A theory-based change model characterising how Recovery Colleges impact at these higher levels is needed for formal evaluation of their impact, and to inform future Recovery College development. The aim of this study was to develop a stratified theory identifying candidate mechanisms of action and outcomes (impact) for Recovery Colleges at staff, services and societal levels. Inductive thematic analysis of 44 publications identified in a systematised review was supplemented by collaborative analysis involving a lived experience advisory panel to develop a preliminary theoretical framework. This was refined through semi-structured interviews with 33 Recovery College stakeholders (service user students, peer/non-peer trainers, managers, community partners, clinicians) in three sites in England. Candidate mechanisms of action and outcomes were identified at staff, services and societal levels. At the staff level, experiencing new relationships may change attitudes and associated professional practice. Identified outcomes for staff included: experiencing and valuing co-production; changed perceptions of service users; and increased passion and job motivation. At the services level, Recovery Colleges often develop somewhat separately from their host system, reducing the reach of the college into the host organisation but allowing development of an alternative culture giving experiential learning opportunities to staff around co-production and the role of a peer workforce. At the societal level, partnering with community-based agencies gave other members of the public opportunities for learning alongside people with mental health problems and enabled community agencies to work with people they might not have otherwise. Recovery Colleges also gave opportunities to beneficially impact on community attitudes. This study is the first to characterise the mechanisms of action and impact of Recovery Colleges on mental health staff, mental health and social care services, and wider society. The findings suggest that a certain distance is needed in the relationship between the Recovery College and its host organisation if a genuine cultural alternative is to be created. Different strategies are needed depending on what level of impact is intended, and this study can inform decision-making about mechanisms to prioritise. Future research into Recovery Colleges should include contextual evaluation of these higher level impacts, and investigate effectiveness and harms.

Mechanisms of Action and Outcomes for Students in Recovery Colleges.

Recovery colleges are widespread, with little empirical research on how they work and the outcomes they produce. This study aimed to coproduce a change model characterizing mechanisms of action (how they work) and outcomes (their impact) for mental health service users who attend recovery colleges. A systematized review identified all publications about recovery colleges. Inductive collaborative data analysis of 10 key publications by academic researchers and coresearchers with lived experience informed a theoretical framework for mechanisms of action and student outcomes, which was refined through deductive analysis of 34 further publications. A change model was coproduced and refined through stakeholder interviews (N=33). Four mechanisms of action for recovery colleges were identified: empowering environment (safety, respect, and supporting choices), enabling different relationships (power, peers, and working together), facilitating personal growth (for example, coproduced learning, strengths, and celebrating success), and shifting the balance of power through coproduction and reducing power differentials. Outcomes were change in the student (for example, self-understanding and self-confidence) and changes in the student's life (for example, occupational, social, and service use). A coproduced change model mapping mechanisms of action to outcomes was created. Key features differentiate recovery colleges from traditional services, including an empowering environment, enabling relationships, and growth orientation. Service users who lack confidence, those with whom services struggle to engage, those who will benefit from exposure to peer role models, and those lacking social capital may benefit most. As the first testable characterization of mechanisms and outcomes, the change model allows formal evaluation of recovery colleges.