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Best Practices: Recovery Centers for People With a Mental Illness: an Emerging Best Practice?



The authors report a process evaluation that used rigorous qualitative methods consistent with best practice to assess the development and impact of a nascent recovery center in the New York City area. The center successfully delivered services that focused on helping increasing numbers of consumers achieve educational and functional improvements. Consumers perceived the center as providing a strong sense of community while also serving as a "stepping stone" to wider opportunities. Because they offer a feasible and popular means to help individuals with mental illness acquire skills, recovery centers may be an emerging best practice. Further research is necessary to test their efficacy.
PSYCHIATRIC SERVICES oJanuary 2012 Vol. 63 No. 1
The authors report a process
evaluation that used rigorous
qualitative methods consistent
with best practice to assess the
development and impact of a nas-
cent recovery center in the New
York City area. The center suc-
cessfully delivered services that
focused on helping increasing
numbers of consumers achieve
educational and functional im-
provements. Consumers per-
ceived the center as providing a
strong sense of community while
also serving as a “stepping stone”
to wider opportunities. Because
they offer a feasible and popular
means to help individuals with
mental illness acquire skills, re-
covery centers may be an emerg-
ing best practice. Further re-
search is necessary to test their
efficacy. (Psychiatric Services 63:
10–12, 2012)
In 2003, the New Freedom Com-
mission called for mental health
services to become more recovery
oriented (1). In response, new inter-
ventions to enhance recovery have
been created. One innovative inter-
vention has been the development of
recovery centers that offer a variety of
services and resources that aim to fos-
ter various aspects of recovery among
people with severe mental illness (2).
Some recovery centers are consumer
operated and peer run, whereas oth-
ers are more reliant on professional
staff (3).
Recovery centers aim to differenti-
ate themselves from day treatment
centers, clubhouses, and other shel-
tered environments, which often fo-
cus on providing a place of refuge and
slow adjustment to living with a psy-
chiatric disability (4). These older
models, especially day treatment cen-
ters, place less emphasis on rapid
transition from a service-dependent
lifestyle to a full life in the communi-
ty (5). In contrast, recovery centers
represent a newer model that focuses
on a renewed notion of recovery by
providing recovery-oriented inter-
ventions affecting various life do-
mains, including education, employ-
ment, wellness management, and
housing (6).
Research on recovery centers and
other newer models of recovery-ori-
ented interventions is scant. A recent
survey found a variety of promising
approaches, largely unstudied, that
could be classified under the rubric of
recovery center (2). One quasi-exper-
imental study that evaluated the im-
pact of a recovery center on con-
sumers found that it developed
“readiness for rehabilitation and re-
covery” by significantly improving
empowerment and “recovery atti-
tudes” (7). The center used an educa-
tional model that is described in de-
tail elsewhere (6).
This column reports a qualitative
evaluation of a nascent recovery cen-
ter in New York City. The results of
the evaluation are consistent with
other research that suggests that re-
covery centers may be an emerging
best practice (2,3,6,7). We also explic-
itly detail the methods used to per-
form the evaluation because they are
consistent with best practice in quali-
tative research.
Pathways Resource Center
Pathways to Housing, Inc., created a
small-scale recovery center named
Pathways Resource Center in May
2008 with the aim of providing a vari-
ety of recovery-oriented services to its
clientele. Pathways implements the
Housing First model of supportive
housing, which provides permanent
independent housing and consumer-
driven support services to persons ex-
periencing severe mental illnesses
and substance use disorders. One of
the defining aspirations of Pathways’
programs is that if given the right
supports, consumers can maintain in-
dependent and meaningful lifestyles
with minimal dependence on services
(8). The center, created to reflect that
philosophy, is dedicated to a notion of
recovery that emphasizes the con-
sumer’s capacity to move on from a
service-dependent lifestyle (1).
The target population for the center
is people who are living in supported
housing in the New York City area that
is provided by a separate arm of Path-
ways to Housing. All of the residents
have a diagnosis of severe mental ill-
ness, and many have co-occurring dis-
orders, such as substance abuse, HIV
infection, or diabetes.
Very soon after the center’s open-
ing, a number of classes started, each
running to a strict timetable. A stable
pool of clients, approximately 30 per
week, began to attend the classes. Be-
tween May 2008 and October 2009,
the number of classes grew and diver-
sified, and the number of new atten-
dees steadily rose. By October 2009,
Recovery Centers for People With a
Mental Illness: an Emerging Best Practice?
RRoobb WWhhiittlleeyy,, PPhh..DD..
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Dr. Whitley is affiliated with the Douglas
Mental Health University Institute,
McGill University, Perry Pavilion E-3108,
6875 Lasalle Blvd., Montreal, Quebec,
Canada H4H 1R3 (e-mail: robert.whit Ms. Siantz is with the Uni-
versity of Southern California School of
Social Work, Los Angeles. William M.
Glazer, M.D., is editor of this column.
BBeesstt PPrraaccttiicceess
approximately 50 people per week
were using the center.
Most of the classes are led by paid
staff or volunteers from the commu-
nity. A small number are led by con-
sumers. Because living in poverty
makes it difficult for members to
come to the center, Pathways to
Housing provides free travel cards or
lunches to those who attend class.
These benefits enable the most vul-
nerable to participate without eco-
nomic impediment and are highly val-
ued by the clientele. They should be
considered part of the best practice
for recovery centers.
Classes can be described as ad-
dressing matters related to functional
recovery or clinical recovery. Func-
tional recovery refers to activities that
equip participants with everyday
skills and knowledge that can en-
hance normal functioning in society.
The center offers weekly classes in
functional activities, including com-
puter education (five hours), GED
completion (90 minutes), literacy (90
minutes), employment search assis-
tance (three hours), photography
(three hours), art (three hours), com-
munications (two hours), and cooking
and nutrition (one hour).
Practical, skills-based functional
classes dominate the weekly sched-
ule, although they are augmented by
a small number of groups that meet to
specifically target clinical recovery.
Clinical recovery refers to activities
that address the common symptoms
of severe mental illnesses and co-oc-
curring substance use disorders.
These weekly activities include harm
reduction classes (two hours), an
anger management group (one hour),
a stress release group (one hour), and
a recovery group (one hour).
Best practices:
qualitative research
The qualitative evaluation was gov-
erned by three objectives, namely to
track the developmental trajectory of
this innovative recovery center, elicit
the views of the clientele about the
impact of the center, and assess chal-
lenges associated with implementa-
tion. We strove to use best practices
in qualitative research when assessing
development and impact of the cen-
ter. Qualitative research is generally
considered more rigorous if the inves-
tigation employs more than one
method. This technique, known as
triangulation, allows researchers to
gain varying perspectives on an issue
(9). For this reason, we used both
participant observation and focus
groups as methods of investigation.
The authors conducted five focus
groups at regular intervals between
July 2008, just after the center
opened, to October 2009. All users of
the center were invited to attend
these focus groups through open ad-
vertisement and word of mouth. All
focus groups were recorded and tran-
scribed for later analysis. Focus
groups were interspersed with regu-
lar (generally twice a month) observa-
tion of clients by one of the authors
from September 2008 to July 2009.
Observation involved going to the
center to view activities, participate in
classes, or attend social events. In addi-
tion, we selected consumers to take for
lunch or accompany on walks around
the neighborhood to further elicit their
perspectives on the center. We enu-
merated the number of attendees at
the classes observed and also consulted
sheets that were used to meas-
ure attendance at every class. Unfortu-
nately, because the sign-in sheets were
inconsistently administered by class fa-
cilitators, they provided only a rough
indicator of attendance.
The analysis of results was also con-
sistent with best practice in qualita-
tive research (10). All focus group
transcripts and field notes were im-
ported into atlas-ti computer soft-
ware. We engaged in conventional
methods of thematic analysis to an-
swer the research questions. Themes
were identified independently and
emerging themes were later dis-
cussed and a consensus was reached.
This form of multiple coding in qual-
itative research, known to be a strong
check and balance of observer bias, is
recommended as a way to improve
validity. Once the analysis had been
completed, the first author returned
to the recovery center, in May 2010,
to discuss emerging themes with fo-
cus group participants, who agreed
with our primary conclusions. Again,
the process of checking conclusions
with study participants adds rigor to
qualitative research.
Perceived benefits
of the center
Participants at the center spoke very
favorably about its impact on their
day-to-day lives. They noted that the
center was equipping them with
skills and abilities that they could use
as a springboard to obtain gainful
employment, attend accredited edu-
cational courses, and access other
opportunities in the outside world.
One participant called the recovery
center “a stepping stone for each and
every one of us.” Another noted, “I
think in just being here, in every as-
pect, it’s upgrading—you know—
your own skills. Because, we are in-
teracting with each other just like in
an office.” Another said, “It’s a place
where you can come and expand
your educational abilities.”
When talking about the computer
class, one participant stated that, “it
is a trade that you learn that will give
you a benefit in the future, ‘cause
computer pays well . . . like, make
more money as a computer opera-
tor.” These quotes were emblematic
of the view reported by many partic-
ipants that providing education was
the most appreciated of the center’s
Many classes involved consider-
able teamwork and peer support,
which fostered a strong sense of ca-
maraderie. For example, the nutri-
tion class involved shopping and
cooking together, and the art and
the photography classes involved
working together, sometimes in
pairs and as a team. A focus on
working as a team and the sense of
community it fostered were also
perceived as benefits of the center.
As one participant said, referring to
other participants, “I call them my
family. You know . . . these are my
family. When I know that when I’m
done, I could come to somebody
here. They notice that I don’t have a
family. I could speak to somebody
and I know that they are going to
give me the right advice, you know.
It made me think about not getting
into trouble and for me to do the
right thing.” Notably, this consumer
regarded this sense of family not
only as a benefit in itself but also as
a moral corrective by providing a re-
newed sense of accountability.
PSYCHIATRIC SERVICES oJanuary 2012 Vol. 63 No. 1 1111
PSYCHIATRIC SERVICES oJanuary 2012 Vol. 63 No. 1
The center’s challenges
At the conclusion of the research in
October 2009, the center had settled
into a schedule of staying open from
10 a.m. to 4 p.m. on Monday to Fri-
day. The center had also established
strictly enforced rules and regulations
as a result of discord during the early
months of the center’s life. For exam-
ple, a frequent complaint was that
people arrived late for groups, al-
legedly to benefit from the free travel
cards or lunches that were associated
with attendance without having to
fully participate. Likewise some con-
sumers complained about others who
came to the center but did not partic-
ipate or contribute to the life of the
These complaints led to intense de-
bate at the center about acceptable
behavior that prompted the con-
sumers themselves to create a set of
rules and regulations. These emerg-
ing rules stipulated that people could
not be at the center if they were not
attending a class; that those who ar-
rived more than ten minutes late for a
class were denied entry; that the cen-
ter close for lunch, and that people
could be suspended from the center
for up to two months. In fact at least
one individual was suspended during
the research.
A final challenge was the question
of whether people should be expected
to move on. In line with Pathways phi-
losophy (8), consumers agreed that
the center should not become just an-
other day treatment center where
people would stagnate indefinitely,
becoming so comfortable that they
were reluctant to leave. The rules and
regulations of Pathways Resource
Center reflected that desire. Never-
theless, although many consumers
saw the recovery center as a stepping
stone, others became comfortable
with the sense of camaraderie associ-
ated with the center and seemed quite
reluctant to move on. For example,
one consumer noted, “We embrace
each other, support each other, coun-
sel and support each other. . . . We de-
pend on each other.” This dependen-
cy, in some cases declared openly, act-
ed as an impediment to moving on for
some consumers.
Discussion and conclusions
The recovery center described by this
study took the form of a small educa-
tional institution that was designed
specifically for people with a severe
mental illness. It was similar to a pop-
ular and effective recovery center in
Boston described by one of the few
previous studies of recovery centers
(6,7). The distribution of activities
suggested that the center’s philoso-
phy was strongly oriented toward en-
couraging clients to meet the bench-
mark for entering appropriate educa-
tional facilities such as community
college, to become competitive in the
open job market with an eye to find-
ing gainful employment, and to en-
hance skills such as cooking or anger
management that may allow better
daily functioning.
A focus on education, employment,
and functional improvement overlaps
with many of the activities provided
by progressive day treatment centers
and clubhouses. However, the high
proportion of time devoted to such
activities and the strict school-like at-
mosphere make Pathways Resource
Center somewhat distinct from these
older models. This suggests that the
center aligns well with newer incarna-
tions of recovery centers that empha-
size the importance of education and
functional recovery over and above
clinical recovery (2,3,6,7)
In line with other recent research,
this study affirmed the feasibility and
popularity of recovery centers that fo-
cus on educational and functional im-
provement (2,6,7). However, it pro-
vided no information about the cen-
ter’s efficacy and effectiveness. Fu-
ture research should rigorously evalu-
ate outcomes as well as process to as-
sess overall influence of such centers.
Process evaluations can follow the
procedures we have outlined, which
were consistent with best practice in
qualitative research. Outcome evalu-
ations will require quasi-experimental
or randomized designs.
Acknowledgments and disclosures
The Columbia University Center for Home-
lessness Prevention Studies (CHPS) provided
the funding for this research to Dr. Whitley
while he was a CHPS Scholar. The authors
thank Sam Tsemberis, Ph.D., and Pathways to
Housing staff for graciously facilitating field
visits to the center.
The authors report no competing interests.
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... In the context of supporting recovery among people with mental health problems and illnesses, RECs put these principles into practice by focusing on individual strengths, personal growth, and self-determination [10,12]. The aims of RECs are to support the life goals of participants in the areas of health and well-being, education, employment, and wellness management [4,12,15,27,30]. Key characteristics of RECs include peer and professional involvement in the design and delivery of services through the process of co-production, a community focus, and inclusivity [17,19,29]. ...
... In the US, limited but similar findings have been reported. For example, a rigorous quasi-experimental evaluation of an REC in Boston found a significant short-term impact on participants' feelings of empowerment, selfefficacy, support and affirmation [9]; and in a multimethods evaluation of a REC in New York, participants reported improved educational and functional skills, in addition to experiencing a strong sense of community [30]. ...
... Our findings are also consistent with and expand upon previous studies describing outcomes among REC participants, including improved self-understanding and confidence [28,32]; empowerment, self-efficacy and support [3,9]; hopefulness [3,20]; and a sense of community [30]. In addition to these outcomes, our findings suggest participants transitioning out of homelessness specifically develop improved interpersonal skills and prosocial behaviours, experience improvements in health and well-being, and become more goal-and future-oriented as a result of REC participation. ...
Full-text available
Background: Recovery Education Centres (RECs) are increasingly implemented to support the process of recovery for individuals experiencing mental health challenges. However, the evidence on key REC mechanisms and outcomes, particularly for diverse subpopulations or service delivery contexts is scant. This study identified mechanisms and outcomes of an REC focused on adults with mental health challenges transitioning from homelessness. Methods: Qualitative methods were used to explore in-depth the experiences of homeless and unstably housed participants experiencing mental health challenges in Toronto, Canada. Twenty service users participated in semi-structured interviews between July 2017 and June 2018, six to 14 months following REC enrollment. A realist informed interview guide explored participants' perspectives on key REC mechanisms and outcomes. Interviews were audio-recorded, transcribed verbatim and analyzed using inductive thematic analysis. Investigator triangulation and member checking processes enhanced analytical rigour. Results: Participants perceived that program participation supported the process of recovery through several mechanisms: a judgment-free environment; supportive relationships, mutuality and role modelling; deconstruction of self-stigma; and reclaiming of one's power. Participants described several outcomes at the personal, interpersonal and social levels, including improvements in health and well-being; self-esteem, confidence and identity; sense of empowerment, control and personal responsibility; as well as improvements in interpersonal skills, pro-social behaviours and ability to self-advocate; and increased goal development and future orientation. Conclusions: Findings suggest RECs can support the process of recovery among people transitioning from homelessness and can successfully support subpopulations experiencing mental health challenges and social disadvantage.
... Recovery education centers (RECs) are a new model in which recovery supports are provided through education rather than through traditional health and social services. They help individuals shift their identities from 'patients' with service-dependent lifestyles to 'students/members' who learn new skills to support independent community living and personal goal achievement (Hutchinson, 2011;Perkins, Repper, Rinaldi, & Brown, 2012;Whitley & Siantz, 2012). ...
... Presumed key ingredients of RECs. RECs use an adult educational approach with a recovery focused curriculum guided by collaboration between students/members and staff who work together in co-production, co-delivery and co-learning (Farkas, Gagne, Anthony, & Chamberlin, 2005;Perkins, Meddings, Williams, & Repper, 2018;Perkins et al., 2012;Whitley & Siantz, 2012). Co-production situates service users as experts, whose direct knowledge and experience is critical for the development and delivery of recovery-oriented services (Alford, 2014;Boyle & Harris, 2009;Boyle, Stephens, & Ryan-Collins, 2008;Cahn, 1997;Perkins et al., 2018). ...
... learning plans can be vehicles for students/members to identify their personal recovery goals and direct their learning); inclusive (low-barrier access to REC learning opportunities); and having a strengths-based approach (achievements, strengths, and skills of students/members and staff are identified, and built upon). Finally, RECs have a community-focus that uses engagement with community organizations to facilitate pathways to valued roles, relationships and activities for participants (Farkas et al., 2005;Meddings, McGregor, Roeg, & Sheperd, 2015;Perkins et al., 2018;Perkins et al., 2012;Whitley & Siantz, 2012). ...
Background Recovery education centers (RECs) offer recovery supports through education rather than traditional health services. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Canada, is among the few that are internationally focused on individuals with histories of homelessness. Although research suggests that RECs positively impact participants, there is a paucity of rigorous studies and none address the engagement and impacts on homeless individuals. Aims This protocol describes a realist-informed evaluation of STAR, specifically examining (1) if STAR participation is more effective in promoting 12-month recovery outcomes than participation in usual services for individuals experiencing housing instability and mental health challenges and (2) how STAR participation promotes recovery and other positive outcomes. Methods This study uses a quasi-experimental mixed methods design. Personal empowerment (primary outcome) and recovery, housing stability, social functioning, health service use and quality of life (secondary outcomes) data were collected at baseline, and 6 and 12 months. Intervention group participants were recruited at the time of STAR registration while control group participants were recruited from community agencies serving this population after screening for age and histories of housing instability. Interviews and focus groups with service users and providers will identify the key intervention ingredients that support the process of recovery. Results From January 2017 to July 2018, 92 individuals were recruited to each of the intervention and control groups. The groups were mostly similar at baseline; the intervention group’s total empowerment score was slightly higher than the control group’s ( M ( SD): 2.94 (0.23) vs 2.84 (0.28), p = .02), and so was the level of education. A subset of STAR participants ( n = 20) and nine service providers participated in the qualitative interviews and focus groups. Conclusion This study will offer important new insights into the effectiveness of RECs, and expose how key REC ingredients support the process of recovery for people experiencing housing instability.
... Needs for further developments of community mental health services which support service users' active participation and social inclusion in the community, has been highlighted (WHO, 2001(WHO, , 2005(WHO, , 2013 and discussed in the literature on mental health policy (Corrigan, Mueser, Bond, & Solomon, 2008;Huxley & Thornicroft, 2003;Knapp et al., 2007;Ramon & Williams, 2005). A psychosocial approach in mental health work aims to support social inclusion by providing accessible, flexible and "recovery-oriented" services in local communities (Elstad, 2014;Elstad & Norvoll, 2013;Whitley & Campbell, 2014;Whitley & Siantz, 2012;Whitley, Strickler, & Drake, 2012). Such services have also been encouraged as a strategy for health promotion (Dalgard et al., 2011;WHO, 2005). ...
... Internationally, services with a "low threshold" approach have been developed within what is known as "recovery-oriented" mental health services, recognising that people with experience of mental illness need to guide their own recovery (Whitley & Campbell, 2014). There are, however, variations in the mental health policy which "surrounds" such services, and the organization of services can also vary within countries (Conradson, 2003;Elstad, 2014;Parr, 2000;Philo, Parr, & Burns, 2005;Whitley & Siantz, 2012;. To understand the nature and common features of "Recovery Centers", surveyed 24 services; most from the USA and some from Australia, Canada and New Zealand. ...
... Although these services varied in their structure, findings suggested that such settings can be empowering arenas for people with severe mental health problems by providing a hopeful, supportive and non-stigmatizing environment. Further studies of "Recovery Centers" in the USA concluded that they provided highly valued support, which enabled many users to face life in the community with confidence (Whitley & Campbell, 2014;Whitley & Siantz, 2012). These settings, which were interpreted as "safe backstage sanctuaries" that provided a physical and ontological space for recovery were discussed as "an emerging best practice" (Whitley & Siantz, 2012, p. 10). ...
Full-text available
Elstad & Eide, Cogent Medicine (2017), 4: 1362840 PSYCHIATRY | RESEARCH ARTICLE Social participation and recovery orientation in a “low threshold” community mental health service: An ethnographic study Toril Anne Elstad1* and Arne Henning Eide2,3 Abstract: Accessible and flexible “low threshold” community services have been recommended in order to assist people’s social participation and recovery from mental health problems. In this ethnographic study from a Norwegian city, we studied activities and social interaction within three community mental health centres with a low threshold organisation and recovery approach. These centres were part of the same community mental health service, and aimed to function both as social meeting-places and as steps towards rehabilitation. Through participant observation and qualitative interviews, we explored in what way this service could contribute to service users’ recovery. Central features of social interaction were support from both professionals and peers, along with sharing of practical advice and experiences. This encouraged social participation and seemed to enhance mutual experiences of recognition. In the article we highlight how these centres could assist recovery from mental health problems by functioning as available “resource-bases” in the community.
... A defining feature of peer respites is that they are operated by staff members who have personal experience with the mental health system and are typically trained using Intentional Peer Support (IPS) (Mead 2009). Similar to other peer-based services, such as recovery centers (Whitley and Siantz 2012), peer respites facilitate supportive relationships between guests, and help guests create connections within the community outside of the respite. Respites also typically provide optional skill building and wellness groups, and can serve as conduits to 1 3 community-based self-help resources, such as the Wellness Recovery Action Plan (Copeland 2002). ...
... That participants in the present study found the lack of structure and authority to be worrisome could speak to the need to clarify and add structure to the roles of peer providers delivering care in community mental health settings. This finding could also indicate a need to create and clarify ground rules at the beginning of a given groups' respite stay, as has been done by consumers of previous peer-based services previously (Whitley and Siantz 2012). Service providers who connect consumers with peer respites should also be clear on what respires are, so that potential respite guests know what to expect, and whether a respite would be a therapeutic place for them. ...
Full-text available
This qualitative study explored the experiences of persons staying at two peer respites through interviews with 27 respite guests near the end of their stay and at 2–6 months following their stay. Trained peer interviewers conducted baseline and follow-up interviews. Peer respites can be beneficial spaces within the mental health system for guests to temporarily escape stressful situations while building relationships with other persons with mental illness, though some respondents were uncomfortable receiving services from peers, and several guests did not want to leave after their stay. Ongoing training of peers and orientations for respite guests can help ensure optimal respite experiences.
... Among recovery-focused interventions, Recovery Education Centres (RECs) offer recovery supports through education rather than traditional health and social services (15). First established in the United States in the 1990s, RECs use an adult learning approach rooted in collaboration between service users and providers, working together in co-production, co-delivery, and co-learning (19)(20)(21). Recovery Education Centres now operate in over 20 countries, including the United States, Canada, Australia, New Zealand, and Europe (22), with the highest number in the United Kingdom, which currently has over 85 RECs (23,24). ...
Full-text available
Purpose: Recovery Education Centres (REC) in mental health offer a new model of providing recovery supports through emancipatory adult education and recovery-oriented service principles. Despite the widespread adoption of RECs, there is limited evidence regarding factors enabling engagement and participation, particularly for unique subpopulations or service delivery contexts. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Ontario is the first REC in Canada and one of few worldwide supporting adults transitioning out of homelessness. This research aimed to investigate individual and program level enablers of engagement and participation in a REC for this population. Methods: Qualitative methods were used to explore the experiences of 20 service user participants through semi-structured interviews exploring their experiences of REC participation and perceived key program features. Interviews were conducted between July 2017 and June 2018, six to 14 months following REC enrollment, and analyzed using inductive thematic analysis. Results: In contrast to past experiences with health and social services, participants described a welcoming and respectful physical and interpersonal environment with low-barrier seamless access facilitating their engagement and participation. Although the realities of homelessness presented barriers for some, participants described that the involvement of peers, as role models, and the self-directed, strengths, and skills-based curriculum, co-produced and co-delivered by peers and professionals, were instrumental in activating the process of recovery through education. Conclusions/implications: Findings are consistent with the growing evidence base of the defining features of RECs and suggest this model can be successfully extended to support recovery among adults transitioning out of homelessness. This unique examination of Canada's first REC for adults exiting homelessness can help guide program and policy development to better support this disadvantaged population.
... Additionally, service user accounts may be influenced by concerns about negatively evaluating their workers or reflect internalised stigma related to mental health diagnosis (Tew, 2005). This may be particularly relevant to service users diagnosed with psychosis (Huggett et al., 2018) In order to increase rigour, two other evaluations of recovery-focused programmes have triangulated data from interviews with direct researcher observations (Whitley et al., 2009;Whitley & Siantz, 2012). However, these provided limited insight into any attitudinal barriers to implementation, as the reasoning process leading to staff actions were not examined. ...
Evaluation of recovery-focused interventions for people with psychosis may be enhanced by the use of Interpersonal Process Recall (IPR). The aim of this study was to examine whether the inclusion of IPR alongside semi-structured interviews in the formative evaluation of a novel collaborative care intervention increased understanding about both practitioner and service user experiences. It also explored the impact of the IPR process on participants. Four service users and the practitioner delivering the intervention participated in semi-structured interviews and an adapted IPR process. The themes identified from different data sources were systematically compared using framework analysis. Semi-structured interviews indicated that the intervention was operating as intended but IPR data revealed exceptions. Practitioner IPR interviews identified practitioner barriers to delivery and fostered critical self-reflection. Service user IPR interviews facilitated critical feedback but also caused some distress. Interviews gave more information about organisational level contextual factors. IPR increased understanding of how the intervention was being delivered and experienced. IPR should be used alongside other forms of qualitative data collection. The potential of IPR to impact on intervention delivery should be taken into account. Further research is needed to establish for whom IPR is likely to be most effective.
... (Whitley & Siantz, 2012). Another source of social support for individuals with mental and substance use challenges is peer support workers, who have been shown to increase positive feelings, social support and sense of community belonging(Davidson, Bellamy, Guy, & Miller, 2012). ...
Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24‐month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009–2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor‐Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (−0.20, −0.33, −0.21) and higher percentages of days stably housed (−0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.
... Recovery Education Centres use principles of adult education to challenge student identities based on disability and illness, emphasizing functional recovery and community participation. In addition to focusing on self-directed learning, rather than traditional therapies, Recovery Education Centres are guided by several common principles, including various degrees of service user involvement in program design and delivery, and a focus on self-management, individual growth and self-determination (Perkins et al. 2012;Whitley and Siantz 2012). STAR, as a Recovery Education Centre, is similarly grounded in principles of emancipatory adult education, fostering student empowerment and the development of competencies and strengths through critical reflection (Mezirow 1990;Oh 2013). ...
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The Supporting Transitions and Recovery (STAR) Learning Centre is a Recovery Education Centre designed to support housing tenure and community integration among people experiencing mental health challenges and housing instability in a large urban setting. Grounded in principles of emancipatory adult education, and user involvement in program design and delivery, the Recovery Education Centre supports student empowerment, and strengthens key domains of individual vulnerability to homelessness. The Centre can complement traditional mental health services and foster service provider reflexivity, confronting individual and institutional discrimination towards this population.
The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co‐production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery.
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Background: Recovery orientated intervention has experienced a paradigm shift towards stakeholder training and education within recovery colleges. Such colleges are typically underpinned by a culture of emancipatory education that aims to facilitate recovery through educational choice. Aims: The study aims to establish regional readiness for a recovery college. Specifically, we aim to uncover key stakeholder attitudes towards recovery, outline a contextual conceptualization of recovery and show how inductive, community-based research can incorporate stakeholder views with core fidelity markers of a recovery college. Method: A mixed methods approach, specifically a cross-sectional survey, was adopted to intersect quantitative scales of stakeholder attitudes and qualitative assessment of recovery concepts and community needs. Results: Stakeholders’ recovery attitudes were positive overall with some variation between participant groups. Concepts of recovery were developing independent abilities, establishing connectedness to support and as a journey. The needs cited by the stakeholders were largely correlated with the core fidelity markers of a recovery college. Conclusion: A community psychology approach offers a means to ascertain regional readiness for a recovery college, and uncover key development foci based on community needs. We recommend that service areas adopt a similar approach when considering recovery-orientated service developments.
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This brief report describes a recovery education program that is designed to develop health as a foundation for recovery from psychiatric illnesses. Using readiness to change theory, health promotion, and psychiatric rehabilitation processes that are bundled in an adult education model of service, participants learn the knowledge, skills, and supports they want and need to increase their domains of wellness that will support their recovery. Author's relevant knowledge and citations of health and behavioral health evidence. Health promotion that is delivered in a healthy environment enhances people's quality of life, promotes readiness for role change and in the end, works to ensure that people with mental illnesses have a right to optimal health. To support rehabilitation and recovery, practitioners are encouraged to review this program model and select elements described to replicate in various mental health settings.
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Various strategies are available within qualitative research to protect against bias and enhance the reliability of findings. This paper gives examples of the principal approaches anti summarises them into a methodological checklist to help readers of reports of qualitative projects to assess the quality of the research.
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This study examined the effectiveness of the Pathways to Housing supported housing program over a five-year period. Unlike most housing programs that offer services in a linear, step-by-step continuum, the Pathways program in New York City provides immediate access to independent scatter-site apartments for individuals with psychiatric disabilities who are homeless and living on the street. Support services are provided by a team that uses a modified assertive community treatment model. Housing tenure for the Pathways sample of 242 individuals housed between January 1993 and September 1997 was compared with tenure for a citywide sample of 1, 600 persons who were housed through a linear residential treatment approach during the same period. Survival analyses examined housing tenure and controlled for differences in client characteristics before program entry. After five years, 88 percent of the program's tenants remained housed, whereas only 47 percent of the residents in the city's residential treatment system remained housed. When the analysis controlled for the effects of client characteristics, it showed that the supported housing program achieved better housing tenure than did the comparison group. The Pathways supported housing program provides a model for effectively housing individuals who are homeless and living on the streets. The program's housing retention rate over a five-year period challenges many widely held clinical assumptions about the relationship between the symptoms and the functional ability of an individual. Clients with severe psychiatric disabilities and addictions are capable of obtaining and maintaining independent housing when provided with the opportunity and necessary supports.
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This study examined the effectiveness of an educational approach to psychiatric rehabilitation called the Recovery Center. Using a quasi-experimental design we recruited 97 intervention and 81 comparison participants and examined the intervention's impact on health, mental health, subjective, and role functioning outcomes. Results suggested that this intervention was effective in improving subjective outcomes, especially empowerment and recovery attitudes, both of which received primary emphasis in the intervention. The Recovery Center, which integrates a bio-psychosocial framework with psycho-educational interventions shows promise as a complement to traditional mental health services in developing readiness for rehabilitation and promoting recovery among individuals with severe psychiatric disabilities.
"Truly a remarkable book. Not only does it contain a brief history and philosophy of consumer-operated programs in the mental health field but also hands-on examples of eight case studies from across the country as well as glossaries, contact lists and directories. Embedded within these programs are essential ingredients of empowerment, choice, respect for diversity, creativity, humor, and advocacy. Such components are critical for humans to reclaim their lives after serious and persisting challenges such as mental illnesses. This book illustrates the wide variety of ways people can help themselves by helping others."- Courtenay M. Harding, Senior Director, Center for Psychiatric Rehabilitation, Boston University On Our Own, Together looks in depth at eight successful peer-run programs for adults with serious mental illnesses. The book grew out of a 1998 meeting that led off a nationwide study to assess not only the effectiveness of consumer-operated services programs (COSPs) but also their implications for the future of mental health care in the United States. The book clusters the COSPs into three key types: drop-in centers, which provide varied services for their members, including meals, housing assistance, and stigma-free environments; educational programs, which train mental health consumers in recovery skills for themselves and for other consumers; and services based on peer support and mentoring. Despite their differences, the book shows, the programs share many essential characteristics. Most significantly, they demonstrate the benefits of allowing mental health consumers to operate and govern their own organizations. Also important is their emphasis on equality, mutuality, empowerment, recovery, belonging, and hope in administering services. Such core values, the book suggests, distinguish peer-run programs from the professional services that have long dominated the mental health system. In contrast to the dry, clinical reports that make up much of the current literature, this book is written "from the inside out" and, for the most part, by the people who developed the programs and who live them every day. It reveals peer-run programs as valuable resources within the mental health system and, indeed, a precious necessity for many consumers.
Recovery centers are physical entities offering various services and resources for people living with severe mental illness. In this study we identified and surveyed 24 recovery centers recruited through snowball sampling. The goal was to understand the range, common features and nature of current incarnations of recovery centers, assessing commonalities and differences with regards to: (1) overarching philosophies; (2) organizational and operational factors; (3) clientele; (4) service offerings; (5) staffing and financing; and (6) governance and oversight. We discuss some of the advantages and disadvantages of recovery centers, especially important given wider policy commitment to recovery, detailing the importance of future research and evaluation.
Outcomes for 112 clients with severe mental disorders in a community mental health center that converted its rehabilitative day treatment program to a supported employment program were assessed during the year after the program conversion. The study replicated a previous study in showing that the rate of competitive employment improved, especially among clients who had formerly attended the day treatment program, without evidence of adverse effects.
This paper is an overview of qualitative research and its application to psychiatry. It is introductory and attempts to describe both the aims of qualitative research and its underlying philosophical basis. We describe the practice and process of qualitative research and follow this with an overview of the 3 main methods of inquiry: interviews, focus groups, and participant observation. Throughout the paper, we offer examples of cases where qualitative research has illuminated, or has the potential to illuminate, important questions in psychiatric research. We describe methods of sampling and follow with an overview of qualitative analysis, appropriate checks on rigour, and the presentation of qualitative results. The paper concludes by arguing that qualitative methods may be an increasingly appropriate methodology to answer some of the demanding research questions being posed in 21st century psychiatry.