- David Best, Ph.D.
Co-producing recovery measurement: A partnership approach to developing holistic recovery measures
Rationale: In recent years we have had some significant successes in developing the REC-CAP as a system for measuring recovery capital that splits into two component parts:
1. A measurement tool that tracks recovery progress and well-being across the core domains of personal, social and community capital
2. The resulting score profile informs a programme of recovery care planning and pathways to effective community engagement to provide an evidence-based model for supporting growth in recovery capital
There are now more than 20,000 completed REC-CAP forms that are providing us with a large and growing evidence base primarily in recovery residences. This is allowing us to track who is likely to be retained in the residences and also what characteristics are associated with recovery capital growth over time in residences.
Yet, this tells us only part of the story about what the process of recovery is and about the populations that are affected by it. In our partnership work with various entities, we have been asked about developing a version of the REC-CAP that measures the well-being of family members, and of staff in recovery residences and in recovery community organizations. We have also been asked about how easy it is to adapt the REC-CAP for settings other than recovery residences.
A brief detour into research methods and design: Developing reliable and robust research measures is a complicated process. You need to ensure that the measure is consistent over time and across settings (referred to as ‘reliability’); that it measures what you think it measures (‘validity’); that it has internal consistency; that it is acceptable and meaningful to those who complete it; and that it is able to differentiate between populations (‘specificity and sensitivity’).
This is always a bit of a compromise and there is a constant pay-off between depth and intensity of measures and the burden it places on those who you want to complete it – thus, the pressure to make questionnaires shorter and to present them in forms that are more accessible (via iPads and cell phones), ideally with instant feedback and results.
Then there are the specific requirements of recovery measures. The first is that there can be no ‘laboratory’ feel to the work – it has to be strengths-based and engaging and designed to support and enhance recovery activities and research. The second is the essential requirement for co-production – that people in recovery are an active part of the process from the outset and that they have ownership and engagement at all stages of the development and implementation processes.
Partnerships in Michigan: We are absolutely delighted to be working in partnership with the Michigan Alliance of Recovery Residences (MARR) supported by the Michigan Department of Health and Human Services in setting this project up. But crucially we have been delighted by the engagement and support of the following recovery-focused organizations in Michigan:
Building Men for Life
Recovery Institute of Southwest Michigan
Live Right Recovery
Superior Connections RCO
Superior Housing Solutions
Our aim is to develop and test four new measures to complement the existing REC-CAP and to build our inclusiveness and partnership approach to building the science of recovery capital:
1. REC-CAP for RCOs: This is the simplest tool to start with – we have suggested a few minor amendments to the main measure that would make it more suited to non-residential clients and we will try this out with each of our partner organizations over the course of a three-month window to test how clients and recovery navigators find the process of using the new tool and how much it helps them to support recovery capital growth
2. W-REC-CAP: One of the huge omissions in the area of recovery research generally is the well-being and capital of the workforce, in particular the peer workforce. We are creating a worker version for three main reasons:
a. Because recovery is a social process and each party (peer specialist and person in recovery) should benefit from it
b. Because the well-being of the peer workforce is not currently assessed in any systematic way, and
c. As a result, the training and support needs, and the impact of emotional labour and stress, is not generally addressed in a systematic and scientific way. This is essential to nurturing and supporting a key constituency of any recovery-oriented system of care
3. O-REC-CAP: As we know from treatment services, the outcomes people experience in recovery organizations results not only from their own efforts, but also the relationships they develop, and the recovery resources, and supports they can access (Simpson, 2000). We are developing an executives level assessment of recovery capital that will allow us to measure the organizational components of recovery organizations
4. H-CAP: Finally, we know that recovery is a social process that takes the form of a ‘social contagion’ (White, 2010). Part of that contagion is the positive impact that personal recovery can have on the family and the friends of people in recovery. What we are developing here is a measure of Human Capital that will assess strengths and well-being across a range of life domains. In other words, what the H-CAP allows us to assess is that, when Jessica goes into an RCO or recovery residence, her recovery capital will hopefully go up, but we can now measure what impact it has on David, her husband, in terms of his strength and wellbeing.
This will not be a quick or simple process and at our second workshop, we were told in no uncertain terms that two of the measures were far too long! But we will revise and test and work with our wonderful group of RCOs and their clients to build resources that will improve RCO service delivery in Michigan but will also contribute to our broader understanding of recovery processes and will help to build credibility to the science of recovery and recovery capital in particular.
In doing so, we are also building a Michigan Community of Practice around recovery capital and its assessment and will work towards building connections, hope, identity, meaning and empowerment for the participants, for ourselves and more widely across the recovery community.
Simpson, D. (2000) TCU model of treatment process and outcomes, TCU IBR Research Summary, www.ibr.tcu.edu
White, W. (2010) Recovery is contagious, Blog - Chestnut Health System; williamwhitepapers.com