Mechanisms of change and participant outcomes in a Recovery Education Centre for individuals transitioning from homelessness: a qualitative evaluation

Abstract

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 semistructured 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 audiorecorded, 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 for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

“…Improvements in recovery outcomes among REC participants were also noted in qualitative findings from this evaluation ( 38 ), highlighting perceived improvements in health and well-being, self-esteem and confidence, interpersonal skills, and goal orientation ( 4 ).…”

“…Recovery Education Centres (RECs), offering education and role modelling in a judgment free non-clinical environment, are a promising approach to enhancing recovery outcomes for adults experiencing mental health challenges ( 1 , 3 , 4 ). First appearing in the United States in the 1990s, RECs have since been implemented in more than 20 countries, including the United Kingdom, the United States, Canada, Australia, New Zealand, and Europe ( 5 , 6 ).…”

Engaging Adults Experiencing Homelessness in Recovery Education: A Qualitative Analysis of Individual and Program Level Enabling Factors

“…The mean hours of STAR participation among study participants was approximately 80 h. At the time of their interview, the mean age of participants was 44.6, the majority identified as female (N=13 or 65%) and Caucasian (N=16, 80%). Further demographic characteristics of participants are shown in Table 1 ( 31 ).…”

Personal narratives of learning self‐management: Lessons for practice based on experiences of people with serious mental illness

“…Further, powerful messages are conveyed by recommending peer support and offering peer-therapist co-designed and coled services. Traditional power hierarchies are deconstructed in co-production (Reid et al, 2020).…”

“…Recognising the expertise from lived experience and integrating recovery with self-management, others used strategies such as peer-therapist co-led e.g., Modified Recovery Workbook (Barbic et al, 2009), peer-led e.g., Health And Recovery Peer Program (Druss et al, 2010) and Wellness Recovery Action Planning (Jonikas et al, 2013), and peer-to-peer interventions (Sterling et al, 2010). Further, co-designed, co-produced, and co-led interventions for persons with lived experience and health professionals to learn from each other have emerged in supportive learning environments of Recovery Colleges (Theriault et al, 2020) and Recovery Education Centres (Reid et al, 2020). Questions remain about how best to deliver self-management support.…”