Recovery education for people experiencing housing instability: An evaluation protocol

Abstract

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.

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

“…Member checking strongly validated emerging themes. Our results are likely to be generalizable to other RECs given the close fidelity of our program to the REC model [10,29], suggesting that our findings can be used to inform program and policy development in similar contexts and with similarly marginalized populations.…”

“…Three researchers with expertise in thematic analysis independently coded three transcripts using an inductive, line-by-line approach before meeting on three occasions to compare findings, resolve differences and achieve consensus [25]. Three additional transcripts were then double-coded to establish inter-rater reliability (k = 0.72) [10]. The remaining transcripts were then coded by the same three researchers.…”

“…The Supporting Transitions and Recovery (STAR) Learning Centre at St. Michael's Hospital in Toronto, Ontario was developed in 2014 as the first REC in Canada and one of the few worldwide focused on people experiencing or transitioning out of homelessness [6,10]. Classes and workshops at STAR are offered by peers with lived experience of mental health challenges and homelessness, social and health service providers, and invited topic experts.…”

“…This qualitative study was part of a larger, mixed methods evaluation [10]. Eligibility criteria included age 16 years or older; current or recent (past 2 years) experience of homelessness or precarious housing (see Durbin et al, [10], for definitions); and capacity to consent to research participation. Purposive sampling was used to select those participants from the larger sample (N = 92) who were able to reflect on and provide insight into their experiences with services.…”

“…political reforms and creating a just and democratic society [14], partly by empowering individuals to redress undesirable or unfair situations [21]. 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].…”