Led by EVE, a programme within the Health Service Executive (HSE), a major provider of vocational and psychosocial rehabilitation services in Ireland, the Recovery Context Inventory (RCI) has come about as a result of a rigorous and staged development process, involving persons in recovery and other stakeholder groups over a number of years.
The RCI has received funding support from the HSE, the Genio Trust, National Disability Authority and Community Foundation Ireland and formal academic support from the School of Psychology, University College Dublin. In addition, a large number of people have generously offered invaluable informal advice and support to this project.
RCI Research Development
The RCI is the first recovery context measurement tool fully developed in Ireland and the UK. It is based upon the seminal doctoral research of Tom O’Brien and developed by EVE, in response to an identified gap for a tool which could assist people in planning and developing their recovery, by considering the impact of personally important life circumstances and to assist services to meet the challenges of evolving into recovery-oriented services.
The design criteria underpinning the development of the RCI were that it should:
- Be the product of a gold standard and rigorous scientific development process.
- Be based on a consensus of recovery-impacting factors as selected by those with experience of mental health difficulties and those who support their personal recovery.
- Be highly personalised and take into account the unique nature of the recovery process.
- Allow each person to track changes in their recovery over time.
- Take advantage of web technologies to include accessibility features and to provide instant feedback once the RCI is completed.
- Present feedback in visual format for easy interpretation.
- Be usable with and without support from others.
- Be developed with an accompanying RCI Recovery Planning Workbook so the two can work together to allow people to use the feedback gained from completing the RCI to develop recovery action plans.
- Allow services to generate anonymised summary reports based on how their service users respond to the RCI statements in order to inform service design, delivery, monitoring and evaluation, as well as supporting staff in working in a recovery-oriented way.
The development of the RCI was influenced by theoretical underpinnings and previous research on the dynamic nature of recovery as a process in the context of an active relationship between the person and those things in their more immediate and wider social environment which help and hinder their recovery.
Some of these theoretical underpinnings include:
- Conceptualisations of recovery from user and consensus models that stress the centrality of personal lived experience and the unique process of recovery.
- The Strengths model (e.g. Rapp & Goscha, 2006).
- Positive Psychology (e.g. Seligman & Csikszentmihalyi, 2000).
- Health promotion (e.g. Hamilton & Bhatti, 1986).
- Population Health (e.g. Kindig & Stoddart, 2003).
RCI Stages of Development
Stages 1 - 4
The development of the Recovery Context Inventory has involved a rigorous scientific and staged process using both qualitative and quantitative best practice scale development research methods.
Over a number of years, we have worked closely with hundreds of people representing service users, families, carers, service providers and policy makers from Ireland and the United Kingdom in the RCI development process.
The image below outlines the development stages of the RCI.
As part of the "Advancing Recovery in Ireland (ARI)" project, 89 people across seven mental health services in Ireland were trained as RCI Facilitators. This in turn led to 127 people completing the RCI in six mental health services.
Evaluating the Implementation of the RCI in Irish Mental Health Services
Following the implmentation of Stage 5 above, a comprehensive evaluation was completed. Feedback on the experience of use of the RCI was gathered from participants attending six mental health services in Ireland, facilitators in each of the locations, and the project site lead in each service. The responses of 127 people who completed the RCI were also analysed and compared to their responses on a number of other well recognised measures. Themes were identified from all sources of information and recommendations were made for amendments to the RCI and for the future development of the tool.
The evaluation won the HSE Open Access Award in the mental health category in 2015. The full evaluation report can be read here. An executive summary of the report can be read here.
Independent Review of the RCI
In September 2015 Dr Donal McAnaney completed an independent review of the RCI, which set out to:
Explore the need for a recovery measurement tool to support the effective implmentation of Irish mental health policy
Benchmark the RCI against similar tools internationally in terms of its psychometric properties including validity, its cultural fit , the comprehensiveness of its resources and its ease of use. The views of two international experts were also solicited.
Assess the structural fit between the RCI and current services and planned mental health service development in Ireland. Contributions were also received from a number of Irish representative organisaitons in the field of mental health.
A copy of Dr McAnaney's report can be read here.
Producing the RCI-30
In response to feedback received from the evaluation in Stage 5, the RCI was shortened from 80 items to 30 items. This was achieved using Exploratory Factor Analysis and Confirmatory Factor Analysis with the reponses of 338 Irish mental health service users (data gathered from Stage 4 and Stage 5). Psychometric properties, including reliability and validity were also examined for the 30 item questionnaire. The results suggest that the RCI is a reliable and valid tool suitable for use as a measure of those factors in a person's life which support recovery and wellbeing. A brief report outlining the process used, and the results of the analyses can be read here.