With recovery now the dominant model for alcohol and drug treatment, commissioning and research in both England and Scotland, there is a clear need to have an accessible, simple-to-use method for mapping recovery achievements in and out of formal treatment. This article introduces the REC-CAP (short for recovery capital), a new instrument that provides frontline staff with an easy-to-complete assessment of a client’s recovery functioning, and can become a useful component of recovery-oriented care planning. In addition to locating the client within a recovery framework, it will also provide an organisation with objective measures of changes and gains made by recoverees during and after formal treatment.
In both Scotland (Scottish Government, 2007) and England (Home Office, 2008), public policy has seen a radical shift in focus and emphasis away from drug and alcohol interventions targeting crime and blood-borne disease to a more optimistic model based on individual wellbeing, quality of life and active engagement in the community. This transition to a recovery approach echoes the evidence from the mental health field where recovery has been shown to be characterised by a clutch of linked characteristics – connectedness, hope, identity, meaning and empowerment (collectively, CHIME; Leamy et al, 2011).
While the transition to a recovery model has provided much-needed hope and belief to addiction professionals, policymakers, family members and those with addiction problems, it also provokes a significant challenge for the science of addiction, around the measurement of success. Although there are a number of tried and tested outcome measures – the Addiction Severity Index (ASI) and the Maudsley Addiction Profile (MAP) to name but two – they have both emerged out of a pathology model where the aim of treatment has been the reduction of acute symptoms and adverse life consequences. They are not suited to the measurement of a growth of wellbeing and positive achievements as would be needed to track a recovery journey. What the REC-CAP does is to address this omission and so create a measure of growth that can continue long after acute treatment needs have been addressed, and which measures wellbeing and engagement in society.
The key to this dilemma is addressed in an article by White and Cloud (2008) who concluded that long-term recovery is much better predicted on the basis of strengths than on the management and reduction of pathology symptoms. This builds on work previously done by Granfield and Cloud (2001) who used the term ‘recovery capital’ for the first time to refer to the resources available to an individual to support their recovery journey. Elaborating on this, Best and Laudet (2010) categorised recovery capital as containing three dimensions:
• Personal recovery capital represents the skills, capabilities and resources a person has that includes such things as self-esteem, resilience and communication skills.
• Social recovery capital is the central component of recovery capital and includes the level of social support the person has, a network of support for their recovery and their commitment to and engagement with the support network.
• Community recovery capital is the resources available in the community, consisting of the quality of treatment services, but crucially the availability and attractiveness of recovery communities and champions.
The three levels of recovery capital are assumed to exist in a complex and interactive dynamic, where improvements in one area have positive knock-on effects in the others.
However, much of the work on recovery capital in the addictions field has been largely theoretical and it was really with the production of a measure that this changed. One of the authors of this article, along with William White, a research consultant for Chestnut Health Systems and a leading recovery figure in the US, and Teodora Groshkova from the Institute of Psychiatry, worked together to produce the Assessment of Recovery Capital (ARC: Groshkova, Best and White, 2012). This is a validated and accepted research tool currently used in a number of countries that measures personal and social recovery capital, and which has been shown to be associated with positive treatment outcomes (Best et al, in preparation).
So what is the REC-CAP?
We have taken elements of four established engagement, outcome and recovery measures to create a flexible online recovery mapping measure that can be linked to both care planning and review, and to recovery management outside of treatment services. The four elements are:
• Basic recovery enablers: Measures of key life issues mapped using elements of the Treatment Outcome Profile (TOP). These are not regarded as elements of recovery capital (and so are not shown in the REC-CAP star) but are seen as key issues to address to facilitate the recovery journey.
• Treatment motivation and engagement: Measuring desire for help and treatment engagement for those in treatment using the Client Evaluation of Self and Treatment (CEST).
• Recovery capital: Divided into separate sub-scales for personal and social recovery capital, and measured using the Assessment of Recovery Capital (ARC).
• Recovery community engagement: Involvement in social groups supportive of recovery, assessed on the Recovery Group Participation Scale (RGPS).
These combine into five measures that are all scored out of 20 – treatment motivation, treatment engagement, personal recovery capital, social recovery capital, and community recovery capital.
Entering the scores creates a visual map of recovery wellbeing as shown in the accompanying illustration.
What is unique about the REC-CAP is that it is entered online and will automatically populate the graph above – initially to show how the person compares to other clients from that service – and so identify what strengths and resources they have for their recovery journey. However, in all review completions of the REC-CAP, the graph will show their own change in wellbeing, providing the person in recovery (and the worker) with a measure of growth in recovery capital.
Being a mapping system that is completed online, there is no paperwork, no data to be entered by harassed admin staff and no delays between completing the form (the initial form takes around 30 minutes and the review less than 10) and observing the scores. The online system is structured so that the results are available as soon as the last question is answered. This is a recovery outcome system that is flexible and easy to use, and one that minimises the burden on staff and on clients. We are currently exploring ways in which it can be linked to services’ existing databases.
As a result, it has real application as a clinical recovery tool – where the worker and client complete the REC-CAP in a treatment session, they have immediate access to the results in the form of a graph or a printout of the scales. It provides immediate feedback on strengths and gaps, representing a genuine commitment to partnership recovery working for agencies and their clients. The REC-CAP is basically a client-level assessment that is collaborative and shared in supporting and developing recovery journeys and pathways, but it can also be used as a performance management measure in services to assess progress in enabling clients’ recovery journeys.
The REC-CAP system is now up and running, with a full worker manual and training pack and an IT support system in place to enable its immediate application either in DAATs or agencies.
Looking to partner
We are looking for agencies to partner with us in testing the REC-CAP, which is based on reliable and valid measures of wellbeing and recovery. It would provide an agency with an opportunity to pioneer an innovative recovery oriented approach to client management and to work in collaboration with us.
The REC-CAP is unique – it is one of the first tools that will help to maximise the recovery potential of clients and introduce an evidence-based recovery assessment into the care planning of clients that starts but does not end with formal treatment. If you would like more details on the REC-CAP or would be interested in working with us as an early adopter of the REC-CAP tool, please do not hesitate to contact us at firstname.lastname@example.org.
David Best, is director, ACT Recovery; head of research and workforce development, Turning Point, Melbourne and associate professor of addiction studies, Monash University. Tracy Beswick is director of operations and Merce Morell is director of resource management at ACT Recovery, www.actrecovery.co.uk