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Negotiating the Practical Meaning of Recovery in a Process of Implementation

An Empirical Investigation of How a Participatory-Inspired Research Approach to Implementation Might Facilitate a More Recovery-Oriented Practice: The Case of RENEW-DK

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Abstract

As implementation of recovery-oriented practices has proven difficult, this study investigates whether a participatory-inspired approach to implementing and adjusting a recovery-oriented model, RENEW-DK, might facilitate a more recovery-oriented practice among the professionals in public sector services. Ten narrative interviews with professionals was analyzed from a Science and Technology Studies perspective, and special attention was devoted to the concepts of distortion and stigmatization. Despite a one-year participatory process of model adjustment and implementation, professionals experienced RENEW-DK as a distortion and thus shaped their practice of RENEW-DK according to organizational requirements and professional beliefs instead of making their practice more recovery-oriented. The study calls attention to the need to acknowledge contradictions between intentions in general models and values in specific organizations with local norms and practices.

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Data Availability

The empirical material generated in this project will not be publicly available due to the rules of the Danish Data Protection Agency. It will, however, be available from the corresponding author, after publication, upon reasonable request and following a signed confidentiality agreement with the Danish Data Protection Agency in the Capital Region of Denmark.

Notes

  1. Many definitions and understandings of recovery-oriented practice exist, but we refer to the framework presented by Le Boutillier et al. 2011 containing four domains: (1) promoting citizenship, e.g. social inclusion and meaningful occupation; (2) organizational commitment, e.g. that services and organizational structures should be flexible in meeting the needs of the service user; (3) supporting personally defined recovery, e.g. peer-support, strengths focus and a holistic approach; and (4) a working relationship entailing partnership and inspiring hope.

  2. In standard PAR processes, practitioners collaborate with the researcher on determining the purpose of the research and development process. However, in our study, we intended to give professionals more influence on the implementation process through methods from PAR. Thus, in PAR processes, it is not tradition to departure a development process from the basis of a model, because it can be argued that a predetermined model will instigate an inappropriate power balance thereby not allowing the practitioners to have the desired voice in the process.

    However, we have flipped this script by using PAR approaches as a means to try to empower professionals in implementation processes and to investigate whether such an approach might be valuable in implementation of recovery-oriented models when aspiring for a more recovery-oriented practice. Since our approach thus differs from traditional PAR, we have chosen to term our approach’participatory action research-inspired’ to avoid any unfortunate confusion.

  3. Reasons for choosing these sites are offered in the section “Implementation process and context”.

  4. Reasons for choosing this model, and a description of its content, are offered in the section “The intervention RENEW”.

  5. In Denmark, out-patient treatment for non-psychotic disorders is organized and restricted through so-called ‘packages’, whereby a certain number of services are provided depending on diagnosis, e.g., patients with anxiety and social phobia receive a standardized 15-h package containing, among other things, a medical evaluation and therapy (Danish Regions 2014).

  6. Typically, in traditional employment centers a categorization process does take place. But in the EC where this study was conducted, this process of categorization of the young adults took place before enrollment. Thus, this was not part of the professionals’ duties in this study.

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Acknowledgements

The authors would especially like to thank the young adults and professionals participating in this study. We would also like to thank Research Associate Professor JoAnne Malloy, Institute on Disability, University of New Hampshire and co-developer of the RENEW model and collaborator in this project for providing training and assistance throughout implementation of RENEW.

Funding

This work was supported by the Intersectoral Research Unit, The Capital Region (Grant Numbers Pb-2014-5, P-2014-2-09); and The Health Foundation (Helsefonden) (Grant Number 2012B199).

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Authors and Affiliations

  1. Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, The Mental Health Services of the Capital Region of Denmark, Maglevaenget 2, Building 2, 2750, Ballerup, Denmark

    Michaela Hoej

  2. Competence Centre for Dual Diagnoses, Mental Health Centre Sct. Hans, The Mental Health Services of the Capital Region of Denmark, Boserupvej 2, 4000, Roskilde, Denmark

    Katrine Schepelern Johansen

  3. Department of Communication and Arts, Roskilde University, Universitetsvej 1, 40.2, 4000, Roskilde, Denmark

    Birgitte Ravn Olesen

  4. Mental Health Services West, Region Zealand, Faelledvej 6, Building 3, 4th Floor, 4200, Slagelse, Denmark

    Sidse Arnfred

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  1. Michaela Hoej
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Correspondence to Michaela Hoej.

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Conflict of interest

As stated, Michaela Hoej was employed by the two organizations in which this study was conducted. Otherwise, the Authors declare no conflict of interest.

Ethical Approval

The project was approved by The Danish Data Protection Agency (journal number 03610 and ID-number: RHP-2015-006). The Regional Committee on Research Ethics was also contacted for approval (Protocol number: H-7-2014-FSP15), but the project was not liable to notification, because no biological material was included in the research. Hence, no approval was necessary. Furthermore, the Danish National Board of Health was contacted (Case number 2014111813), but the project was not liable for notification here either.

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Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

The study was conducted in accordance with the Code of Ethics of the American Anthropological Association (http://s3.amazonaws.com/rdcms-aaa/files/production/public/FileDownloads/pdfs/issues/policy-advocacy/upload/AAA-Ethics-Code-2009.pdf).

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Hoej, M., Johansen, K.S., Olesen, B.R. et al. Negotiating the Practical Meaning of Recovery in a Process of Implementation. Adm Policy Ment Health 47, 380–394 (2020). https://doi.org/10.1007/s10488-019-00993-4

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