Measuring Recovery in Adult Community Addiction Services

Commencing with the Blueprint for Mental Health Services in New Zealand (Mental Health Commission, 1998), there has been a strong commitment towards implementing a recovery approach within New Zealand's mental health and addiction services. The Ministry of Health's strategic document Rising to the Challenge 2012-2017: Mental Health and Addiction Service Development Plan (2012) continues to have a strong emphasis on a culture of recovery. "Recovery" is a subjective term that means different things to different people. Personal recovery differs from clinical recovery, which is primarily focused on symptom abatement and improved functioning (Mental Health Commission, 2011). The recovery process involves people gaining control over their substance use to maximise their health and wellbeing and fully participate in society (see U.K. Drug Policy Commission, 2008). Recovery has been described as "creating a meaningful self-directed life regardless of challenges faced, that includes building resilience, having aspirations and the achievement of these" (Te Pou, 2014a, p. 5). While recovery is an individual process involving multiple pathways which takes place over time, common elements include relationships and support from others, hope and optimism about the future, building a positive identity, finding meaning in life, personal responsibility and control (Davidson et al., 2008; Davidson & White, 2007; Leamy, Bird, Le Boutillier, Williams, & Slade, 2011). A key component of recovery-oriented service delivery involves supporting clients to strive towards personally valued goals, and reintegrate into society through genuine working relationships, and a commitment to recovery principles (Le Boutillier et al., 2011; Slade, 2012). The ADOM has been developed for the purposes of routine outcome measurement in AOD treatment services, and includes two items assessing changes in personal recovery. From the outset, development of the ADOM has involved input from people using AOD services in New Zealand. It is important that outcome measures incorporate questions that matter to consumers and their acceptability is assessed (Fitzpatrick, Davey, Buxton & Jones, 1998). The ADOM is a three part measure containing 20 items that is administered collaboratively by practitioners and tangata whaiora (clients). The measure's standardised administration procedure involves data collection at key clinical treatment stages of treatment admission, 6-week review, 3-month review, ongoing 3-month reviews, and treatment discharge (see Te Pou, 2014b). The ADOM is freely available at http://www.matuaraki. org.nz Section 1 of the ADOM contains 11 relatively specific items assessing the type and frequency of substance use over the past four weeks. Section 2 includes seven items assessing the frequency of lifestyle and wellbeing issues, including physical and mental health, relationships, employment, housing and criminal activity. Both Sections 1 and 2 have previously been tested and recommended for routine use across AOD treatment services in New Zealand (Deering et al., 2009; Galea, Websdell, Galea-Singer, 2013; Pulford et al., 2010). Section 3 of the ADOM includes two items focused on recovery. The recovery items were added to the ADOM following feedback from clients of addiction treatment services and consultation with sector representatives (Galea et al., 2013). The first recovery item in section 3 assesses how close people are to where they want to be in their recovery. Responses are rated on a 10-point scale ranging from 1 (no anchor) to 10 (best possible). Research by Galea and colleagues (2013) indicates this item is perceived as useful by clients in measuring their recovery. It was however found to have positive but low inter-rater reliability based on eight practitioner's ratings of two vignettes of clinical scenarios (Galea et al., 2013). Factors contributing to the low interrater reliability of this item may include the level of training of practitioners in administering the ADOM, the absence of a response anchor for response option one, and the ability of individuals to discriminate between different response options (see Fitzpatrick et al. …