Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol

Rationale for the N.I.R.E study

Currently, there is a diverse amount of literature available into neurodiversity in the traditional educational space (Clouder et al., 2020; Rodgers Behavioural Health, 2021; Smagorinsky, 2020). In addition, within the recovery college space, a quick internet search documents multiple examples of recovery colleges already offering specific courses on aspects of neurodiversity – such as autism (Online Recovery College, 2023; Sussex Recovery College, 2022) and ADHD (Sussex Recovery College, 2022). Consequently, some third level colleges that offer Peer Support Worker training, like Atlantic Technological University in the Republic of Ireland, have also offered specific modules to this cohort of students in order to build a cohort of peers that are specialised in neurodiversity (Atlantic Technological University, 2022). However, despite the above advances in the field, there is a paucity of evidence examining recovery college staff and students’ observations, perspectives, and experiences of recovery education and neurodiversity. With the increase in neurodiversity specific courses and lack of evidence base on how to best facilitate these courses and support neurodivergent students, there is a palpable sense of anxiety within the historically purely mental health focused recovery college space to address this growing need.

Aim and objectives

As such, the overall aim of this proposed study is to explore whether recovery colleges and those who work within them are suitably equipped to support neurodivergent students receiving recovery education for their mental health and well-being. To meet this aim, the proposed study has a number of objectives including:

Scoping review

As noted earlier, the first activity of this project is to scope out the literature base as it relates to neurodiversity in recovery education. To do this, a scoping review which examines peer reviewed and grey literature on the subject of neurodiversity within recovery education will occur. This is necessary in order to confirm the paucity of literature we suspect is there currently on this aspect of recovery education/mental health. In order to support rigour, this scoping review will adhere to the methodological framework described by Arksey and O’Malley in their seminal 2005 work. Additionally, this scoping review will also adhere with the associated Preferred Reporting Items for Systematic Reviews and Meta-Analysis amendments for scoping reviews [PRISMA-ScR] as described by Tricco et al. (2018). In addition, a scoping review protocol has been registered with Opens Science Framework [OSF] repository on the 27^th June 2024 and has been assigned the following registration doi: https://doi.org/10.17605/OSF.IO/853K2. This protocol is currently under consideration by BMJ Open for publication. As such, for more information pertaining to the scoping review, please click on the registration doi link above.

Work package one

Work package one comprises of a qualitative investigation into recovery college staff observations and experiences of neurodiversity within recovery college environments of four nominated colleges which one of the authors of this protocol [OZ] is affiliated with. As described above, the sample of this work package comprises of recovery education staff within one of the four chosen recovery colleges [Compass Recovery College, Devon Recovery Learning Community, Wokingham Recovery College and Stepping Stones Recovery College]. To determine sample size, a process of information power will be utilised. Information power is a principle which basically suggests that the more a sample knows about a particular phenomenon under investigation, the lower the number of participants one needs within a study (Malterud et al., 2016). Therefore determining the final sample size will not be possible at this phase of the study. Additionally, to narrow down the sample somewhat, an inclusion/exclusion criteria has been created. For a staff member to be considered for inclusion in this work package, they need to meet the following criteria

Recruitment. Once ethical approval is achieved, the researcher will contact each of the four chosen recovery colleges to ask for permission to access the research site. To support this, a research proposal will be supplied to these gatekeepers along with a confirmation note from University College Cork’s Social Research Ethics Committee [SREC] confirming ethical approval has been granted. To gain access to staff of these recovery colleges, a poster will be circulated to them via the staff interweb. Additionally, the poster will also be shared on the designated N.I.R.E. study social media platform on LinkedIN. Once a potential participant contacts the researcher, the researcher will discuss the details of the study with them and provide them with an information leaflet and informed consent form for them to review. The participant is then given time, at least seven days, to consider whether or not they wish to partake in the study. If the participant wishes to partake in the study, they will be invited to an interview on a University College Cork licenced MS Teams platform.

Data collection. Data will be collected from participants through a semi-structured interview process. Semi-structured interviews are in-depth interviews that require participants to answer open ended questions documented in an interview topic guide (Jamshed, 2014). However, the semi-structured nature of the interview means that the interview topic guide is not followed rigidly, but instead serves as a guide to steer the discussion.

Data analysis. Qualitative data from the semi-structured interviews will be transcribed verbatim and analysed using the computer software programme NVivo Version 14 for MacBook, with copyright for the use of same being held by the lead author’s [MJN] institutional affiliation – University College Cork. The mechanism of analysis is Braun and Clarke’s (2006; 2019; 2022; 2024) reflexive thematic analysis. This process involves the researcher becoming familiar with the data gathered through multiple readings of the transcripts (Norton et al., 2023). From which, initial codes will be generated and enhanced to become themes which are then revised, adjusted and refined by the researcher through NVivo. The process also allows the researcher to reflect on their own subjectivities and pre-conceived ideas surrounding the research topic.

Work package two

Like work package one, work package two also consists of a qualitative investigation. However, this time, the focus is shifted so that the observations and experiences of recovery education from recovery college students who self-identify as neurodivergent is of primary interest. This work package will occur in tandem with work package one as it focuses on the four particular colleges that one of the author’s [OZ] is associated with. Sample size is once again determined by the process of information power. To support the narrowing of participants, the sample must comply with the following inclusion/exclusion criteria:

Recruitment. Once ethical approval is achieved, the researcher will contact each of the four chosen recovery colleges to ask for permission to access the research site. This will be done as per the mechanism employed in work package one above. To gain access to the students who identify as neurodivergent, the researcher will ask these recovery colleges to circulate a poster amongst their networks. This will also be shared on the specific recovery college’s social media as well as the N.I.R.E study’s own social media LinkedIN page. Once a potential participant contacts the researcher, the details of the study will be discussed with these students and they will be provided with an information leaflet and an informed consent form for them to review. The participant is then given time, at least seven days, to decide if they wish to partake in the study. If the participant wishes to partake in the study, they will be invited to an interview on a University College Cork licenced MS Teams platform.

Data collection. Data collection for this work package mirrors that discussed in work package one.

Data analysis. Data analysis for this work package mirrors that discussed in work package one.

Work package three

The final work package mirrors that of work packages one and two. However, this time, the study will broaden its focus so that recovery college staff and students’ observations and experiences of neurodiversity are captured within recovery education settings across the United Kingdom [England, Scotland, Wales and Northern Ireland]. The sample size will once again be determined by the principle of information power. The process of narrowing the sample will also include an inclusion/exclusion criteria which mirrors that of work package one and two, but with one caveat:

Recruitment. Once work packages one and two are completed, the researcher will identify and contact the recovery colleges within each of the study sites within the United Kingdom to ask for permission to access these sites. This will be done as stipulated in work package one and two above. To gain access to staff of these recovery colleges, a poster will be circulated via the staff interweb. Additionally, the poster will also be shared on the N.I.R.E study LinkedIN social media page. To gain access to students who identify as neurodivergent, the researcher will ask these recovery colleges to circulate a poster amongst their networks. This will also be shared on the recovery college’s and the N.I.R.E study’s social media accounts. Once a potential participant contacts the researcher, the researcher will discuss the details of the study with them and provide them with an information leaflet and an informed consent form for them to review. The participant is then given time, at least seven days, to consider whether or not they wish to partake in the study. If the participant wishes to partake they will be invited to an interview on a University College Cork licenced MS Teams platform.

Data collection. Data collection for this work package mirrors that discussed in work packages one and two above.

Data analysis. Data analysis for this work package mirrors that discussed in work packages one and two above.

Guideline development

To further support this work and to ensure that the information found by the N.I.R.E study is implemented into practice across the UK and elsewhere, this study also plans to produce two guidelines – the first after work packages one and two are complete, the second after work package three is completed. The need to develop guidelines to support neurodivergent individuals in recovery colleges is further spurred on from the increasing prevalence of neurodiversity among those with mental health challenges. In developing such guidelines, it is hoped that recovery colleges can foster neuro-inclusive environments, by enhancing staff preparedness, and ensuring recovery outcomes are improved for neurodivergent students by addressing their needs holistically. Once again, due to the co-productive nature of the working environment in which this study is situated, these guidelines will be co-produced and co-authored by those who work/use recovery colleges and identify as neurodivergent. This will ensure that all information written in both set of guidelines will be an accurate reflection of as many neurodivergent voices as possible, and as a result, are best able to serve and support this population.

In the creation of this protocol, it was noted that the Reporting Items for practice Guidelines in HealThcare [RIGHT] statement was deemed the most appropriate statement to follow as our guidelines are to support the creation of a neuro-affirming environment and not to develop guidelines relating to for example a particular drug’s use for a particular condition and so on (Chen et al., 2016). However, the RIGHT statement has yet to develop a protocol statement to support researchers in preparing a protocol for same. This is despite the fact that Luo et al. (2022) have suggested that there is one in development. As such, as part of the wider N.I.R.E study, we have utilised aspects of Chen and colleagues original RIGHT guidelines, in order to make a protocol for the creation of both sets of these guidelines. This protocol has been created and is currently under consideration for publication by BMJ Open.

Patient and Public Involvement

This proposed study has been co-designed with public and patient involvement [PPI] representation. Equally, the proposed study itself will also be co-produced with these same PPI representatives. Some of whom [WGP, LL, OZ] are co-authors of this paper. The study will also be overseen by a wider research advisory group. This research advisory group also consists of these PPI representatives and also others who work in the recovery education system within the UK. As part of their work, the research advisory group reviewed this study protocol prior to its registration with OSF repositories, submission to the journal and eventual publication.

Strengths and limitations to the N.I.R.E study

The proposed study demonstrates several strengths. It adopts a qualitative methodology which is well-suited for exploring complex experiences and perspectives that cannot be captured through quantitative means. The study's approach, encompassing staff and student perspectives across multiple recovery colleges, thereby ensuring an in depth comprehensive understanding of neurodiversity within these settings. The study aims to address a significant research gap by exploring neurodiversity within recovery colleges, which will inform the future development of neuro-inclusive practices and policies in these settings. It is the first study of its kind that is conducted that addresses the pressing matter of accessibility of content and inclusion in adult educational settings.

Despite this, the proposed study also has a number of potential weaknesses. For example, the lack of research and work that has been carried out to date on the topic. As such it is difficult to benchmark what the findings will provide us with and how useful they will be to inform our guidelines to support recovery colleges in being more neuro-inclusive. Additionally, the reliance on self-reported data from participants introduces the risk of bias, as individuals may provide socially desirable responses or struggle to articulate their experiences fully. The study's scope, while valuable, may face challenges in capturing the full diversity of neurodivergent experiences due to the complexity and variability of neurodivergence itself. Furthermore, the interpretation of data through reflexive thematic analysis, though robust, depends heavily on the researcher's subjective lens of the data collected, which may inadvertently influence the results despite efforts to maintain reflexivity and rigour. These factors could limit the broader applicability and replicability of the study's conclusions. However, despite this, the need for this research to be carried out outweights the potential limitations noted above and as such, the research has been approved to commence in January 2025.