What is INSPIRE?
INSPIRE is a measure designed to assess a service user’s experiences of the support they receive from a mental health worker for their recovery. It was originally developed in two versions: a 27-item full version (INSPIRE) and a 5-item short version (Brief INSPIRE). Both versions are completed by a service user about their worker. It was developed at King’s College London.
Both versions of INSPIRE have been psychometrically evaluated – click here. INSPIRE was developed as part of the REFOCUS programme of work with input from service users, mental health professionals and researchers. It is one of the measures used in the REFOCUS trial, testing a recovery intervention.
INSPIRE and Brief INSPIRE are Patient-Rated Experience Measures (PREMs). Additionally, a new version called Brief INSPIRE-O has been developed to measure recovery (rather than recovery support), i.e. a Patient-Rated Outcome Measure (PROM). Brief INSPIRE-O is based on Brief INSPIRE, but not yet fully evaluated.
Theory base for INSPIRE
INSPIRE is based on two reviews. Our review of international best practice in supporting recovery identified four domains, including Support for recovery and Working relationships. Both versions of INSPIRE assess Support, and the full version of INSPIRE also assesses the Relationship. The items are based on our systematic review of personal recovery, which identified five key recovery processes – Connectedness, Hope, Identity, Meaning and Empowerment (the CHIME Framework).
There are three versions: INSPIRE, Brief INSPIRE and Brief INSPIRE-O.
INSPIRE assesses recovery support from a worker and has two sections – Support (20 items) and Relationship (7 items). The Support section identifies the level of worker support for the items rated by the service user as important for their recovery. The Relationship section assesses the relationship between the service user and the mental health worker. You can download INSPIRE, the INSPIRE scoring instructions and the INSPIRE score sheet.
Brief INSPIRE assesses recovery support from a worker and has 5 items – one item for each of the CHIME recovery processes. It does not record individual preference for different types of support, or assess the relationship. You can download Brief INSPIRE, the Brief INSPIRE scoring instructions and the Brief INSPIRE score sheet.
Brief INSPIRE-O assesses recovery and has 5 items – one item for each of the CHIME recovery processes. It is based on Brief INSPIRE, and evaluation is underway in Denmark and the Netherlands. You can download Brief INSPIRE-O, the Brief INSPIRE-O scoring instructions and the Brief INSPIRE-O score sheet. Brief INSPIRE-O has been translated into Danish (contact: Stine Bjerrum Moeller, firstname.lastname@example.org) and Dutch (contact: Wilma Swildens, email@example.com).
Using and modifying INSPIRE
You do not need a licence to use INSPIRE or Brief INSPIRE, and they can be used without permission for teaching, research or clinical purposes providing no change is made.
INSPIRE and Brief INSPIRE are copyrighted and their content cannot be changed without permission. You have permission to modify the format but not content of the measure, for example to include it in an assessment battery, or on a clinical information system. You also have permission to change the term ‘worker’ in the opening administration instructions to be more specific, e.g. to ‘care co-ordinator’ or ‘nurse’. We also get contacted to ask if INSPIRE can be modified to assess support from a service or team rather than from an individual worker. We advise against this – please read the next FAQ outlining why. However, if having considered these issues you still want to modify INSPIRE to ask about support from a team or service, you can. We do not allow INSPIRE to be modified for completion by another informant (e.g. a family member). If you wish to modify INSPIRE in some other way then please contact us at firstname.lastname@example.org.
Why not a measure of team support?
As we report in the development paper (reference below), we piloted a team version of INSPIRE, and found several issues with it:
a) How should INSPIRE be rated if different workers from the same team provide different (and even opposite!) levels of recovery support?
b) Our understanding of the ‘team’ was sometimes different from the service user’s understanding. We thought it meant the nurse / psychiatrist / psychologist etc. in the mental health team, but we found that for some service users, their understanding of their team included for example their family doctor / GP and their probation officer.
c) Service planners and workers think in terms of teams. By contrast, for service users the relationship with workers is the mechanism by which care is delivered, strengths amplified, values respected etc. Therefore the individual worker is the better ‘unit’ of assessment for a service user-rated assessment.
We therefore decided to measure recovery support from an individual worker. Where a service uses a team-based approach with several staff working with the service user, we suggest the INSPIRE rating is made about the worker they see most often or have the closest working relationship with.
Of course, rating an individual worker can be anxiety-provoking for the worker – and the service user! Most services using INSPIRE try to avoid having the worker directly involved in giving or receiving the measure, to reduce social desirability bias. It can be helpful to both workers and service users to describe the INSPIRE rating not as a judgement about the worker’s performance, but rather as a means of finding out clinically useful information about what matters to the service user, so workers can use their skills in areas of life which matter most to the person.
There are three ways the INSPIRE Support section can be inconsistently completed. Here is how we recommend each inconsistency be corrected (assuming you just have the data so can’t ask the individual to clarify what they mean):
1. Neither Yes nor No is rated but there is an agreement rating – recode the missing value to Yes and keep the agreement rating.
2. No has been rated and there is an agreement rating – delete the agreement rating.
3. Yes has been rated but there is no agreement rating – recode Yes to No.
What is the INSPIRE score?
The 27-item INSPIRE has two sub-scales: Support and Relationship. These are reported separately, and each sub-scale score ranges from 0 (lowest support for recovery) to 100 (highest support for recovery).
The 5-item Brief INSPIRE has one total score, ranging from 0 (low recovery support) to 100 (high recovery support).
How can INSPIRE scores be interpreted?
INSPIRE has been used with a group of 92 people in the INSPIRE validation study (Williams et al, 2015) and with groups of 193 and 210 people in the REFOCUS Trial (Slade et al, 2015). These studies involving people using community-based adult mental health services, with a primarily psychosis diagnosis. Across the three groups, the average INSPIRE rating was 72% for the Support sub-scale and 78% for the Relationships sub-scale.
If the INSPIRE Support score is lower than 72%, the message might be “When we tested INSPIRE with people using mental health services, the average support score was 72%. As your support score is lower than this, you might want to discuss this with your worker, to make sure they know the things that matter to you, and let them know how they could be more helpful in their support. You could show them your INSPIRE ratings as part of this discussion, to highlight the areas you rated as important but not well supported”.
If the INSPIRE Support score is higher than 72%, the message might be “When we tested INSPIRE with people using mental health services, the average support score was 72%. As your support score is higher than this, you might want to discuss this with your worker, to make sure they know their support is of value to you. You could show them your INSPIRE ratings as part of this discussion, to highlight the areas that you rated as important and particularly well supported”.
If the INSPIRE Relationship score is lower than 78%, the message might be “When we tested INSPIRE with people using mental health services, the average relationship score was 78%. As your relationship score is lower than this, you might want to discuss with your worker how they can work better with you, or whether there is an option of having another worker. You could show them your INSPIRE ratings as part of this discussion”.
If the INSPIRE Relationship score is higher than 78%, the message might be “When we tested INSPIRE with people using mental health services, the average relationship score was 78%. As your relationship score is higher than this, you might want to discuss this with your worker, to make sure they know that you value your relationship with them. You could show them your INSPIRE ratings as part of this discussion.”
Using INSPIRE to improve recovery support
Some possible uses are:
- Using INSPIRE as a tool to support conversations to happen between workers and service users, with the recording of INSPIRE scores showing that the conversation has taken place. A clear leadership communication that the main focus is on supporting workers to have conversations that matter will get a much better completion rate than a focus just on INSPIRE completion rates
- Using INSPIRE scores over time to understand how things are progressing for the service user, with charting of progress over time used to inform conversations between workers and service users
- Benchmarking across teams and team types to inform service development and workforce planning. For example, if certain teams are better than others at helping service users to feel in control of their life, then there may be cross-team learning opportunities.
Which version of INSPIRE should we use?
If your main focus is on encouraging conversations about values, life goals and how to best support recovery then use INSPIRE. As a side benefit, you might choose to calculate the Support and Relationship scores, and/or to calculate the Brief INSPIRE score, so you can follow scores over time.
If your main focus is on obtaining a score for recovery support with minimum burden, then use Brief INSPIRE.
If you are introducing INSPIRE across a large system, in which some workers will use INSPIRE to shape the conversation and others just need to get a score, then workers can be given the option to choose which version they use. Both versions can be used to calculate the Brief INSPIRE score for recovery support.
What does ‘INSPIRE’ stand for?
‘INSPIRE’ is not an acronym and doesn’t stand for anything – it is just the name of the measure.
Is INSPIRE a PROM or a PREM?
INSPIRE and Brief INSPIRE are Patient-Rated Experience Measures (PREMs).
Brief INSPIRE-O is a Patient-Rated Outcome Measure (PROM).
The academic reference for INSPIRE and Brief INSPIRE is:
Williams J, Leamy M, Bird V, Le Boutillier C, Norton S, Pesola F, Slade M (2015) Development and evaluation of the INSPIRE measure of staff support for personal recovery, Social Psychiatry and Psychiatric Epidemiology, 50, 777-786
Please reference this paper in any publication about INSPIRE.
You have permission to translate INSPIRE or Brief INSPIRE if:
a) the following statement is made in English and your local language on your translation:
INSPIRE was developed in English by Julie Williams, Mary Leamy, Mike Slade and colleagues at King’s College London. Further information available from researchintorecovery.com/inspire. This version was translated into <language> by <your name and contact details>
b) your translation is distributed free of charge by you to academic and clinical colleagues who request a copy, and no charge is made for its use for research, clinical or teaching purposes.
c) you send a copy to us (email: email@example.com) to include as a download in our below list of translations.
Translations must be comparable with the original English INSPIRE. Minor modifications can be made to the wording for each item to maximize conceptual equivalence, but other elements (sub-scale structure, number of items, rating scale etc) cannot be changed. We particularly encourage the development of high-quality translations, for example by following a formal methodology for translation, such as described here.
Download INSPIRE Translations
|Arabic||Coming soon||Mohammad Abu-Mahfouz||MA2659@live.mdx.ac.uk|
|Danish||Download||Download||Malene Frokjaer Krogsgaaardz|
|Finnish||Download||Download|| Sirpa Tölli|
|German||Download||Coming soon||Esther Indermaur|
|Japanese||Download||Download|| University of Tokyo team|
|Norwegian||Download||Download||Thomas Kristian Tollefsen|
|Slovene||Coming soon||Katarina Trzanfirstname.lastname@example.org|
|Traditional Chinese||Download||Rose Chiuemail@example.com|
If you want to use INSPIRE or publish academic papers about INSPIRE, please go ahead – there is no need to contact us for permission. By contrast, if you wish to publish a book or other product (e.g. software) about or using INSPIRE that will be sold, please email firstname.lastname@example.org to obtain permission.
INSPIRE was developed by Julie Williams, Mary Leamy and Mike Slade, with support from Yan Weaver, Vicky Bird and Clair Le Boutillier.