What is INSPIRE?
INSPIRE is a family of measures designed to assess a service user’s experiences of the support they receive from a mental health worker for their recovery. INSPIRE was originally developed in two versions: a 27-item long version (Full INSPIRE) and a 5-item short version (Brief INSPIRE). Both versions were developed at King’s College London as part of the REFOCUS programme with input from service users, mental health professionals and researchers, are completed by a service user about their worker, and have been psychometrically evaluated in this paper.
INSPIRE is in use in many countries. For example, it is recommended for use in England by ImROC in its Briefing paper 8 on Quality and Outcomes, and for use in Ireland by the Bamford Review. Other papers citing INSPIRE are here
Full INSPIRE and Brief INSPIRE measure recovery support. Additionally, a new version called Brief INSPIRE-O has been developed to measure recovery, rather than recovery support. Brief INSPIRE-O is based on Brief INSPIRE, and has not yet been 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. All versions of INSPIRE assess Support, and Full INSPIRE also assesses the Relationship. INSPIRE 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).
You can download the English versions of INSPIRE here.
Full 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 Full INSPIRE, the Full INSPIRE scoring instructions and the Full 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 (e.g. here) and the Netherlands. You can download Brief INSPIRE-O, the Brief INSPIRE-O scoring instructions and the Brief INSPIRE-O score sheet.
All versions of INSPIRE are distributed using an Attribution-NonCommercial-No Derivative Works 4.0 International Public Licence (CC BY-NC-ND 4.0), which means that it can be used without permission for clinical, educational or research purposes, providing no change is made to the content and no charge is made. You do not need to contact us for this permission.
If you wish to charge for use of any version of INSPIRE, either directly on a pay-per-use basis or indirectly by including it within a commercial product such as software or a book, then you will first need to contact us to obtain a commercial use licence granting an Attribution-No Derivative Works 4.0 International Public Licence (CC BY-ND 4.0).
We allow three modifications to INSPIRE:
- [All versions] You can modify the format but not content of the measure, for example to include it in an assessment battery or on a clinical information system.
- [Full INSPIRE and Brief INSPIRE only] You have permission to change the term ‘worker’ in the opening administration instructions to be more specific, e.g. ‘care co-ordinator’ or ‘nurse’.
- [Full INSPIRE and Brief INSPIRE only] We advise against modifying INSPIRE to assess support from a service or team rather than from an individual worker. Please read the next section 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 make this change.
You do not need to contact us for permission for the above modifications. Please ensure that any reporting of the results describes how INSPIRE has been modified.
If you wish to change INSPIRE in any other way then you need to contact us to obtain our permission. Note that we do not allow INSPIRE to be modified for completion by another informant, such as a mental health worker or a family member.
Why not a measure of team support?
As we report in the development paper, we piloted a team version of Full 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 in Full INSPIRE and Brief INSPIRE. 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.
What is the INSPIRE score?
Full 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).
Brief INSPIRE and Brief INSPIRE-O each have one total score, ranging from 0 (low recovery support) to 100 (high recovery support).
There are three ways the Support sub-scale in Full INSPIRE can be inconsistently completed. Assuming you just have the data so can’t ask the individual to clarify what they mean, here is how we recommend each inconsistency be corrected:
- Neither Yes nor No is rated but there is an agreement rating – recode the missing value to Yes and keep the agreement rating.
- No has been rated and there is an agreement rating – delete the agreement rating.
- Yes has been rated but there is no agreement rating – recode Yes to No.
How can INSPIRE scores be interpreted?
Full 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 Full 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 Full 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 Full 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 of Full INSPIRE and Brief INSPIRE they use. Both versions can be used to calculate the Brief INSPIRE score for recovery support.
If you are using INSPIRE as an outcome monitoring tool then use Brief INSPIRE-O.
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?
Full INSPIRE and Brief INSPIRE are Patient-Rated Experience Measures (PREMs).
Brief INSPIRE-O is a Patient-Rated Outcome Measure (PROM).
The reference for Full 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. Available here
Please cite this reference whenever reporting findings about INSPIRE.
For Brief INSPIRE-O, indicate that Brief INSPIRE-O is based on Brief INSPIRE and cite the above reference.
You have permission to translate any version of INSPIRE providing all these conditions are met:
a) The translation is clearly labelled both in English and in the translated language, e.g. Brief INSPIRE (French).
b) The translation is compatible with the original English measure. Minor modifications can be made to the anchor points for items to maximise conceptual equivalence and ensure cultural compatibility, but other elements (e.g. structure, number and focus of items, rating scale etc.) cannot be changed. We encourage but do not require the development of high-quality translations, for example by following a formal methodology for translation, such as described here.
c) The following statement is made in English and the translated language:
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 translation was published in year by name and contact details of translator.
d) Your translation includes the following statement in English (and, where meaningful, in the translated language):
Distributed using Creative Commons License: CC BY-NC-ND 4.0.
This means that your translation is distributed using an Attribution-NonCommercial-No Derivative Works 4.0 International Public Licence (CC BY-NC-ND 4.0) so it can be used without permission for clinical, educational or research purposes, providing no change is made to the content and no charge is made. Please contact us if you receive a request for permission to change or charge for your translation
e) You send us a PDF copy of your translation which we will make available as a download in our translations list.
If you plan to make a translation please send us information about the specific INSPIRE measure(s) you will be translating and your name and email details to list in the translator table.
Download INSPIRE Translations
|Mikkel A. Auning-Hansen
|Malene Frokjaer Krogsgaaardz
|Stine Bjerrum Moeller
|University of Tokyo team
|Thomas Kristian Tollefsen
|Portuguese translation coming soon!