Recovery High School: What Do Students Think?

Background and Purpose: Recovery high schools (RHSs) offering intervention for academic and substance misuse (SM) problems are increasingly popular to address high rates of addiction and associated academic failure throughout the U.S. Limited research shows promising RHS outcomes for substance use reduction and improved mental health. Most adolescents with SM have co-occurring mental health (MH) problems which is not surprising considering the likelihood that youth with SM have experienced trauma and other risk factors. Unfortunately, most RHSs do not integrate MH care. In addition, most RHSs employ abstinence-only approaches. Providers must think critically about potential for unintended consequences such as exacerbating SM and MH problems and contributing to stigmatization and marginalization when RHSs are implemented without understanding perspectives of those impacted most directly. The effectiveness of RHSs is likely to be optimized by adapting program development in response to student feedback.

Qualitative research on RHSs is especially limited. Studies have implemented qualitative methods to characterize relapse factors for RHS participants or interviewed school staff and local stakeholders, however no existing research has sought feedback from students themselves. This study explores student perceptions of their RHS experiences using focus group data that is part of program evaluation of an innovative RHS.

Methods: High school students meeting criteria for an Intensive Outpatient Program were voluntarily admitted into a new RHS due to SM, co-occurring MH problems, and disruption of traditional education. The intervention is an integrated model between the public school district and a behavioral health service provider in the Southern U.S.

The participants (n=6) were high school students who had attended the RHS program from 1 to 5 months at the time of the focus group (60 minutes in length). Study participants attended a focus group about their perceptions and experiences with the RHS. A semi-structured interview was conducted by researchers to elicit feedback and discussion regarding students’ experiences, perceptions, and recommendations.

Thematic analysis was employed through an iterative process and the final stage involved researcher agreement.

Results: Theme 1: this program seems different captures that students were wary about enrolling in the program, noticed consistent change occurring with the formative intervention, and voiced their preferences. Theme 2: frustrations and limitations to promoting recovery includes quotes expressing how parts of the program limit their academic and SM recovery progress. Theme 3: perceptions of and hope for recovery, conveys experiences transitioning away from active substance misuse.

Conclusions: The study was limited to data available at the early stage of program development and participation yet makes important contributions. This research is the first known to apply qualitative methodology centering the voices of students enrolled in a RHS to inform optimal program development. Particularly interesting are student perspectives regarding harm reduction and positive reinforcement. Social workers who work with adolescents and providers developing RHSs may apply the findings to promote effective programming. Future research is needed with larger sample sizes and diverse recovery high school communities.