Guidance for Workers
Using the Recovery Star
TM
The Recovery Star is for use with people who are experiencing problems
with mental health. It is designed as an integral component of one-to-one
keywork or support focusing on recovery or managing well with mental health
problems. It is suitable for people experiencing a wide range of mental health
difficulties for short or long periods of time.
1
Completing the Recovery Star is intended to be a helpful, engaging and
empowering process that stimulates and focuses discussion and provides a
useful, shared basis for an action or support plan. It supports strengths-based,
person-centred and trauma-informed approaches. The Star is a flexible tool
that relies on the skills of the professionals using it, as well as on a degree
of understanding and trust between them and the service user. The Star is
designed to be used one to one; the aim is to have a genuine interaction and
complete it collaboratively. This can help someone feel more in control and
support their recovery.
Not only is this
a useful tool for
assessment and
identification of
needs, its use over
time can demonstrate
to commissioners that
they are getting the
right outcomes from
the services they fund.
Department of Health
Green Paper, 2009 (on
the Recovery Star)
The Star is a flexible tool that consists of:
• The Recovery Star Chart, Notes and Action Plan for completion by
workers with service users
• The Recovery Star User Guide, with accessible and detailed scales for
each of the ten outcome areas and a detailed description of the Journey
of Change
• This Guidance for Workers
• Flashcards for use with service users
• A web application for online completion at www.staronline.org.uk
In addition, Triangle have also published the following supporting documents:
• An overview of the development process
• A review of the supporting evidence for the fourth edition
• A review of the psychometric validation of the Recovery Star.
This guidance supports the fourth edition of the Recovery Star (2019). The
introduction to the User Guide details improvements made for this edition.
Background and further information about the Outcomes Star suite of tools
can be found at www.outcomesstar.org.uk.
1 Keywork may have another name in your service, but includes assessing a service user’s needs, agreeing
goals and providing support and referrals to help them meet those goals. The keyworker is the person who is
assigned special responsibility for working with that service user.
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Before you use the Recovery Star
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Make sure that you have received training in using the Recovery Star
and that you are familiar with the materials and know when and how the
Star is used in your service. It’s vital that you understand and use the Journey
of Change underlying the scales – stuck, accepting help, believing and
trying, learning, and self-reliance. This will ensure consistent and reliable
information as a basis for support planning and for use by your service. You
also need to be familiar with all the scale descriptions, so you can unpack and
rephrase them as needed for the service user.
How to introduce the Recovery Star
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Think about where to complete the Star, and try to find a place where the
service user can feel at ease. Take account of situations or topics that may
trigger anxiety or anger, perhaps from trauma, to give the best possible
conditions to support the conversation and enable the service user to focus
and take an overview of their life.
Before you introduce the Star to service users for the first time:
• Devise a short script to introduce the Star in a way that feels natural to
you and clear for those you are working with
• If you meet with the service users you support in groups, it can be
useful and save time to explain the Star to the group before starting
one-to-one work within individual sessions
• Consider giving service users who are interested a copy of the User
Guide to read before the session. Although this is quite detailed
and relies on someone being comfortable with reading, the whole
document is worded in accessible language, so it can be shared.
When introducing the Star:
• Explain that people may start anywhere on the journey, can move both
up and down on the scale and that 10 is the top of the Star scales but
not the end of the journey
• Be clear that this is about exploring where they are and building up
a map of their world, experiences and journey – it is not about being
judged as good or bad
• Avoid using the term “score” – refer to where someone is on the
scale or Journey of Change and refer to the stage names, colours and
numbers, depending on what works best for each individual
• Encourage people to ask questions so they feel as comfortable as
possible about the Recovery Star and reassure them that they will have
choices about the pace and process.
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I felt fully involved;
it was clear and easy
to understand and
focused on me as a
whole person, not just
as a problem.
Service user, Tulip Day
Centre
It felt like a
conversation –
it felt as if for the first
time someone had
really listened to me.
Service user, Tulip Day
Centre
Overall, the skills and approach needed to introduce and use the Recovery Star well are likely to be in
keeping with being person-centred and trauma-informed, as well as other good practice in your service.
Some suggested phrases for introducing the Star include:
“The Recovery Star is a way of tracking your journey and finding out about the areas where you need
more information or support.”
“The Star tells us where you are now and what needs to happen next, and it helps you and me plan our
work together.”
How to complete the Recovery Star
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Complete the Star collaboratively with a service user in a way that responds to their needs and
abilities. The aim is to engage them in meaningful discussion, and to listen and learn about them, rather
than to complete the Star as quickly as possible.
Discuss each area. Let the service user decide which scale to start with or choose one that is concrete and
may be easier to discuss (for instance, “Physical health”), to help build their sense of control and put them
at ease.
Do more asking than telling to help the service user share their perspective and build a better picture of
their needs. This also helps to build the relationship and show that the Star is about helping people achieve
their goals.
Use the scale descriptors as a basis for discussion about the chosen area, or have an open discussion
about the area, and then use the scale to place the service user on the Journey of Change. The brief visual
scales in the User Guide and the Flashcards are designed to be used directly with service users. Although
the detailed scales are intended primarily as a resource for workers, they are written to be accessible,
so feel free to refer to specific points for clarification with service users. Avoid reading them out in their
entirety because of their length.
Always use the detailed scales and be aware of the Journey of Change when deciding where a
service user is on their journey. These are designed to reduce subjectivity – otherwise one person’s 3
could be another person’s 8 and the completed Star won’t be a useful basis for completing the support
plan, and your service won’t be able to treat collated Star data as reliable for reporting purposes.
If you don’t agree, have a discussion – this can help you learn about the service user and help them
reflect on their situation and see it in new ways. If a service user is able to engage meaningfully and is at 5
or above for most of the Recovery Star areas, encourage them to take the lead in placing themselves on the
scales. You may need to be more directive for service users in the accepting help stage, and those who
are stuck in all or most areas won’t discuss the Star meaningfully and you may need to do a worker-only
reading.
This process requires good keyworking skills, some knowledge of the person and a relationship with them.
You will need to encourage those people with low confidence to see their strengths, and others to be more
realistic.
If you can’t reach agreement, record both readings on the Star, labelling which is the worker’s
view and which is the service user’s. Use the Star Notes to record points from your discussion. Use your
professional judgement to decide when further discussion isn’t helpful.
Spend time reflecting on areas where the service user has strengths, drawing out the abilities and
skills they are using, as well as on the areas where they have difficulties. This can build their awareness of
what they are good at and confidence that they can meet other challenges.
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Recognise external factors. While the Journey of Change focuses on the
service user, there may be societal factors or other conditions beyond their
control – and beyond the control of your service – which make it harder for
things to improve. These may include poor housing, financial difficulty or
lack of suitable mental health provision or other services. These also need
to be acknowledged and recorded when using the Star. For example, lack
of money may affect how people can participate in activities or eat well.
Your service may then be able to use this information to identify gaps in
provision, plan future developments or raise issues with policy-makers.
Recognise other factors. While the emphasis in the Recovery Star is on
where someone is now and how they can be supported to make progress,
there may be trauma or other factors from their past that contribute to
their mental health issues and/or to what they need now. As with external
factors, these need to be acknowledged and will affect how you work with
someone, in line with good practice in your service.
When you have completed all of the scales, join the points to
create a shape. Mark each reading on the Star Chart and join the points.
Encourage the service user to do this and create the shape. This applies
whether you and the service user are completing the Star on paper or on
screen, for example using the Star Online.
How to use the completed Star as the basis for a
support plan
Look at the shape of the completed Star together and prompt the service
user to comment on it as a basis for agreeing what to do next. Ask
questions such as:
• Is the shape of the Star an accurate picture of how things are for you
now?
• What does it tell you about what is and isn’t going well?
• What are the strengths that you bring to the areas that are going
well? How might you apply those strengths in other areas of your life?
• What does your Star tell you about areas where you need to make
changes or where you could do with more support?
• What is it most important to address first?
Once you have chosen the areas to be included in the support plan, further
motivational questions for each area include:
• Where on the journey do you want to get to and by when?
• What needs to be done to bring about that change?
• Who is responsible for these actions? When can they be completed?
Complete the Recovery Star Action Plan or use your organisation’s
action planning documentation. The Journey of Change provides valuable
pointers for thinking about the goals of support with the service user and
achievable, realistic actions:
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Seeing the Star
visually helps me
to see that I am
changing, that things
are happening, that
there is a light at the
end of the tunnel.
Service user
Journey of Change stage
Goals of keywork
Self-reliance (9-10)
At this stage service users are doing well, so the main actions will be:
• Continuing to reinforce the learning
• Building and reinforcing support networks outside of the service
• Focusing on the future
Example: if a phone call needs to be made, the service user makes it
independently.
Learning (7-8)
When service users reach this stage, the focus of support may include:
• Helping them to reflect on how they have overcome problems and how they
can learn from this
• Celebrating their achievements
• Supporting them to deal with difficulties themselves
Example: if a phone call needs to be made, the worker may help the service user
prepare for it and make sure they have all the information they need – but the
service user makes the call.
Believing and trying (5-6)
At this stage service users are changing their perspective, taking responsibility
and trying new things. They may give up easily when these don’t seem to work,
so goals and actions may include:
• Supporting and reinforcing their new-found sense of agency and responsibility
• Helping them to plan what they are going to do and develop strategies for
themselves
• Encouraging them to try new approaches and keep going when things go
wrong
Example: if a phone call needs to be made, the service user may make it but with
the worker nearby to help if it becomes difficult.
Accepting help (3-4)
Service users at this stage are starting to open up to help but don’t yet take the
initiative. The approach may include:
• Reassurance that some of the things that concern them are being addressed
on their behalf, with their agreement
• Building trust, a relationship, and a belief that change is possible
Example: If a phone call needs to be made, at this stage it will be made by the
worker, but with the service user present and giving their consent.
Stuck (1-2)
Since service users at this stage are not engaged or interested in changing, the
focus could be on ensuring that they are safe and on building a relationship with
them. Actions may include:
• Sorting out practical issues on their behalf where they are at risk of violence,
losing benefits, being evicted or other dangers
• Trying to ensure they feel as safe and in control in the service as possible
• Encouraging them to recognise the situation they are in and accept help
Example: if a phone call needs to be made, at this stage it will be made by the
worker alone.
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Revisit the Recovery Star at regular reviews
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Make sure you know the timing and frequency of Star reviews in your service;
these work best when integrated with support plan reviews and usually
happen every three to six months. At each review, repeat the process of
discussing each of the Star areas and agreeing where the service user is on
each scale, preferably without reference to the previous Star readings. Once
completed, you can display the current and previous readings to give an
instant visual picture of change, either on paper or on screen if using the Star
Online.
Encourage open discussion, looking at the new Star shape. Possible
review questions include:
• How do you feel about the shape of the Star?
• Where do you see the progress you have made?
• What has helped you to make progress? What strengths have you
brought to this? What can you learn from this and apply to other areas?
• What areas do you want to address now – the same as before or new
ones?
• Where do you want to get to by the next review? What actions will it
take to make this happen?
Complete a new action plan and, if working on paper, file the Star Chart
and Action Plan and enter the data as required. If you complete the Star
on screen with the service user, for example using the Star Online, the data
should be captured automatically, but make sure you are familiar with your
organisation’s policy. You may need to print the Star, Star Notes and Action
Plan for your files and/or to give a copy to the service user to take away.
When positive change occurs, reviews can be helpful and encouraging for you
and the service users you work with, as the Star makes progress very evident.
Seeing progress on the Star can help to encourage everyone involved and
reinforce change.
2 Dickens, G, Weleminsky, J, Onifade, Y and Sugarman, P (2012) Recovery Star: Validating User Recovery, The
Psychiatrist, 36, pp 45–50
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The Recovery Star
has been received
enthusiastically by
both mental health
service providers
and service users.
This study provides
further evidence for its
adoption in recoveryfocused mental health
services.
“Recovery Star:
Validating User
Recovery” research
paper, 2012
2
Frequently asked questions
Using the Star may mean working with service users in a different way. How natural and easy it feels
for you will depend on your way of working prior to using the Star. Most workers find that the Star
is fairly self-evident and feels familiar and comfortable after they have used it a few times, but the
following questions often come up in training.
What if a service user does not engage with the Star?
Service users who are stuck in most or all areas of the Star will probably not engage meaningfully
with the Star. They may be stuck because of the strength of their symptoms at the time, or because
they are very focused on one problem they are facing, making it hard to step back and look at their
life as a whole. You may choose to come back to the Star at the next appointment if their mood and
ability to engage fluctuates, or to do a worker-only assessment if it is a more lasting issue. You could
share the worker-only Star with them later, to show how things have improved or to prompt learning
and discussion.
It is unusual for service users to engage with support but resist using the Star. If this happens, listen
to their reasons, try to ensure that they understand the aim of the Star and feel comfortable with it
and answer any questions or concerns they have, such as about how the information is used. You
may also want to point out the benefits of the visual, shared picture and that the Star is an integral
part of how your service provides support, or you may want to encourage them to try it in other
ways.
What if a service user doesn’t want to discuss certain areas?
This can happen when service users feel that some of the scales are not relevant because they do not
have an issue in these areas. If you also feel that a particular area poses no problems, simply place the
service user at 10 for that scale and move on.
Some areas may be particularly sensitive or the service user may not be willing to discuss them. Many
workers find that seeing an area on the Star can be a helpful way to introduce sensitive topics that
need to be discussed. However, the relationship of trust between the worker and the service user is
more important than the Star. If it’s not helpful to continue, opt for either 10 or 1, and move to the
next scale.
What if we don’t agree on where a service user is in an area?
This is a helpful starter for discussion and it’s important to listen carefully to what the service user has
to say. However:
• If service users are not yet believing and trying, you will need to take more of a lead
• If you suspect they do not want to acknowledge difficulties they are experiencing, use your
professional skill and judgement in the same way as you would without the Star. Unless there is
a realistic picture of how things are, the service user may not get the support they need
• If you and the service user still don’t see things the same way after discussion, record both
views on the Star Chart, either during the session or afterwards. Your views may converge later.
If things don’t improve for service users, will that reflect badly on me?
The purpose of the Star is to help service users see where they have come from and where to go
next. It will also help your service see where it is assisting them to make positive changes, and identify
areas that may need further attention. When service users do not show improvement on the Star,
there are many possible explanations. It is not about judging the work of individual members of staff.
However, this may be something to raise in supervision, for support where things are difficult.
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Won’t service users be demotivated if they go back down the scales?
When things get worse, workers are sometimes concerned that seeing this so clearly on the Star will
demotivate service users. Usually, however, people are only too aware of this and acknowledging
it can be the first step in addressing it. It can be helpful to point out recent changes that could
have made things harder for a while and to reassure service users that if they were learning or
self-reliant before, they probably have what they need to tackle the new situation and things will
improve again.
Service users may be lower on a scale in a review than in an initial assessment because they have
developed greater trust or self-awareness, or perhaps because you have been able to get to know
them better. It is important to recognise that moving down the scales may not be a slip-back at all
but the reflection of a closer and more productive relationship.
What if a service user has limited literacy or English?
The Star materials are designed to be used flexibly. If a service user’s English is limited, you may
need to paraphrase into simplified language to support their understanding. If a service user has
limited literacy, you could give them the Star Chart and the Flashcards and read out the short scale
descriptions of the stages you feel they are closest to at that time. Make sure you still refer closely to
the detailed scales in this guide yourself.
Why do the bold statements say “I” and the detailed bullets say “you”?
The bold statement at the start of each detailed scale stage is an ‘I’ statement/first person, and is
the same as the statement in the brief visual scales in the User Guide, and in the short Scales where
supplied – these are in the service user’s voice, to support them to talk about and recognise where
they are on the scale. The bullet points below are worded as ‘you’/second person, as in your voice
talking to the service user.
Not all the bullet points in the detailed scales are relevant for my service user – does that
matter?
Some of the bullet points are written as an absolute statement and some are prefaced by “you
may” or “perhaps”. All the absolute statements need to apply in order for a service user to be at
that stage. Those prefaced by “perhaps” may or may not apply for a particular service user – these
statements are there to suggest possible reasons for someone being at a given stage and to help
people recognise where they are on the scale.
The examples of behaviours or context given in the bullet points can never be exhaustive. Use
whichever examples are most relevant for the person you are with and feel free to add further
examples verbally. Not all the examples will run through the full scale – some examples will only apply
towards the start of the scale and others become relevant higher up. For example, concerns about
the service user’s home being at risk may be in stages 1 to 3, but stage 4 states that this is no longer
a concern. This is then assumed to still be the case at 5 and 6 and so is not repeated. This avoids
undue repetition and allows space for more relevant examples, such as living well with others.
How does the Recovery Star fit with trauma-informed approaches?
The Recovery Star approach is to build a strong sense of collaboration and a shared foundation for
your work together. Using the Recovery Star well supports workers to listen and gives weight to
the perspective and needs of each service user. It’s important to recognise the need for people who
have experienced trauma to be in their “window of tolerance” in order to be able to engage in a
meaningful way. Workers need to be aware of this when completing the Star and to help build a
sense of safety and control so that service users are able to engage and make progress.
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