CTNMH
Recovery domains for care planning and
everyday practice: Clinicians’ views and
service directions
Terry J. Lewin, Ketrina A. Sly, Agatha M. Conrad, Barry Frost,
Megan Turrell, Suzanne Johnston, Sadanand Rajkumar,
Kerry Petrovic, Tirupati Srinivasan
“Learning Objectives” (As stated in Abstract)
Learning Objective One:
Improved understanding of rehabilitation and recovery domains, and
variation across service groups in recovery oriented practice.
Learning Objective Two:
Greater appreciation of potential collaborative client/clinician assessment
tools for care planning (e.g., Recovery Star). While generalist and specialist
mental health (MH) teams may differentially impact upon the various recovery
domains, we need to develop a consistent, balanced, integrated, and
consumer-focused approach to care planning across our services – hopefully
using complementary measures.
Assessment and Evaluation Framework (1)
• A consensus is starting to emerge in the Mental Health literature that seeks
to strike a better balance between “clinical recovery” (e.g., symptom
reduction, relapse prevention, risk management) and “personal recovery”
(e.g., promoting social and personal identity, goals, hope, and responsibility)
(Slade, 2010).
• “… Quantitative approaches are needed to evaluate interventions that
support recovery, and to understand the relationship between changes
in recovery domains … and clinical domains of outcome” (Slade et al.,
2012).
• “… More broadly, best available evidence drawn from international
guidelines suggests that mental health systems can support recovery in
relation to four domains of practice: promoting citizenship, organisational
commitment, supporting personally defined recovery and working
relationships (Le Boutillier et al. 2011)” (Slade et al., 2012).
Assessment and Evaluation Framework (2)
• “… Recovery is an individual and dynamic process, and [this review] is
not intended to be a rigid definition of what recovery ‘is’, but rather a
resource to inform future research and clinical practice … (Slade et al.,
2012).
• Within the Australian context, preliminary attempts have been made to
assess the value of existing recovery measures for routine use in mental
health services, both as tools for “monitoring recovery status and
change” (by individual consumers), and the “recovery orientation of
services” (Burgess et al., 2011); however, gold standard measures are
not yet available (Williams et al., 2012).
“Assessing the value of existing recovery measures for routine use in
Australian mental health services”
Philip Burgess, Jane Pirkis, Tim Coombs, Alan Rosen
Australian and New Zealand Journal of Psychiatry 2011; 45:267–280
Instruments designed to measure
Instruments designed to measure the
Individuals’ Recovery
Recovery Orientation of Services
(9 Criteria)
(6 Criteria)
1: Explicitly measures domains related to 1: Measures domains directly relevant to
personal recovery
the recovery orientation of services
2: Is brief and easy to use (≤ 50 items)
2: Is manageable and easy to use in terms
of administration (≤ 100 items)
3: Takes a consumer perspective
4: Includes a consumer perspective
4: Yields quantitative data
3: Has undergone appropriate processes
of development, piloting and
5: Has been scientifically scrutinized
documentation, and ideally been
6: Demonstrates sound psychometric
scientifically scrutinized
properties (e.g., of internal
consistency, validity, reliability and
sensitivity to change)
7: Is applicable to the Australian context 5: Is applicable to the Australian context
8: Is acceptable to consumers
6: Is acceptable to consumers
9: Promotes dialogue between
consumers and providers
“Assessing the value of existing recovery measures for routine use in
Australian mental health services”
Philip Burgess, Jane Pirkis, Tim Coombs, Alan Rosen
Australian and New Zealand Journal of Psychiatry 2011; 45:267–280
Instruments designed to measure
Instruments designed to measure the
Individuals’ Recovery
Recovery Orientation of Services
(9 Criteria)
(6 Criteria)
1: Explicitly measures domains related to 1: Measures domains directly relevant to
personal recovery
the recovery orientation of services
2: Is brief and easy to use (≤ 50 items)
2: Is manageable and easy to use in terms
Considerable variability
in domains assessed
of administration (≤ 100 items)
3: Takes a consumer perspective
4: Includes a consumer perspective
4: Yields quantitative data
3: Has undergone appropriate processes
of development, piloting and
5: Has been scientifically scrutinized
documentation, and ideally been
6: Demonstrates sound psychometric
scientifically scrutinized
properties (e.g., of internal
consistency, validity, reliability and
sensitivity to change)
7: Is applicable to the Australian context 5: Is applicable to the Australian context
8: Is acceptable to consumers
6: Is acceptable to consumers
9: Promotes dialogue between
consumers and providers
Service users views of outcome measures
Crawford et al. (2011) - Table II. Features of an appropriate outcome
measure according to group members.

Should be based on patient rather than staff-rated judgements

Includes ‘positive’ as well as ‘negative’ items

Is comprehensive – neither too long nor too short

Avoids questions that are intrusive about private issues such as sex life

Makes note of the time and place where the outcome is measured

Includes space for ‘added comments’

Should be used by staff who have good interpersonal skills and have been
properly trained in the use of the outcome measure

If self completed, is presented in a professional manner
“Selecting outcome measures in mental health: the views of service users”
Crawford et al. (2011) Journal of Mental Health, 20(4): 336–346
Consensus Domains ?
A decade ago, initial attempts were made to develop a comprehensive
‘consensus cognitive battery (for schizophrenia)’ for assessing cognitive
change in clinical trials
- Resulting in the selection of ten existing tests covering seven domains
- Known as the MATRICS Consensus Cognitive Battery (MCCB)







MATRICS domains:
Speed of processing (e.g., trail making, symbol coding, category fluency)
Attention/vigilance
Working memory (verbal and nonverbal)
Verbal learning
Visual learning
Reasoning and problem solving
Social cognition
GREEN MF, NUECHTERLEIN KH, GOLD JM, BARCH DM, COHEN J, ESSOCK S, FENTON WS, FRESE F, GOLDBERG TE, HEATON RK, KEEFE RSE,
KERN RS, KRAEMER H, STOVER E, WEINBERGER DR, ZALCMAN S, MARDER SR. Approaching a consensus cognitive battery for clinical
trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry
2004;56:301-307.
KERN RS, NUECHTERLEIN KH, GREEN MF, LAADE LE, FENTON WS, GOLD JM, KEEFE RSE, MESHOLAM-GATELY R, MINTZ J, SEIDMAN LJ,
STOVER E, MARDER SR. The MATRICS consensus cognitive battery, part 2: Co-norming and standardization. American Journal of
Psychiatry 2008;165:214-220.
http://www.researchintorecovery.com/
Slade et al. (2012) .“International differences in understanding recovery:
systematic review”, Epidemiology and Psychiatric Sciences, 21: 353-364.
Conceptual framework coding for recovery conceptualisations – by Country
Slade et al. (2012) .“International differences in understanding recovery:
systematic review”, Epidemiology and Psychiatric Sciences, 21: 353-364.
Conceptual framework
Connectedness
RECOVERY
PROCESS
Hope and optimism
about the future
(CHIME)
Identity
(Other super-ordinate
categories:
Characteristics of the
Recovery Journey,
Recovery Stages)
Meaning in life
Empowerment





















Peer support and support groups
Relationships
Support from others
Being part of the community
Motivation to change
Belief in possibility of recovery
Positive thinking and valuing success
Having dreams and aspirations
Hope-inspiring relationships
Dimensions of identity
Rebuilding/redefining positive identity
Over-coming stigma
Meaning of mental illness experiences
Spirituality
Quality of life
Meaningful life and social roles
Meaningful life and social goals
Rebuilding of life
Personal responsibility
Control over life
Focusing upon strengths
Slade et al. (2012) .“International differences in understanding recovery:
systematic review”, Epidemiology and Psychiatric Sciences, 21: 353-364.
International Journal of Mental Health Nursing (2013) 22, 3–14
Recovery of evidence-based practice
Sarah E. Gordon and Pete M. Ellis
“… More specifically, studies from different nations reflect consistency in the components, across 12
potentially discrete and independent domains that consumers identify as important” … (Gordon
et al. 2004; Graham et al. 2001; Miller et al. 2003; Ohio Department of Mental Health 2009):
1. Relationships, trust, connectedness, social
support, interdependence.
2. Day-to-day functioning, coping, and managing,
including work (having the ability to work).
3. Connection to one’s culture, cultural identity,
drawing strength from one’s culture.
4. Physical health and health risks. Includes
alcohol and drug use, side-effects of
medications, sleeping, and eating.
5. Quality of life, life satisfaction, enjoying the
environment, feeling alert and alive, able to
enjoy pastimes/hobbies.
6. Illness symptoms.
7. Coping with and recovering from illness, selfmanaged care, staying out of the mental health
system, understanding of illness.
8. Hope, journey from alienation to purpose,
reawakening of hope after despair.
9. Empowerment, being in control, exercising
choice, positive sense of self, selfdetermination.
10. Spiritual strength, increased spirituality.
11. Resources, basic needs (e.g. food, money,
accommodation, transport).
12. Satisfaction with services (including cultural
relevance of services)
Illustrative recovery goals identified by participants with
‘psychiatric disability’ (N = 144)
Conceptualization that
includes:
multiple domains,
individualized
processes,
stages of
change/recovery.
MH Recovery –
“Movement towards”
well-being and
meaning
(versus avoidance of
symptoms)
• Five stage model of psychological
recovery based on Andresen et al. (2003)
• Seven overarching value domains
(based on the Recovery Goal Taxonomy)
Clarke, Oades & Crowe (2012). Psychiatric Rehabilitation Journal, 35:297-304
Illustrative recovery goals identified by participants with
‘psychiatric disability’ (N = 144)
Conceptualization that
includes:
multiple domains,
individualized
processes,
stages of
change/recovery.
MH Recovery –
“Movement towards”
well-being and
meaning
(versus avoidance of
symptoms)
• Five stage model of psychological
recovery based on Andresen et al. (2003)
• Seven overarching value domains
(based on the Recovery Goal Taxonomy)
Clarke, Oades & Crowe (2012). Psychiatric Rehabilitation Journal, 35:297-304
Flexibility: Different goals for different stages of recovery
“… Individuals further
along in their recovery
set significantly more
approach goals and
types of goals set
appear to reflect
broader life roles”
(p. 297)
MH Recovery –
“Movement towards”
well-being and
meaning
(versus avoidance of
symptoms)
Clarke, Oades & Crowe (2012). Psychiatric Rehabilitation Journal, 35:297-304
Assessment and Evaluation Framework (3)
• In the Hunter region, we have begun to explore the utility of the Mental
Health Recovery Star (MacKeith and Burns, 2010), both as a collaborative
assessment and recovery planning tool for working with individuals,
and as a framework for examining clinicians’ current views and practices.
• “The Mental Health Recovery Star was commissioned in the UK by the
voluntary sector umbrella body the Mental Health Providers Forum
(MHPF). … Considerable user involvement and extensive mental health
service user feedback were integral to the development of the tool. …
Recovery Star is predicated on an underlying model of a ‘ladder of
change’ comprising five stages: being stuck, accepting help,
believing, learning and self-reliance.” (Dickens et al., 2012)
Sample Ladder
Sample Ladder
(Detail)
Possible ‘higher-order clusters’ within Recovery Star
A: Mental/Physical
Health
C: Networks
• Managing
mental health
• Physical
health & selfcare
• Addictive
behaviour
• Living skills
• Work
• Responsibilities
• Social
networks
• Identity and
self-esteem
• Relationships
• Trust and hope
B: Activities &
Functioning
(Consistent with
Factor 2 from
Dickens et al. 2012)
D: Self-image
Possible ‘higher-order clusters’ within Recovery Star
A: Mental/Physical
Health
C: Networks
• Managing
mental health
• Physical
health & selfcare
• Addictive
behaviour
• Living skills
• Work
• Responsibilities
• Social
networks
• Identity and
self-esteem
• Relationships
• Trust and hope
B: Activities &
Functioning
(Consistent with
Factor 2 from
Dickens et al. 2012)
D: Self-image
Possible ‘higher-order clusters’ within Recovery Star
A: Mental/Physical
Health
C: Networks
Connectedness
• Managing
mental health
• Physical
health & selfcare
• Addictive
behaviour
• Living skills
• Work
• Responsibilities
• Social
networks
• Identity and
self-esteem
• Relationships
• Trust and hope
“RECOVERY PROCESS”
(CHIME) – Slade et al. (2012)
B: Activities &
Functioning
Meaning
in life
(Consistent
with
Factor 2 from
Dickens et al. 2012)
&
Empowerment
D: Self-image
Hope and
Optimism about
the future &
Identity
Recovery Star – Clinical Outcome Tool vs.
Collaborative Care Planning
Several Criticisms:
• IRR based on
staff only ratings;
• Collaborative
nature of tool not
‘unusual’ or a
major limitation;
• Poor choice of
comparator;
• Need different
approaches to
validation;
• Not designed to
be an ‘objective
outcome measure’
– but a tool for
care planning and
change.
• Responsive to change
• Two factors:
internal vs. external
management/
relationships
(Likely to be highly
dependent on nature of
sample and timeframes)
• “The ‘work’ item proved to be one of the least amenable
to change … there may be a need to clarify the item
descriptor to allow for a range of interpretations of ‘work’.”
Intermediate Stay Mental Health Unit (ISMHU)
•
20 bed non-acute inpatient unit located on the James Fletcher Hospital
campus in Newcastle
•
Opened: November, 2010
•
Stand alone unit – separated from acute unit by approx. 9 km
•
Admissions planned and co-ordinated – utilising rehabilitation coordinators providing liaison across inpatient and community services
•
Recovery/rehabilitation focused model of care – program based - approx.
6 week length of stay
•
Recovery model underpinned by Recovery Star framework and
associated, locally devised resources and training materials
ISMHU Evaluations – Components & Timelines
Staff
Survey
(Baseline)
2010
...
Staff
Survey
(Followup)
2011
2012
N D J
F M A
M
J
J
A S O N D J
F M
Review of First 12 Months – (Nov. 2010 to Nov. 2011)
 Unit opened 22nd Nov. 2010
 Establishment, achievements and challenges
 Descriptive analyses (N = 123 admissions to 22/11/11)
 Re-admissions review (N = 48 discharges to 22/5/11)
Formal Service Audit – (April 2011 to March 2012)
 Unit fully operational (20 beds)
 All new admissions during 12 month period (N = 132)
 Ongoing admissions (April, May 2012), allowing for
minimum 3 month follow-up
 Data extraction (end of August 2012)
 Focus: client characteristics; episode details; clinical
symptomatology; diagnosis; intervention/activity
codes; clinical outcomes; service utilisation/
engagement and Recovery Star data
 Client profiles and relationships among key indices
Adm. 4
6
6
3
15
11
13
13
10
14
7
12
13
8
12
7
12
Additional components: Ongoing service profiles (vs.
comparable clients without ISMHU admissions) – during
prior and subsequent 2 years (future project)
A
M
Ongoing
Adm.
J
J
A
Minimum
3 Month
Follow-up
…
Participant Characteristics (1)
Baseline
Survey
(N = 194)
Primary Role
Clinical role
Nursing
Allied Health
Other – Medical, Director
Non-clinical role
74
67
25
28
(38.1%)
(34.5%)
(12.9%)
(14.4%)
Follow-up
Survey
(N = 200)
71
61
24
44
(35.5%)
(30.5%)
(12.0%)
(22.0%)
Combined
(N = 394)
145 (36.8%)
128 (32.5%)
49 (12.4%)
72 (18.3%)
Note: 77.2% of participants were female (304/394)
Average age = 44.1 years
Moderate overlap across phases: At follow-up, only 32%
reported baseline participation and 29% were ‘unsure’
Participant Characteristics (2)
Primary Work Location
(Clinician sub-categories)
Long Stay Unit
Acute Inpatient Unit
Intermediate Stay Unit
Community MH
Baseline
Survey
(N = 166)
18 (10.8%)
44 (26.5%)
25 (15.1%)
79 (47.6%)
Follow-up
Survey
(N = 156)
11 (7.1%)
45 (28.8%)
17 (10.9%)
83 (53.2%)
Combined
(N = 322)
29 (9.0%)
89 (27.6%)
42 (13.0%)
162 (50.3%)
Analysis Strategy
•
The major analyses focused on overall comparisons between clinicians from different work
locations, whilst statistically controlling for gender and clinical role effects.
•
Three-step hierarchical regression analyses were used:
o
Step 1: Gender, Clinical Role (2 contrast coded variables)
o
Step 2: Survey Phase, Work Location (see below)
o
Step 3: Phase by Work Location interactions
(To minimise the number of statistical tests)
• Three Work Location related planned orthogonal contrasts were examined:
o
Long Stay Unit clinicians Vs. the Rest;
o
Acute Inpatient Unit clinicians Vs. Intermediate Stay and Community MH clinicians; and
o
Intermediate Stay Unit clinicians Vs. Community MH clinicians
•
•
Outcome variables:
o
Importance placed by unit/service on recovery-oriented practice [Follow-up Only]
o
Importance given to specific recovery domains in care planning
o
Perceived impact of current treatment practices
Threshold for statistical significance: p < 0.01
Recovery-oriented practice
Question 12 from Follow-up Survey:
“How much importance does your unit/service place
on recovery-oriented practice - e.g.,
encouraging self-determination and self
management, strengths-based care, promoting
personal goals and aspirations, addressing multiple
factors impacting on wellbeing, carer involvement,
supporting social inclusion and participation?”
Importance placed on recovery-oriented practice
High
Considerable
Moderate
Some
None
Acute < Community MH and ISMHU (p < 0.001)
Key survey questions for all mental health clinicians
Selected questions from:
Rehabilitation and Recovery Survey
Importance for Care Planning
(Baseline: Q10; Follow-up: Q11)
“In developing care plans for clients, how much
importance does your unit/service place on each of the
following recovery domains?”
Perceived impact of current treatment practices
(Baseline: Q9; Follow-up: Q10)
“How much impact (for clients) do you feel our current
treatment practices are likely to have on each of these
recovery domains?”
Rating scale:
1: None
2: Some
3: Moderate
4: Considerable
5: High
Choice of recovery domains:
Several survey questions were framed in terms of the
ten recovery domains used in the Mental Health
Recovery Star client/clinician assessment and recovery
planning tool, which was developed in the UK by
Triangle Consulting and is available for use under a
Creative Commons licence (see
www.outcomestar.org.uk)
Recovery Domains
Managing Mental Health
(e.g. managing symptoms & encouraging selfreliance)
Self-care and Physical Health
(e.g. managing physical health & self-care)
Living Skills
(e.g. ability to live independently, shop, cook, clean,
budget)
Social Networks
(e.g. encouraging participation and community
activities)
Work
(e.g. full or part-time work, studying or volunteering)
Relationships
(e.g. developing closeness with family, friends or
partner)
Addictive Behaviour
(e.g. developing coping strategies to reduce potential
harm)
Responsibilities
(e.g. self-managing daily responsibilities - i.e. bills,
neighbours)
Identity and Self Esteem
(e.g. liking who they are, satisfying sense of self)
Trust and Hope
(e.g. having a sense of hope, and trusting in self and
others)
On-line Survey
(Zoomerang/Survey Monkey)
Importance for Care Planning
MANAGING MENTAL HEALTH
(No Survey Phase or Interaction Effects)
5
TRUST & HOPE
4
SELF-CARE & PHYSICAL
HEALTH
3
IDENTITY & SELF-ESTEEM
LIVING SKILLS
2
1
RESPONSIBILITIES
SOCIAL NETWORKS
Intermediate Stay Unit
ADDICTIVE BEHAVIOUR
WORK
Acute Units
Long Stay Units
RELATIONSHIPS
Community MH
Importance for Care Planning
MANAGING MENTAL HEALTH
(No Survey Phase or Interaction Effects)
5
TRUST & HOPE
4
SELF-CARE & PHYSICAL
HEALTH
3
IDENTITY & SELF-ESTEEM
LIVING SKILLS
2
1
RESPONSIBILITIES
SOCIAL NETWORKS
Intermediate Stay Unit
ADDICTIVE BEHAVIOUR
WORK
Acute Units
Long Stay Units
RELATIONSHIPS
Community MH
Importance for Care Planning
MANAGING MENTAL HEALTH
(No Survey Phase or Interaction Effects)
5
TRUST & HOPE
4
SELF-CARE & PHYSICAL
HEALTH
3
IDENTITY & SELF-ESTEEM
LIVING SKILLS
2
1
RESPONSIBILITIES
SOCIAL NETWORKS
Intermediate Stay Unit
ADDICTIVE BEHAVIOUR
WORK
Acute Units
Long Stay Units
RELATIONSHIPS
Community MH
Importance for Care Planning
Statistically significant contrasts
(p < 0.01 or lower):
## Acute < Community and
ISMHU combined
TRUST & HOPE
** Community < ISMHU
++ Long Stay < Rest
## ++
MANAGING MENTAL HEALTH
(No Survey Phase or Interaction Effects)
##
5
SELF-CARE & PHYSICAL
HEALTH
4
**
3
##IDENTITY & SELF-ESTEEM
LIVING SKILLS
2
## **
1
RESPONSIBILITIES
##
SOCIAL NETWORKS
##
Intermediate Stay Unit
ADDICTIVE BEHAVIOUR
WORK
##
RELATIONSHIPS
##
Acute Units
Long Stay Units
Community MH
Perceived impact of current
treatment practices
“How much impact (for clients) do you feel our current
treatment practices are likely to have on each of these
recovery domains?”
Mean Rating
1: None; 2: Some; 3: Moderate 4: Considerable; 5: High
Managing Mental Health
Living Skills
Trust & Hope
Social Networks
Identity & Self-Esteem
Self-Care & Physical Health
Relationships
Responsibilities
Addictive Behaviour
Work
Ratings by
Clinicians
from across
MH services
(N = 313)
3.74
3.54
3.39
3.32
3.32
3.31
3.26
3.23
3.16
3.13
Likely intervention benefits
“For the typical client, how likely are xxxx
interventions to produce positive changes
on each of these recovery domains?”
Mean Rating
1: No at all; 2: Somewhat; 3: Moderately
4: Very; 5: Extremely
Living Skills
Trust & Hope
Managing Mental Health
Social Networks
Self-Care & Physical Health
Identity & Self-Esteem
Relationships
Work
Responsibilities
Addictive Behaviour
ISMHU Clinicians (n = 38)
Individual
Group
Interventions
Interventions
(e.g., MH education; medication
management; motivational
interviewing; ADL education;
individual counselling; CBT;
healthy lifestyle education;
computer and Internet access;
social skills training; relapse
prevention)
4.21
4.06
4.03
4.00
3.94
3.91
3.89
3.85
3.63
3.54
(e.g., MH education; skill
development; anger management;
drug and alcohol education; family
interventions; healthy lifestyle;
relaxation; social skills)
3.76 *
3.74 *
4.06
3.80
3.43 *
3.62 *
3.60
3.21 **
3.43
3.43
Comparison with Individual Interventions: p <.01; ** p<.001
Interventions
• Comprehensive Individualised rehabilitation program (together with a
mixture of Group programs) that aim to enhance:
• Symptom control
• Resilience and coping skills
• Living skills
• Personal relationships
• Community integration
• Social inclusion
• Programs available across the whole week
• Key worker utilises a collaborative goal setting tool (Recovery Star) to
assist in the development and implementation of the care plan
Intervention Log (using existing Code Sets)
DMHS(T)11/04
HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT
PLEASE USE GUMMED LABEL IF AVAILABLE
SURNAME
Intermediate Stay Mental Health Unit
UNIT NUMBER
OTHER NAMES
ADDRESS
This log allows for the documentation and electronic recording of key interventions provided to each client admitted to ISMHU. Please tick all
group programs that the client, carer or family member successfully participated in. For individual tailored interventions, tick only those
interventions provided in addition to the group programs targeted at identified clinical goals or specific recovery domains.
CODE
GROUP PROGRAMS:
Managing Mental Health
96079-00
Medication
96141-00
Goal Setting/Goal Review
96086-00
Shopping/Meal Planning
96143-00
Healthy Lifestyles
96140-00
Budgeting
96144-00
Relaxation/Advanced Relaxation
96090-00
Social Skills/Community Access – BBQ, Hobby Starters
96148-00
Consumer Consultant – Wellness Plan
96089-00
Recovery Star
96151-00
Another group program not listed above, please specify:
96164-00
FAMILY/CARER GROUP PROGRAMS:
Family Connection – Family Session 1
95550-01
Mental Health Education and Support – Family Session 2
96102-00
INDIVIDUAL TAILORED INTERVENTIONS:
Mental Health Education
96076-00
Medication Education
96072-00
Cognitive Behavioural Therapy (CBT)
96101-00
Motivational Interviewing/Goal Setting, Counselling
96082-00
Drug and Alcohol Education/Therapy re: substance use
96073-00
QUIT interventions (e.g. smoking cessation)
92010-00
Relapse Prevention Education and Planning
96176-00
Personal Self Care/ Well being – Education/Skills
96075-00
ADL Education/Skills (e.g. meal plan/preparation, living skills)
96077-00
Healthy Lifestyle Education (e.g. diet, exercise, etc.,)
96066-00
Budgeting Skills
96078-00
Home Visit – Environmental Assessment
96168-00
Family Intervention
96081-00
Social Skills (e.g. inclusion exercises, activity participation)
96177-00
Communication skills training- Assertiveness/Anger management
96137-00
Personal Skill Development (e.g. stress management, relaxation)
96001-00
Counselling/Therapy (e.g. confidence, self-esteem, coping skills)
96185-00
Neuropsychological Assessment/Education
95550-10
Cognitive Remediation
96114-00
Linkages with Specialised MH & NGO Services
96108-00
PRA - Linkages with the community
96107-00
Engagement with VETE
96146-00
Linkages with other appropriate Community Services
95550-11
Another individual intervention not listed above, please specify:
96180-00
Staff member authorising completed log
Print Name
Designation
Signature
Date
Observation
INTERVENTIONS
Observation
TICK 
Intervention Log
For individual tailored interventions,
tick only those interventions provided in
addition to the group programs targeted
at identified clinical goals or specific
recovery domains.
MO
Observation
Please tick all group programs that
the client, carer or family member
successfully participated in.
DATE OF BIRTH
Observation
This log allows for the documentation
and electronic recording of key
interventions provided to each client
admitted to ISMHU.
Intervention Log
Preliminary Recovery Star Outcomes
(ISMHU, N = 102)
•
82% of consumers showed an improvement on the Recovery Star as a result of
an admission to ISMHU.
•
Of those who had shown an improvement, 61% had made a substantial
improvement, and 21% a small improvement.
•
Less than 1 in 5 showed either no improvement (11%) or a decrease (7%).
•
The areas of need that showed the largest positive improvements were: Managing
Mental Health (76%), Physical Health & Self Care (68%), Identity and Self Esteem
(68%), Social Networks (66%), Living Skills (65%), Trust and Hope (65%), and
Relationships (61%).
•
The areas with the least number of consumers making a positive change were:
Work (53%), Addictive Behaviour (50%), and Responsibilities (49%) – which
correspond with the domains experiencing the least change reported by Dickens et
al. (2012).
Conclusions - Rehabilitation and Recovery Domains:
• There is considerable variability in the domains assessed by current
‘recovery-related’ measures.
• We need to develop a ‘flexible consensus’ – a small number of broad
(upper-level) domains (≤ 6), with a larger set of sub-domains that can
adequately represent individualised (or system-level) recovery processes
and goals, and different stages of change/recovery.
• Existing and proposed qualitative/quantitative measures can then be
mapped onto those domains (and sub-domains) – and evaluated (e.g.,
acceptability, consistency, sensitivity, utility, etc). Measures may vary but
the terminology and goals need to be coherent.
• Realistic timeframes need to be set for evaluating the effectiveness of
programs – say, a minimum of 3- or 6-monthly assessments over 2 years
(e.g., ‘hope’ and ‘identity’ may change relatively slowly).
Collaborative Client/Clinician Assessment Tools:
• The Recovery Star has been well-received by clients/clinicians within
our health service and is reflecting improvements across the course of
an ISMHU admission.
• Knowledge about its strengths and weaknesses is (slowly) accumulating.
• Particularly positive feature – underpins recovery model and
interventions in ISMHU.
• Needs better integration with electronic records – across
inpatient/community settings.
Survey findings:
• There was reasonable variation within our services in the ‘recovery
orientation’ of clinicians – with a greater emphasis on recovery among
our non-acute and community based staff.
• Not surprisingly, ISMHU affiliated clinicians tended to view all of the
identified recovery domains as important for care planning; however,
they only differed from Community MH clinicians in the importance
attached to Living Skills and Self-Care & Physical Health.
• While generalist and specialist teams may differentially impact upon the
various recovery domains, we need a consistent, balanced, integrated,
and consumer-focused approach to care planning across our services
– so that (at the very least) we are all talking the same language.
• Many of the recovery domains associated with the largest differences
between clinician sub-groups could be viewed as elements of ‘personal
recovery’ (e.g., Work, Social Networks, Identity & Self-esteem, and Trust
& Hope) – suggesting that a greater (service-wide) emphasis may also
need to be placed on these domains.
Survey findings (Continued):
• The perceived impact of current treatment practices was lowest for the
recovery domains of Addictive Behaviours and Work.
• Group interventions are perceived as less likely to produce positive
changes (than individual interventions) – but not for domains relating to
Managing Mental Health and Connectedness (social networks,
relationships).
• Many clinicians (approx. 50%) also expressed a desire for additional
skills training (beyond refresher courses) in providing interventions,
particularly in relation to Addictive Behaviours, Trust & Hope, and Identity
& Self-esteem.
• Thank you for listening, and to everyone who participated in the
Rehabilitation and Recovery Surveys – and to the ISMHU Evaluation
Committee/Team.
Thank You
CTNMH