Transcript Slide 1

Measuring strengths
& recovery
Observations on the Mental
Health Center of Denver
The Mental Health
Center of Denver
Private non-profit
 Mandate to serve the most ill:
Schizophrenia, Bipolar, Major Depression
 City of 500,000 in metro area of 2 million
 Serves 3,000 adults any point in time
 Turns away 2 for every 1 accepted

Services for adults

Intensive
 Various
levels of clinical case management
Outpatient
 Psychiatric Rehabilitation

 Supported
Education & Supported
Employment
Why Visit Denver?
 MHCD
has established an
international reputation for being
“recovery oriented”
 We wanted to discover:
How
this had been achieved
Whether we could do it in the North
West
How was it achieved?
Organisational structure & Philosophy
 Managerial practices

 “Clinical”
leadership
 Approach to staff development
 Employment practices

Recognition of the value and uses of data
Structure and Philosophy

Influence of vocational rehabilitation
 Separate
directorate represented at board
level
 Not managed by clinical services

Centrality of the strengths and recovery
model
Managerial Practices
Clear philosophy of care
 Relatively unbureaucratic approach
 Use of strengths approach with staff
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 For
example in PDPs
Performance evaluation through data
 Active stepped care

Employment practices

Employs large numbers of service users in
multiple roles – some very high level
 This
gives service users a very strong stake in
the organisation

Emphasis on Individual Placement and
Support
Using and Valuing Data
Data expectations are clear and
achievable
 Strong IT department which employs
statisticians
 Data is used throughout the organisation
to change practice

Defining Recovery
Recovery is a Multidimensional
construct
 Recovery means different things for
different people
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Consumers, Clinicians, Managers, other
Stakeholders
These different viewpoints need to be
captured in different ways
Measures of Recovery
Recovery Markers Inventory (RMI)
 Recovery Measure by Consumer
(RMC)
 Recovery Needs Level (RNL)
 Promoting Recovery in Organizations
(PRO)
 The measures of recovery have been
extensively tested for reliability,
sensitivity, and validity

Recovery Marker Inventory

Consists of a series of indicators usually
associated with individual’s recovery
 Based
on items derived from surveys of consumers
and staff
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Collected every other month on every consumer
in high case management teams, according to a
predetermined criterion on outpatient consumers
Recovery Marker Inventory
Dimensions
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Employment
Education/training,
Active/Growth orientation,
Symptom interference,
Engagement/role with service provider,
Housing,
Substance abuse (level of use & stages of
change).
Item difficulty for the Recovery
Marker Inventory V2.1
Symptom
Interference (.83)
Active Growth
(.63)
Engagement/
Participation (-.10)
Housing (-.22)
Employment (.35)
Education (-.79)
• The easiest marker is reduction in symptom interference. In traditional
treatment this will be primary goal.
• As the markers increase in difficulty that means that the number of
consumers that get a high score in this marker decreases,
•For example, if a consumer has a high score in
engagement/participation, they will also have a high score in active
growth and symptom interference because these markers are easier to
achieve for our consumers.
• The hardest marker of recovery for consumers to achieve is education. This
means that most consumers who score high on education will score high on
all other markers of recovery.
Changes in Recovery Markers Inventory
based on Diagnosis
Estim ated Changes in Recovery Marker Scores Over Tim e
5.5
Ability-to-Recover Score
5
HITT Mood and Other
4.5
CTT Mood and Other
OP Mood and Other
HITT Thought
CTT Thought
4
OP Thought
3.5
3
Intake
6
12
18
Evaluation Period (Months)
24
Recovery Measure by Consumer

Intended to measure the consumer’s perception
of their Recovery
 Helps
to understand whether what the clinician
observes matches how the consumer is feeling
 Sometimes, the consumer fills it out with the help of
the clinician, thus sparking new areas to explore
together
Recovery Measure by
Consumer Dimensions
Active/growth orientation
 Hope
 Symptom’s interference
 Safety
 Social network
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Order of Difficulty in RMC V3.0
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The easiest domain is reduction in Symptom interference,
(this was also our lowest indicator in the RMI).
As the domains increase in difficulty (move to the right), the
number of consumers that get a high score decreases,
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For example, if a consumer has a high score in Hope they will
also have high scores in Active growth and Symptom
interference because our consumers get higher scores in these
items.
The hardest domain to achieve is Social networks. This
means that consumers who score high on Social networks
will score high on all other domains of recovery.
Recovery Needs Level
Helps to assign the right level of service to
the consumers
 The basic assumption being that
consumers recover and their needs
change over time.
 Used at MHCD every 6 months in
combination with their Individual Service
Plan (ISP)

Recovery Needs Level
Measures criteria for service needs in 15
areas such as:
 GAF
 Hospitalizations
 Lethality
 Co-Occurring Substance Abuse
 Case Management Needs

Recovery Needs Level
Completed by Primary Clinician in
Electronic Record
 Scored Electronically According to
Algorithm
 Four Levels of Service:
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 High
intensity case management with Residential
services
 High intensity case management
 Medium intensity case management
 Outpatient service
Promoting Recovery in MH
Organizations (PRO)
Sections for each type of staff that
interacts with our consumers (front-desk
clinical, medical, case managers,
rehabilitation)
 Currently is being piloted at MHCD
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The Feedback Loop
“At MHCD, we believe that evaluation is a
critical component of system change.”
 “We have a constant feedback loop about
client’s recovery for clinicians, managers
and directors, thereby providing data to
assist in system transformation.”
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Four Measures of Recovery
(1) Recovery Marker
Inventory (RMI)
(Longitudinal data to support
clinical decision making)
(4) Recovery
Needs Level (RNL)
(Appropriate level of services)
To what degree is
RECOVERY
happening for
consumers at MHCD
(Formative and summative
evaluation of recovery)
(2) Promoting Recovery
in Organizations (PRO)
(Consumer’s perceptions of how well
specific programs and staff are
promoting recovery)
(3) Recovery Measure
Can be used as a “needs
by Consumer (RMC)
assessment”
instrument
(Consumer’s perception
of their
own recovery)
in Recovery-Oriented
Organizations
Pros and Cons
The clinician rated measure has been very
carefully developed, has good properties,
and is easy to use
 The service user rated measures is at an
earlier stage of development
 The Recovery needs inventory would need
major modification
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