How are You Measure Recovery? Current Approaches in Practice and Research BC PSR Advanced Practice Webinar Skye Pamela Barbic 1-4 , PhD, OT 1 Department of Psychiatry, University of British Columbia, Vancouver, Canada 2 Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada 3 St- Paul’s Hospital, Vancouver, Canada 4 Social Aetiology of Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada
Acknowledgements Canadian Institute of Health Research Centre for Addiction and Mental Health University of British Columbia University of Toronto/ McGill/Queen’s/University of Manitoba Granville Youth Health Clinic/St- Paul’s Hospital YMCA CAMH Vancouver-Burnaby Branch + CAMH-TORONTO Wellington Centre, Douglas Institute-MONTREAL Terry Krupa, Bonnie Kirsh, Kwame McKenzie, Stefan Cano, Jeremy Hobart, Jack Stenner, David Andrich, Zachary Durisko, Sean Kidd, Catherine Backman, William Honer, Bill MacEwan, Chris Richardson, Donald Patrick, Todd Edwards, Michael Anhorn, Regina Casey, Mimi Rennie, Anthony Bailey, Howard Choodos, Stephen Epp, Jeff Massey, William Fisher, & Josh McGrane. Sarah Irving, Marie-eve Letellier, Pasqual Boutin
3 Mental Illness in Canada Affects approximately 6.7 million Canadians 1, Results in reduced workplace productivity and over $50 billion in direct costs to the healthcare system. 1,2 Living with a serious mental illness may shorten one’s lifespan by nearly 25 years. 3 High rates of chronic illnesses as diabetes, obesity, heart ailments and respiratory diseases + Vulnerability to homelessness, unemployment and alcohol consumption.
4 Workshop Objectives Identify current measures of personal recovery available in the 1. literature; Summarize the current evidence supporting the sensitivity and 2. potential utility of personal recovery scales as outcome measures for RAS, QPR, IMR, PROM research and clinical practice; Briefly understand how to interpret modern psychometrics methods to 3. select personal recovery scales are fit for purpose to inform important + decisions in mental health. Disseminate knowledge about the optimal use of recovery measures 4. for assessment, planning and evaluation to enhance practice and research.
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Joanne 38 year old woman diagnosed with schizophrenia at the age of 17. Referred to OT after 300 bed closer of hospital which she was admitted to consecutively since age 19. 6
What tools do we have to promote recovery? Do they work? How do we know if they worked? Recovery 7
What do we measure in mental health? Hope, Empowerment, Quality of Life, Cognition, Apathy, Depression, Pain, Mastery, Locus of Control, Happiness, Motivation, Readiness for Change……… Clinical assessment 8
Hope, Empowerment, Quality of Life, Cognition, Apathy, Depression, Pain, Mastery, Locus of Control, Happiness, Motivation, Readiness for Change……… 9
10 RECOVERY
The Recovery Problem Single most targeted outcome in mental health Individual treatment Group level System reform Significant gap in the conceptual clarity of recovery and lack of valid measures that can capture the outcome . 11
Concepts of interest: Personal Recovery Living a satisfying, hopeful, and contributing life, even with the limitations caused by illness. William Anthony, 1993 12
Workshop Objectives Identify current measures of personal recovery available in the 1. literature; Summarize the current evidence supporting the sensitivity and 2. potential utility of personal recovery scales as outcome measures for research and clinical practice; Briefly understand how to interpret modern psychometrics methods to 3. select personal recovery scales are fit for purpose to inform important decisions in mental health. Disseminate knowledge about the optimal use of recovery measures 4. for assessment, planning and evaluation to enhance practice and research. 13
14 How can you measure recovery
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16 Measures at our disposal See handout +
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18 Notes about “measures” Need to be fit for purpose for your context of use Are you “measuring” to develop a recovery profile? Are you measuring to “measure recovery”
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Recovery Measures 20
Workshop Objectives Identify current measures of personal recovery available in the 1. literature; Summarize the current evidence supporting the sensitivity and 2. potential utility of personal recovery scales as outcome measures for research and clinical practice; Briefly understand how to interpret modern psychometrics methods to 3. select personal recovery scales are fit for purpose to inform important decisions in mental health. Disseminate knowledge about the optimal use of recovery measures 4. for assessment, planning and evaluation to enhance practice and research. 21
22 PROM PROJECT: OBJECTIVES Global Objective: to assess the personal recovery needs of Canadians with severe mental illness who receive community outpatient mental health services. Specific objectives to: (i) determine the feasibility of using available personal recovery PROs in a community outpatient mental health setting; (ii) describe the personal recovery profile of a Canadian outpatient sample, and (iii) measure the extent to which the full range of the recovery is covered by + existing rating scales.
23 The Personal Recovery Outcome Measure (PROM) Project Design: Cross sectional survey Single city, Multi-site We asked 228 people to fill in 3 commonly used questionnaires about personal recovery.
24 Participants
25 +
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27 Results for Objectives i and ii Specific objectives to: (i) determine the feasibility of using available personal recovery PROs in a community outpatient mental health setting; 224/228 people completed ALL of the questions. Questionnaire packs took between 10-30 minutes to complete. (ii) describe the personal recovery profile of a Canadian outpatient sample, and + (iii) measure the extent to which the full range of the recovery is covered by existing rating scales.
28 Results showed that overall, people in Toronto are highly motivated to succeed, work, and reach their personal goals. +
29 Mental health +
30 +
Progress Towards Personal Goals in the last 3 months 31 Finished 1. Reduce Smoking 2. Clean apartment No GOAL 3. Build a resume 4. Attend a program Pretty Far Not done anything + A little way no goal not done anything little way pretty far finished
32 Time in structured roles Time in structured roles (hours) 40% 80% 92 45 + 43 29 10 <2 3 TO 5 6 TO 15 16-30 30+
33 REVISIT Mental Illness in Canada Affects approximately 6.7 million Canadians 1, Results in reduced workplace productivity and over $50 billion in direct costs to the healthcare system. 1,2 Living with a serious mental illness may shorten one’s lifespan by nearly 25 years. 3 High rates of chronic illnesses as diabetes, obesity, heart ailments and respiratory diseases + Vulnerability to homelessness, unemployment and alcohol consumption.
34 So what? Specific objectives to: (i) determine the feasibility of using available personal recovery PROs in a community outpatient mental health setting; (ii) describe the personal recovery profile of a Canadian outpatient sample, and (iii) measure the extent to which the full range of the recovery is covered by existing rating scales. + Recovery
Workshop Objectives Identify current measures of personal recovery available in the 1. literature; Summarize the current evidence supporting the sensitivity and 2. potential utility of personal recovery scales as outcome measures for research and clinical practice; Briefly understand how to interpret modern psychometrics 3. methods to select personal recovery scales are fit for purpose to inform important decisions in mental health. Disseminate knowledge about the optimal use of recovery measures 4. for assessment, planning and evaluation to enhance practice and research. 35
36
So what does this tell us: “The IMR/RAS/QPR demonstrates excellent psychometric properties” 37
38 What is measurement?
The story of measurement Rating scales should be developed from clear construct definitions to ensure that a substantive construct theory determines scale content. a construct theory…. ….is “ the story we tell about what it means to move up and down the scale for a variable of interest (eg. Temperature, reading ability, memory). Why is it, for example, that items are ordered as they are on the item map? This story evolves as knowledge increases regarding the construct” (p 308) Stenner, A., Burdick, H., Sandford, E., and Burdick, D. How accurate are lexile text emasures? J Applied Measurement, 2006; 7: 307-322. 39
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