Download - RASDS Manual Version 3 2019 - FINAL
Recovery Assessment Scale – Domains and Stages (RAS‐DS)
Manual Version 3. 2019
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ACKNOWLEDGEMENTS
Reachingthepointthatweareattodayhasinvolvedajourneythatstartedin2005.Therehavebeennumerouscyclesofdatacollection,feedbackandanalysis,collaborativereflection,developmentandtesting.Initially,over250peoplelivingwithmentalillness,50mentalhealthsupportworkersand3non‐governmentorganisations(RichmondFellowshipQueensland,SchizophreniaFellowshipofNSW[nowcalledOneDoorMentalHealth]andRichmondPRA[nowcalledFlourishAustralia])allgenerouslyvolunteeredtheirtimeandexpertisetodevelopandtesttheRAS‐DS.Sincethattime,datagenerouslysharedbyoverathousandconsumersandclosetoahundredmentalhealthworkersorclinicianshavehelpedustocontinuallytestandrefinethetool.Thankyou!
WewouldliketoparticularlyacknowledgetheexpertiseandgenerosityofsomanypeoplelivingwithandrecoveringfrommentalillnesswhohaveengagedinvariouswaysthroughoutthedevelopmentandongoingtestingoftheRAS‐DS.TheRAS‐DSisameasureofconsumerorservice‐userdefinedrecovery(notclinicianorresearcherdefinedrecovery).Withoutyourhonestandgeneroussharingoftheexpertiseandknowledgeeachofyouhavegainedthroughyourownpersonaljourneys,thiswouldbeamuchpoorer,lessvalidmeasure.YouhaveplayedcentrestageintheevaluationandrefiningoftheRAS‐DS.Thankyouforyourconstructivecriticismsaswellasyourpositivefeedbackandsuggestions!
Thankyoutotheorganisationsandmentalhealthworkerswhohavealso,duetotheircommitmenttoadvancingrecovery‐orientedpracticeinAustralia,generouslyandpassionatelyengaged.Again,youhaveprovidedinvaluableinsightsintotheusefulnessoftheRAS‐DSaswellashowtoenhanceitspracticalusefulnessfurther.
WelookforwardtoworkingwithyouandmanyothersonthecontinuedevaluationanddevelopmentoftheRAS‐DSandthismanual.
Note:InAustraliatheterm‘consumer’iscommonlyusedtorefertopeoplelivingwithamentalhealthdiagnosisandusingmentalhealthservices.Itisthereforethistermthatwehavechosentousethroughoutthismanual.Weunderstandthatthisisnotatermthateveryonelikes,andthatothertermssuchas‘service‐user’and‘survivor’arepreferredbysomeandaremorecommonlyusedinothercountries.
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SUGGESTED CITATION:
Hancock,N.,Scanlan,J.N.,Bundy,A.C.,&Honey,A.(2019).RecoveryAssessmentScale–Domains&Stages(RAS‐DS)Manual‐Version3.Sydney;UniversityofSydney.
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CONTENTS ACKNOWLEDGEMENTS....................................................................................................................................................2
SUGGESTED CITATION:....................................................................................................................................................3
CONTENTS...................................................................................................................................................................................4
SECTION 1: MEASURING RECOVERY – CAN WE DO IT AND WHY BOTHER TRYING?.........................................................................................................................................................................................5
Enhancedunderstandings.................................................................................................................................................5
Enhancedcollaborative,recovery‐orientedgoalplanningorpersonalrecoveryplans................5
Measuringrecoveryoutcomesattheindividualandservice/programlevel.......................................5
SECTION 2: INSTRUMENT DESCRIPTION.........................................................................................................7
SECTION 3: INSTRUMENT ADMINISTRATION & USE...........................................................................9
Completingtheform.............................................................................................................................................................9
Conversationsleadingtosharedunderstanding&personalrecoveryplans.......................................9
RepeateduseoftheRAS‐DStoseechangesovertime....................................................................................10
SECTION 4: SCORING.......................................................................................................................................................11
Totalrecoveryscore..........................................................................................................................................................11
Scoringeachrecoverydomain.....................................................................................................................................11
SECTION 5: INSTRUMENT DEVELOPMENT & RESULTS (USEFULNESS & PSYCHOMETRIC PROPERTIES).................................................................................................................................13
ThejourneyofRAS‐DSdevelopment........................................................................................................................13
Asnapshotofresultstodate:........................................................................................................................................14
a.Enhanceunderstandings&facilitationofrecovery‐orientedgoalplanning.....................................14
b.Measuringindividualandserviceleveloutcomes(psychometricproperties)................................15
SECTION 6: OUR FUTURE PLANS/WHAT WE STILL NEED TO EXAMINE & DEVELOP.............................................................................................................................................................................................................16
DoestheRAS‐DSmeasuretheentirerecoveryconstruct?...........................................................................16
IstheRAS‐DSsensitivetochange?.............................................................................................................................16
ExaminingtheRATINGSCALEstructurewithlargersetsofdata.............................................................16
Examiningtest‐retestreliability.................................................................................................................................16
Doestheuseoftheras‐dsleadtobettertherapeuticallianceandgreaterconsumerchoiceandcontrolintheirrecoveryplanning?.................................................................................................................16
CONTACT INFORMATION........................................................................................................................................17
REFERENCES.............................................................................................................................................................................18
APPENDIX 1:............................................................................................................................................................................19
RECOVERY ASSESSMENT SCALE – DOMAINS & STAGES (RAS-DS)............................................19
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SECTION 1: MEASURING RECOVERY – CAN WE DO IT AND WHY BOTHER TRYING? Therearethreemainreasonsformentalhealthservicestouseatoolthatenablesconsumersorserviceuserstothinkaboutandmeasuretheirownrecoveryprogress:
1)enhancedunderstandings(bothpersonallyfortheconsumerandbetweenconsumerandstaffpartnerships)thatleadto
2)enhancedcollaborativeandrecovery‐orientedgoalplanningorpersonalrecoveryplansand
3)measuringindividualandserviceoutcomeswithafocusonrecoveryratherthansymptomreductionforexample.
ENHANCEDUNDERSTANDINGS
Aself‐reportmeasurethatenablesexplorationorenquiryintorecoveryrelatedtopicsgivespeoplelivingwithmentalillness(consumers)astructuredopportunitytoreflectupontheirownrecoveryprogress.Theprocessofcompletingaself‐reportmeasureofrecoverycanfacilitateconsumerstodevelopgreaterrecognitionofthesuccessesandachievementalreadymadeintheirpersonalrecoveryjourneyaswellasidentifyingtheareasthattheyseeasneedingfurtherwork.When(andwesuggestthisisessential)consumershavetheopportunitytotalkabouttheirself‐ratingsofrecoveryprogresswiththeirmentalhealthsupportworkerorclinician,thereistheopportunitytoenhancethesharedunderstanding.Staffreporthavingabetterunderstandingofwhatconsumersarefeeling,experiencingandprioritisinginrelationtotheirrecovery.Equally,consumersfeelthatthestaffpersonwhotheyareworkingwithhasabetterunderstandingofthem,theirsuccesses,feelingsandneeds.
ENHANCEDCOLLABORATIVE,RECOVERY‐ORIENTEDGOALPLANNINGORPERSONAL RECOVERYPLANS
Conversations,inwhichtheconsumerandstaffmemberexploretheconsumer’sself‐ratingofrecovery,leadnaturallytowardsrecoveryplanningthatfocusesupontheprioritiesoftheconsumer.
MEASURINGRECOVERYOUTCOMESATTHEINDIVIDUALANDSERVICE/PROGRAMLEVEL
InAustralia,theoutcomemeasuresselectedforroutineuseacrossStatementalhealthsectorshaveapredominantlysymptom/illnessmeasurementfocus.Thereisarepeatedcallinternationallytoincluderecovery‐orientedoutcomemeasurementinthesuiteofinstrumentsused,particularlywiththegrowingunderstandingandembracingoftheneedforsystemicchangethatseesashiftfromillnessmanagementapproachestorecovery‐orientedapproaches.
Thereisanargumentthatperhapsonlymeasuresofrecovery‐orientedpractice(i.e.,measuresofservicequalityinrelationtotheirrecovery‐orientation)areneeded.Wewouldarguethat1)weneedtoknowthatifrecovery‐orientedpracticeisenhanced,itleadsto
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enhancedindividualrecovery,2)consumershavetherighttoreflectandreportontheirpersonalperspectivesofrecoveryprogress(whootherthanthepersonthemselveswouldknowhowhopefultheyfeelforexample?)and3)inclusionofastructurethatenablesconsumerstoactivelyparticipateinthe‘assessment’processisafundamentalfirststeptowardsself‐directedcare(acornerstoneofrecovery‐orientedpractice).
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SECTION 2: INSTRUMENT DESCRIPTION
TheRAS‐DShas38itemsorstatementsfortheconsumertorate.ItisaLikertscalewith4ratingcategoriesforconsumerstoselectfrom:“untrue”;“abittrue”;“mostlytrue”and“completelytrue”.SeeFigures1and2onthefollowingpageforexamplesofwhattheRAS‐DSlookslike.ThecompleteRAS‐DSisprovidedintheappendicesattheback.
Theitemshavebeendividedinto4recoverydomains:DoingThingsIValue;LookingForward;MasteringMyIllnessandConnectingandBelonging.
AsyouwillseeinSection4wherewedescribehowtoscoretheRAS‐DS,eachdomaincanbeusedandscoredseparatelyaswellascollectivelyforamoreholisticexploration.SeeTable1belowfordescriptionsofthe4domainsandtheirrelationshiptostagesofrecovery.
Table1:FourDomainsofRecoverycoveredbytheRAS‐DS
DOMAINS STAGES
VeryEarly Middle Later
DoingThingsIValue
Unengaged,inactiveorpovertyofactivityorroleengagement;sickorpatientroledominates
Doingthingsthatarepersonallyvaluedandmeaningful;senseofcontributingtoothers
LookingForward
Anguish;hopelessness;viewsselfas“sickperson”
Awareness;insight;actionplan
Incontroloflife;wellbeing;hopefulaboutthefuture;viewsselfasexternaltoexperienceofillness
MasteringMyIllness
Dominatedbysymptoms Controlover,ormanagementof,anyresidualsymptoms;minimalinterferencewithlife
ConnectingandBelonging
Fewrelationships;dependent;mostlyfamily
Largersocialnetwork;greaterdiversityincludingpeers,familyandbroadercommunities;reciprocalinnature;personallysatisfying
Pleasenote:
1.IntheDoingThingsIValuedomain,thereisanemphasisondoingthingsthatarePERSONALLYvalued/meaningfulratherthanafocusonsociallyvaluedactivities/roles
2.TheMasteringMyIllnessdomaindifferstothemedicallyorienteddefinitionofclinicalrecoverythatfocusesonthedegreeofsymptomamelioration.IntheRAS‐DSthefocusisondevelopingasenseofcontrolover&managementofsymptomsandreducingtheirimpactonliving.
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Figure1:ExcerptfromtheRAS‐DS(partofpage1)
(seeAppendixatthebackofthemanualforacompletecopyoftheRAS‐DS)
Figure2:ExcerptfromtheRAS‐DS(partofpage2)
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SECTION 3: INSTRUMENT ADMINISTRATION & USE
COMPLETINGTHE FORM
Thisisaself‐reportmeasure.Therefore,itiscriticalthatconsumerswhousetheRAS‐DSareprovidingtheirOWNself‐assessmentfreelyandthattheirratingsarenotinfluencedbyothers.
However,thisdoesnotmeanthatsomeconsumersmightneedorliketohaveassistancewithreadingtheitems.WehavemadealotofefforttoensurethatthelanguageoftheRAS‐DSisasaccessibleanduser‐friendlyaspossible,but,forvariousreasons,someconsumersmightfindithardtoreadandconcentrateonall38statementsatthesametimeasthinkingaboutthestatementsandratingtheirresponses.
Itismorethanacceptableforstafforpeers/peerworkerstoreadthestatementstotheconsumercompletingtheRAS‐DS.Infact,administeringself‐reportinstrumentsviainterviewhasbeenrecommendedbyothers(Corriganetal,1999).IfeachpersonhastheirowncopyoftheRAS‐DSwhilethisisbeingdone,itwillavoidthesenseof“someonewatchingovermeasIdoit”.Toavoidanysenseofbeingjudgedortheriskthatconsumersrateinthewaythattheythinkotherswantthemto,peoplepresentshouldnotwatchthescoringprocessorcommentontheconsumersratingsuntiltheprocessiscompleted.Consumersmightaskwhatastatementmeans,ifthishappensitwouldbebesttosaysomethinglike“Theimportantthingiswhatitmeanstoyou.Itmightmeandifferentthingstodifferentpeople”.Trytoavoidrephrasingthestatementifyoucanbecausethatcanchangethemeaningwithoutyourealisingit.
Pleasenote:Insomeofthestagesofourresearch,trainedconsumerresearchersreadtheinstrumentstatementsouttoconsumerparticipantsastheycompletedtheratings.Wereceivedonlypositivefeedbackaboutpeersfacilitatingthisprocess.WeanticipateandhopethatmuchofthefutureworkdoneusingtheRAS‐DSwillincludethepeer‐workforce.
CONVERSATIONSLEADINGTOSHAREDUNDERSTANDING&PERSONAL RECOVERY PLANS
ThemagicintheuseoftheRAS‐DScomesfromitsuseasaconversationstarterthatleadstodeeperpersonalandsharedunderstandings.Inourstudiesto‐date,bothconsumersandstafffeedbackdemonstratethat:
DoingtheRAS‐DShelpsalmostallconsumerstothinkaboutandreflectupontheirrecoveryjourney(bothachievementsto‐dateandareastoworkoninthefuture)
StafffrequentlyfindthattheprocessoftalkingoverRAS‐DSresultswithconsumersishelpfulingainingaricherunderstandingoftheperspectives,feelingsandprioritiesoftheconsumerstheysupport.Thosewhouseittoidentifyanddeveloprecoverygoalsalsofindithelpfulinthatprocess.
ThemostusefulormeaningfulwayofusingtheRAS‐DSinpracticeisforstaffand
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consumerstotalkaboutthe‘results’together;identifyingtherecoveryareasthatconsumersfeelpositiveabout(rated3or4)andcelebratingthese.Staffandconsumersshouldalsolookatandtalkabouttheareasofrecoverythatcouldbeworkedon(theonestheyscored1or2)anddiscusswhichofthesearemostimportanttotheconsumerandcouldthereforebeincorporatedintorecoveryactionplansandgoals.
Examplesofquestionsyoumightask....
Canyoutellmemoreaboutwhyyouratedthisonethisway?
Whatwouldittakeforustogetthisoneuptoa4?
WhenyoulookattheRAS‐DSwhichthingsdoyouthinkaremostimportanttoyou/doyouwantustoworkon?
and....Don’tforgettocelebratethesuccesses!!
REPEATEDUSEOFTHE RAS‐DSTOSEE CHANGESOVERTIME
Recoveryisanon‐linearprocess.Sometimesgoingbackwardsinameasurelikethisreflectsthatconsumershavetakenonorarefacingnewchallenges/risks.Weknowthatrisksandchallengesareessentialcomponentsoftherecoveryjourney.Itisimportantnottoassumethata‘backwards’changeisnecessarilyanegative.Again,aconversationisneeded!
Positiveconversationsabout‘backwards’changesinrecoveryscorescanalsoleadtoopportunitiestoreviewandfurtherdeveloprelapsepreventionplansandalsotoaddtoorrefineadvanceddirectivesiftheorganisation/serviceiscourageousenoughtoengageinthatprocess.
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SECTION 4: SCORING Often,formeasurestobeuseful,wearerequiredtoconvertscorestostatisticallyadjustedmeasures(usingsomethingcalledkeyforms).Wearedelightedtoreportthatourdataanalysisshowsanalmostperfectcorrelationbetweenrawscoresandrankings.Wearethereforeabletosaythatusingrawscoresisacceptable(andobviouslymuchsimpler!).
TOTALRECOVERYSCORE
ItisOKtoaddthescoresupforall38itemstogainatotalrecoveryscoreoutof152.
SCORINGEACHRECOVERYDOMAIN
ItisalsoOKtoalsohavesub‐scoretotalsforeachrecoverydomainsothatyoucanseerelativeprogressacrossdomains.However,pleaserememberthattherearedifferentnumbersofitems/statementsineachdomainsoconvertingtoapercentage(%)domainscoremightbemostusefultoconsumerstoseevarianceacrossdomains).Todothis:1.Addtheitemscorestogetherforthedomain2.Dividethetotalforthedomainbythenumberofitemsinthatdomainthathavebeencompletedbytheperson(thiswillgiveyouanaveragescoreforeachdomain)3.Dividetheaveragescoreby4andmultiplyby100Calculations:TotalRecoveryScore Addallitemscores. Thiswillbeatotalrecovery
scoreoutof152DoingThingsIValueRecoveryScore
AddallitemsDivideby6(orlessifanyitemsarenotrated)Divideby4Multiplyby100
Thiswillgiveapercentagescoreforeachdomain
LookingForwardRecoveryScore
AddallitemsDivideby18(orlessifanyitemsarenotrated)Divideby4Multiplyby100
MasteringMyIllnessRecoveryScore
AddallitemsDivideby7(orlessifanyitemsarenotrated)Divideby4Multiplyby100
ConnectingandBelongingRecoveryScore
AddallitemsDivideby7(orlessifanyitemsarenotrated)Divideby4Multiplyby100
Help:Wehavedevelopedanexcelspreadsheetwithcalculationfunctionsembedded.Pleasecontactusifyouwouldlikeacopy.
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ImportantNote:WeunderstandthataddingscoresisusefulwhenusingtheRAS‐DSasanoutcomemeasure.However,wewanttore‐emphasisethatperhapsthemostusefulormeaningfulwayofusingtheRAS‐DSinpracticeisforstaffandconsumerstotalkaboutthe‘results’togetherasdescribedabove.Thatis,toidentifytherecoveryareasthatconsumersfeelpositiveaboutandwheresuccesseshaveoccurred(perhapsrated3or4)andtocelebratetheseaswellaslookingatandtalkingabouttheareasofrecoverythatcouldbeworkedon(perhapstheonestheyscoredasa1or2)andincorporatedintonewrecoveryactionplansandgoals.Sometimeshowever,theaspectthatconsumersmostwanttoworkfurtheronandismostmeaningfultotheirrecoveryisnotthethingtheyscoredmostlow.CommentsonratherthanscoresareoftenthemostusefulpartoftheRAS‐DSfordiscussionandmakingplanstogether.Forthisreason,wehavedevelopedtheRAS‐DS+.RAS‐DS+hasanadditionalcommentscolumnforconsumerstoaddthoughtsandexplanationsabouteachitemastheyworkthroughthescaleifthewishto.Italsohasanopen‐endedquestionattheend:“Isthereanythingelsethatisimportanttoyouandyourrecoverythatwasnotcovered?”Additionally,avisualdisplayofresultscanalsobehelpfulforsomeconsumersinreviewingand‘interpreting’theirresults.Whilemanyorganisationshavenowbuiltagraphingfunctionintotheirownon‐linesystems,wehaveagraphingfunctionbuiltintoanexcelspreadsheetthatwecansendtoyou.Pleasecontactusifyouwouldlikethis.
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SECTION 5: INSTRUMENT DEVELOPMENT & RESULTS (USEFULNESS & PSYCHOMETRIC PROPERTIES)
THE JOURNEYOFRAS‐DS DEVELOPMENT
TheRAS‐DS(RecoveryAssessmentScale–Domains&Stages)hasdevelopedthroughnumerousiterativestudycycles.Itsdevelopmentbeganwithananalysisoftheoriginal41‐itemRecoveryAssessmentScale(RAS)developedinAmerica(Giffordetal.1995). TheRASwasselectedoriginallybecauseithadstrongerreportedpsychometricpropertiesthananyotherrecovery‐basedinstrumentatthattime.Asyoucanseefromourpublishedwork,aftertesting,wefoundthreemainproblemswiththeoriginalinstrument:
poorcategorystructure(althoughtherewerefivepointsontheoriginalscale,whenwedidtheanalysis,therewasonlyreallymeaningfuldifferencesbetween“Agree”/“Stronglyagree”andtheotherpointsofthescale–consumerstendedtouseitasatwopoint“yes”/“no”scale.),
averysignificantceilingeffect(manyconsumersselectedhighscoresonmanyitems,whichsuggestedthattheremaybetoofewitemsrelatingtothelaterstageofrecovery),and
anumberofitemsdidnotseemtolineupwiththeoverallconstructof“recovery”orwererepetitive.
Inasecondstagestudy,weusedfocusgroupswithconsumerswhoreportedbeingfurtheralongtheirrecoveryjourneyinattempttoidentify'missing'items–thatis,toidentifykeyachievementsorchallengesassociatedwithlaterstagesoftherecoveryjourney.Fromthese2studieswedevelopedtheRAS‐DS. Inthethirdstageofdevelopment,wetrialledtheRAS‐DSwiththesupportof3largenongovernmentservicesintwoAustralianstates:TheRichmondFellowshipQueensland,theSchizophreniaFellowshipofNSW(nowcalledOneDoorMentalHealth)andRichmondPRA(NewSouthWales)(nowcalledFlourishAustralia).Over120staff/consumerpaireddatasetswereobtained.ConsumerscompletedtheRAS‐DSandbothconsumerandstaffmemberwerethenaskedtocompleteaquestionnaireaboutitsusefulness.Verypreliminaryanalysisofthedatalookedgood(gooditemfit,internalreliabilityetc.)However,therewasarepeatedthemeinthequalitativedatathatwedecidedneededtobeacteduponimmediately.Staffand,moreimportantly,consumerssaidthattheyneededanotherpointintheratingscalebetween“unsure”and“yes”‐theyneededa“partial”point.Also,wecouldseefromthequantitativedatathatanadditionalpointwouldenhancethesensitivityoftheRAS‐DStocapturechangeovertime.Westoppedthestudy,re‐workedthescaledescriptors,trialledourpreferreddescriptorswithasmallgroupofconsumersandstaffandrecommencedthestudy.Aseriesofstudies,conductedwithbothyouthandadultpopulationsfrom2015onwards,collectivelydemonstratethestrengthoftheRAS‐DS.Itis:a) Ausefultoolthatfacilitatesenhancedunderstandings(bothpersonallyfortheconsumer
and,throughconversation,betweenconsumerandstaffpartnerships),leadingtomorecollaborativeandrecovery‐orientedgoalplanningorpersonalrecoveryplans,and
b) Apsychometricallystrongtoolthatmeasuresindividualandserviceoutcomeswithafocusonrecovery
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ASNAPSHOTOFRESULTS TODATE:
A.ENHANCEUNDERSTANDINGS&FACILITATIONOFRECOVERY‐ORIENTEDGOALPLANNING
AtasteofwhatconsumersandMHworkerssaid....
“MycasemanagerunderstoodmeandIunderstoodme”Consumer
“wasusefulwithregardtoformingthePRP”MHWorker
“Askedrelevantquestionstorecoveryjourney”Consumer
“Veryusefulasameasureofpositiveprogress,ratherthanidentifying
deficits”MHWorker
“Feltdifferenttolastsurvey.Ihaveimprovedknowledgeofsymptoms.Happierwithsituation.”Consumer
“Realisationofwheremymentalhealthisat.Myfamilycannotbemy
onlysupport”Consumer
“itwasahelpfultooltogaininsightintoclientsfeelingsonrecovery”MH
Worker
“DidnotrealisehowmuchthingshadimproveduntilIdidthesecond
survey”Consumer
“noticebigchangeintheway(I)thinkaboutrecovery‐positivechange”
Consumer
“itissonicetoseesmilesonmyclientsfacewhentheycanrelatetoa
statementandwecantalkaboutit”MHWorker
“The4columnsaremuchmoreusefulinidentifyingwherecommunity
membersareatintheirrecoveryandithelpsustoseewhatwecanworkontohelpimprovementalhealth”MH
Worker
“Itwasusefulintermsofopeningupdiscussionaboutspecificissuestheclientdealswith.Gavemesomemoreinsight.”MHWorker
QualitativedatashowsclearlythatdoingtheRAS‐DShelpsalmostallconsumerstothinkaboutandreflectupontheirrecoveryjourney(bothachievementsto‐dateandareastoworkoninthefuture)
QualitativedataalsoshowsthatstaffalmostalwaysfindtheprocessoftalkingoverRAS‐DSresultswithconsumershelpfulingainingaricherunderstandingoftheperspectives,feelingsandprioritiesofthoseconsumerswithwhomtheywork.
ConsumersalsorecognisedthatstaffhadabetterunderstandingofthemafterdiscussionsfollowingcompletionoftheRAS‐DS.
Thosewhouseittoidentifyanddeveloprecoverygoalsalsofindithelpfulinthatprocess.
TIME‐Howlongdoesittake?
Itwilltakemostconsumersbetween5and15minutestocompletetheRAS‐DS(around80%)withoutanysupport/reading.
Ifpeoplewanttoreflectverydeeplyonitems,oriftheyprefer/needassistancewithreadingstatementsanddon’treceiveit,itmaytakelongerthan15minutes.
HowEASYisitforconsumerstouse?78%ofconsumerswhousedtheRAS‐DSrateditas“easy”or“veryeasy”.20%ofconsumersrateditas“hard”.2%rateditas“veryhard”.
Reasonsgivenforeasy/veryeasyratings:“questionswereeasytoreadandanswer”;“justhadtocircle
myanswer”
Reasonsgivenforhardorveryhardrating:“havingtogiveitagreatdealofthought”;“deepdecisions”and
“troublereading”
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B.MEASURINGINDIVIDUALANDSERVICELEVELOUTCOMES(PSYCHOMETRICPROPERTIES)
Through‐outeachstageofearlierdevelopmentandtestingoftheRAS‐DS,rawdataweresubjectedtoRaschanalysisusingWinsteps(http://Winsteps.com,Chicago;Smith&Smith,2004;Linacre,2005).Unlikeclassicformsofanalysis,Raschanalysisconvertsordinalleveldataintointervalleveldataandthismethodofanalysisisincreasinglybecomingthepreferredmethodofanalysisininstrumentdevelopment(Wolfe&Smith,2006).Afurtheradvantageofthismethodofanalysisisthatitismorerobustwithsmallerdatasetsandwheretherearemissingdata(someparticipantsdidnotcompleteeveryquestion).Wewillnotgointofurtherdetailhere,however,ifreaderswouldlikemoreinformationaboutRaschanalyseswereferthemtothereferencesaboveandareveryhappytoprovidefurtherdetail.
InthismanualwewillonlyreportontheanalysesthatarebasedonthecurrentformoftheRAS‐DSthatcontains38itemsandhasa4‐pointratingscale.Resultsfromearlierstagescanbeaccessinthefollowingpublishedmanuscripts(Hancocketal2011,Hancocketal2012).Wemerelypresentauser‐friendlysummaryofourfindingshere.Amoredetailedunderstandingofthepsychometrictestingofthismeasurecanbefoundinthefollowingpublications:
Hancock,N.,Scanlan,J.N.,Honey,A.,Bundy,A.C.&O’Shea,K.(2015).RecoveryAssessmentScale–Domains&Stages(RAS‐DS):Feasibilityandmeasurementcapacity.AustralianandNewZealandJournalofPsychiatry.DOI:10.1177/0004867414564084.
Scanlan,J.N.,Hancock,N.&HoneyA.(2018).'TheRecoveryAssessmentScale–DomainsandStages(RAS‐DS):sensitivitytochangeovertimeandconvergentvaliditywithlevelofunmetneed.PsychiatryResearch,261,560‐564.DOI:10.1016/j.psychres.2018.01.042
Hancock,N.,Scanlan,J.,Smith‐Merry,J.,Gillespie,J.andYenI(2018).PartnersinRecoveryprogramevaluation:changesinunmetneedsandrecovery.AustralianHealthServicesReview,42(4),445‐452.DOI:10.1071/AH17004
Hancock,N.,Scanlan,J.N.,Kightley,M.Harris,A.(2019).RecoveryAssessmentScale–DomainsandStages(RAS‐DS):measurementcapacity,relevance,acceptabilityandfeasibilityofusewithyoungpeople.EarlyInterventioninPsychiatry.DOI:10.1111/eip.12842
PUTSIMPLY:
TheRAS‐DSisareliableandusefulmeasureofrecovery. Thestatements/itemsareallusefultotheoverallmeasurement. The4‐pointscaleworkswellwithalmostallitems.Thereareacouplethatareunclear,butwewillneedmoredatatoseehowtheywork.
ItisOKtoaddthescoresuptogainatotalrecoveryscoreoutof152. ItisalsoOKtoalsohavesub‐scoretotalsforeachrecoverydomainsothatyoucanseewhichdomainspeoplearedoingbetterandlesswellin
EitheranumberofpeoplewhousedtheRAS‐DSacrossthesestudieswereata‘high’stageofrecoveryor‘inrecovery’(atermusedbysomepeopletoreferto“fullyrecovered”)ORwehavenotyetidentifiedalloftherecovery‐orientedachievementsthatoccuraspeopleapproachbeingin‐recovery.Thisexplorationwillcontinue.
MorerecentstudiesprovidegoodevidencethatRAS‐DSissensitivetochange.Thisis,ifaperson’srecoveryprogressesorchanges,thiswillbereflectedintheRAS‐DSscores.
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SECTION 6: OUR FUTURE PLANS/WHAT WE STILL NEED TO EXAMINE & DEVELOP
DOES THE RAS‐DSMEASURETHEENTIRE RECOVERYCONSTRUCT?
Asweexplainedearlier,duringtheprocessofdevelopingtheRAS‐DS,weaddeditems/statementsthatconsumersidentifiedasmissingandbeingimportantaspectsoftheirlaterrecoveryjourneys.
However,testingshowsusthatwhilethoseitemsareindeedpartoftherecoveryconstructandgivearicher/fullerinstrument,theymightnotaddsufficientlytotheneedfora‘harder’setofitems,oritemsrelevanttolaterstagesofrecovery.Thishasledustoconsider2possibilities:
1.TheRAS‐DSstilldoesnot‘capture’oraskaboutalloftheachievementsofthelaterstageofrecovery,or
2.TheRAS‐DSdoescaptureoraskaboutalloftherecovery‘achievements,butmanyofthepeoplewhousedtheinstrumentwereinrecovery.
Thisexplorationwillcontinue.
ISTHE RAS‐DSSENSITIVETOCHANGE?
Asreportedabove,morerecentstudiesprovidegoodevidencethatRAS‐DSissensitivetochange.However,thisworkwillcontinue.Withoutanalternativegold‐standardmeasureofrecoverytocompareRAS‐DSchangesto,buildingrobustevidenceofsensitivitytochangeischallenging.TodatewehaveusedCANSASasaproximalandrelatedmeasureforcomparison.Sensitivitytochangeisanimportantaspectofinstrumentdevelopment/testingandtodatewebelievethatRAS‐DShasthemostrobustevidenceofthiswhencomparedtootherrecoverymeasures.
EXAMININGTHERATINGSCALESTRUCTURE WITHLARGERSETS OFDATA
Whilewearehappywiththefindingstodate,furtherdatawillenableustobemoreconfidentabouttheorderandseparationoftheratingscalestructureforallitems.
EXAMININGTEST‐RETESTRELIABILITY
WewillbeexaminingwhetherconsumersusetheRAS‐DSthesamewaywhentheyuseitrepeatedly.Thatis,wouldpeoplecompletingtheRAS‐DSgivethesameratingstodayastheywouldtomorrowifnothinghadchangedintermsoftheirrecovery?
DOES THE USE OFTHE RAS‐DSLEADTOBETTERTHERAPEUTICALLIANCEANDGREATERCONSUMERCHOICE ANDCONTROLINTHEIRRECOVERY
PLANNING?
RAS‐DSwasalwaysdevelopedwiththisgoalatthefore.Withasolidbodyofevidencenowbehinditsmeasurementproperties,wearecommencingworktoexploreifandhowusingRAS‐DScanleadtoenhancedconsumer/providerrelationshipsandmaximisethechoiceandcontrolaconsumerhasintheirrecoveryplanningandtheactioningoftheseplans.
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CONTACT INFORMATION IfyouhaveanyfurtherquestionsabouttheRAS‐DS,pleasecontactNicolaHancock
DrNicolaHancockSeniorLecturerDisciplineofOccupationalTherapyFacultyofHealthSciencesSydneyUniversityP:+61293519379E:[email protected]‐DSTeamE:[email protected]
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REFERENCES
Corrigan,P.W.,Giffort,D.,Leary,M.,&Okeke,I.(1999).Recoveryasapsychologicalconstruct.CommunityMentalHealthJournal,35,231–239.doi:10.1023/A:1018741302682
Giffort,D.,Schmook,A.,Woody,C.,Vollendorf,C.,&Gervain,M.(1995).RecoveryAssessmentScale.Cambridge,MA:HumanServicesResearchInstitute.
Hancock,N.,Scanlan,J.N.,Honey,A.,Bundy,A.C.&O’Shea,K.(2015).RecoveryAssessmentScale–Domains&Stages(RAS‐DS):Feasibilityandmeasurement.AustralianandNewZealandJournalofPsychiatry.DOI:10.1177/0004867414564084.
Hancock,N.,Bundy,A.,Honey,A.,Helich,S.,&Tamsett,S.(2012).Measuringthelaterstagesoftherecoveryjourney:InsightsgainedfromClubhousemembers.CommunityMentalHealthJournal.Doi:10.1007/s10597‐012‐9533‐y
Hancock,N.,Bundy,A.,Honey,A.,James,G.,&Tamsett,S.(2011).ImprovingmeasurementpropertiesoftheRecoveryAssessmentScale(RAS)withRaschanalysis,AmericanJournalofOccupationalTherapy,65,e77‐e85.Doi:10.5014/ajot.2011.001818.
Hancock,N.,Bundy,A.,Tamsett,S.,&McMahon,M.(2012).ParticipationofMentalHealthConsumersinResearch:Trainingaddressedandreliabilityassessed.AustralianOccupationalTherapyJournal,59(3),218‐224.Doi:10.1111/j.1440‐1630.2012.01011.x
Hancock,N.,Scanlan,J.N.,Honey,A.,Bundy,A.C.&O’Shea,K.(2015).RecoveryAssessmentScale–Domains&Stages(RAS‐DS):Feasibilityandmeasurementcapacity.AustralianandNewZealandJournalofPsychiatry.DOI:10.1177/0004867414564084.
Hancock,N.,Scanlan,J.,Smith‐Merry,J.,Gillespie,J.andYenI(2018).PartnersinRecoveryprogramevaluation:changesinunmetneedsandrecovery.AustralianHealthServicesReview,42(4),445‐452.DOI:10.1071/AH17004
Hancock,N.,Scanlan,J.N.,Kightley,M.Harris,A.(2019).RecoveryAssessmentScale–DomainsandStages(RAS‐DS):measurementcapacity,relevance,acceptabilityandfeasibilityofusewithyoungpeople.EarlyInterventioninPsychiatry.DOI:10.1111/eip.12842
Linacre,J.M.(2005).AUser’sGuidetoWinstepsMinistepRasch‐ModelComputerPrograms.RetrievedFebruary20,2010,fromwww.winsteps.com/winpass.htm
Scanlan,J.N.,Hancock,N.&HoneyA.(2018).'TheRecoveryAssessmentScale–DomainsandStages(RAS‐DS):sensitivitytochangeovertimeandconvergentvaliditywithlevelofunmetneed.PsychiatryResearch,261,560‐564.DOI:10.1016/j.psychres.2018.01.042
Wolfe,E.W.,&Smith,E.V.(2006).InstrumentdevelopmenttoolsandactivitiesformeasurevalidationusingRaschmodels:partII‐‐validationactivities.JournalofAppliedMeasurement,8(2),204‐234.
©2019TheUniversityofSydney Page19
APPENDIX 1:
RECOVERY ASSESSMENT SCALE – DOMAINS & STAGES (RAS-DS)
RecoveryAssessmentScale–DomainsandStages(RAS‐DS–ResearchVersion3).©2015NicolaHancockandTheUniversityofSydney.
Nottobecopiedorusedforanyotherpurposewithoutwrittenpermissionfromtheauthor([email protected])
Name:......................................................
RAS‐DS(RecoveryAssessmentScale–DomainsandStages)
Instructions:Belowisalistofstatementsthatdescribehowpeoplesometimesfeelaboutthemselvesandtheirlives.Pleasereadeachonecarefullyandcirclethenumbertotherightthatbestdescribesyouatthemoment.Circleonlyonenumberforeachstatementanddonotskipanyitems.
DOINGTHINGSIVALUE
UNTRU
E
AbitTRUE
MostlyTRUE
CompletelyTRUE
1 Itisimportanttohavefun 1 2 3 4
2 Itisimportanttohavehealthyhabits 1 2 3 4
3 Idothingsthataremeaningfultome 1 2 3 4
4 Icontinuetohavenewinterests 1 2 3 4
5 Idothingsthatarevaluableandhelpfultoothers 1 2 3 4
6 Idothingsthatgivemeafeelingofgreatpleasure 1 2 3 4
LOOKINGFORWARD
UNTRU
E
AbitTRUE
MostlyTRUE
CompletelyTRUE
7 IcanhandleitifIgetunwellagain 1 2 3 4
8 Icanhelpmyselfbecomebetter 1 2 3 4
9 Ihavethedesiretosucceed 1 2 3 4
10 IhavegoalsinlifethatIwanttoreach 1 2 3 4
11 IbelievethatIcanreachmycurrentpersonalgoals 1 2 3 4
12 Icanhandlewhathappensinmylife 1 2 3 4
13 Ilikemyself 1 2 3 4
14 Ihaveapurposeinlife 1 2 3 4
15 Ifpeoplereallyknewmetheywouldlikeme 1 2 3 4
16 IfIkeeptrying,Iwillcontinuetogetbetter 1 2 3 4
17 IhaveanideaofwhoIwanttobecome 1 2 3 4
18 Somethinggoodwilleventuallyhappen 1 2 3 4
19 Iamthepersonmostresponsibleformyownimprovement 1 2 3 4
20 Iamhopefulaboutmyownfuture 1 2 3 4
21 Iknowwhentoaskforhelp 1 2 3 4
RecoveryAssessmentScale–DomainsandStages(RAS‐DS–ResearchVersion3).©2015NicolaHancockandTheUniversityofSydney.
Nottobecopiedorusedforanyotherpurposewithoutwrittenpermissionfromtheauthor([email protected])
LOOKINGFORWARD(continued)
UNTRU
E
AbitTRUE
MostlyTRUE
CompletelyTRUE
22 Iaskforhelp,whenIneedit 1 2 3 4
23 Iknowwhathelpsmegetbetter 1 2 3 4
24 Icanlearnfrommymistakes 1 2 3 4
MASTERINGMYILLNESS
UNTRU
E
AbitTRUE
MostlyTRUE
CompletelyTRUE
25 Icanidentifytheearlywarningsignsofbecomingunwell 1 2 3 4
26 Ihavemyownplanforhowtostayorbecomewell 1 2 3 4
27TherearethingsthatIcandothathelpmedealwithunwantedsymptoms 1 2 3 4
28 Iknowthattherearementalhealthservicesthathelpme 1 2 3 4
29 Althoughmysymptomsmaygetworse,IknowIcanhandleit
1 2 3 4
30 Mysymptomsinterferelessandlesswithmylife 1 2 3 4
31Mysymptomsseemtobeaproblemforshorterperiodsoftimeeachtimetheyoccur 1 2 3 4
CONNECTINGANDBELONGING
UNTRU
E
AbitTRUE
MostlyTRUE
CompletelyTRUE
32 IhavepeoplethatIcancounton 1 2 3 4
33 EvenwhenIdon’tbelieveinmyself,otherpeopledo 1 2 3 4
34 Itisimportanttohaveavarietyoffriends 1 2 3 4
35 Ihavefriendswhohavealsoexperiencedmentalillness 1 2 3 4
36 Ihavefriendswithoutmentalillness 1 2 3 4
37 Ihavefriendsthatcandependonme 1 2 3 4
38 IfeelOKaboutmyfamilysituation 1 2 3 4