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TheMentalHealthRecoveryStar:

ValidationstudyandfeaturesoftheItalianversion

AnnaPlacentino,FabioLucchi,GianpaoloScarsato,GiuseppeFazzariandGruppoRex.it*PsychiatricDept.no.23DSM,ASSTSpedaliCiviliBrescia

E-mail:[email protected] SUMMARY.Aim.TheMHRSisatoolforassessingtherecoveryprocessofpatientssufferingfrommentalillnessthroughacollaborativeapproach.TheaimofthestudyistodescribethefeaturesofthetoolandreporttheresultsoftheItalianvalidationstudy.Methods.Thestudyinvolved117serviceusersassessedintwophasesamonthapart.InadditiontotheMRHS,theHealthoftheNationOutcomeScales(HoNOS),WorldHealthOrganisationQualityofLife-BREF(WHOQoL-B)andGlobalAssessmentofFunctioning(GAF)wereused.Theacceptabilityofthetoolbyserviceusersandkeyworkerswasassessed,inadditiontoitsmainpsychometricproperties,includingassessmentofreadingsassignedjointlyusingintraclasscoefficientsandconcurrentvalidityusingthePearsoncorrelationcoefficient.Results.TheMHRSdemonstratedtemporalstabilityinallareas.SignificantcorrelationswerefoundbetweentheMHRSandthemostsimilarareasofthescalesused.Inter-raterreliabilitywasnotstudiedsufficiently.OveralltheMHRSwasdeemedasatisfactoryandeasytooltouse.Jointevaluationsweremostlycompletedinlessthan45minutes.Conclusions.TheMHRSisdeemedacceptablebyserviceusersandkeyworkers,andischaracterisedbypracticalandusefulvisualaids.Itcontributestoidentifyingpatientrecoverypathwaysandencouragesacollaborativeapproachbetweenusersandkeyworkers.Theresultsoftheevaluationofthepsychometricpropertiesappearedpromisingbutwerenotexhaustive.Althoughfurthereffortscouldbedirectedatexaminingtheseaspects,andconsiderationshouldbegiventotraditionalmethodsformeasuringtheoverallsubjective/objectiverecoveryapproach,thevaluablecollaborativecontributionoftheMHRSinempoweringusersandsupportingkeyworkersintheirroleascasemanagerscannotbedenied. KEYWORDS:evaluationtools,recovery,mentaldisorders,MentalHealthCare INTRODUCTIONThesubjectofco-productionhaschangedtheconceptofwelfare(1),andwhenitcomestohealthservices,especiallymentalhealthservices,itssynergywiththerecoverymodel(2)hasacquiredbroadconsensus.Inthisframework,theinvolvementofusersintheco-productionofmedicalinterventionsisanissuewhichisdebatedinnumerousdocumentsfromauthorisedagenciesandorganisations(3).TheNationalInstituteforHealthandCareExcellencedealswiththesubjectusingtwoguidelines–onespecificallyformentalhealth,withafocusonimprovingtheexperienceofserviceusersthroughtheiractiveparticipationinservicedelivery,andthesecondrelatingtopathwaysthatcontributetoimprovingthehealtheffectsofinterventionsjointlyconstructedthroughcommunityengagementwithdirectbeneficiaries(4,5).Theconcretemanifestationoftheseprinciplesintheday-to-dayprovisionofmentalhealthservicesstillseemstobeinconsistentandaffectedbylocalfactors,andthisisalsothecaseinItaly(6).Basedontheseassumptions,andwithaviewtoreassessingmodelsandinterventionsinpsychiatricservices,itwouldappearusefultoprovidekeyworkers,whointeractwithusersandtheirfamilieseveryday,witheasy-to-usetoolsthatsteertheiractivitytowardsmethodsbasedonco-productionandrecovery. Inrecentdecadestheconceptofrecovery(7)hasgraduallyacquiredincreasingimportanceinmentalhealthresearchandpolicy.AsstatedbySladeetal.(8),mentalhealthservicesshouldreshapetheirroleandfacilitatetheuserrecoveryprocess.Inparticular,therecoveryprocessprovidesatransformationopportunityforservices,byencouragingtheincreasedparticipationofserviceusersandinvolvingtheminthedefinitionoftheirowncareobjectives(9).TheMHRSfitsintothiscontext,andisatoolwhichisusefultokeyworkersandcasemanagersforconstructingandmonitoringpersonalisedrehabilitationandcareplans,whilekeepingthefocusonusersandoptimisingtheirpathway.TheMHRSwasdevelopedbyTriangleConsultinginconjunctionwiththeMentalHealthProvidersForumintheUK,whereitwasthesubjecttoevaluationofitspsychometricproperties(11)andfoundapplicationinawiderangeofservices


andprojects,tothepointofbeingconsideredfordefiningoutcomemeasureswithingovernmentPaymentsbyResultsprojects.ThetoolisbecomingwidespreadinEnglish-speakingcountriesandtwoinitiativesareinprogresstomakeitavailableinotherlanguages-French,Danishand,throughthisstudy,Italian.TheaimofourcontributionistoillustratethemainfeaturesoftheMHRSandoutlinetheresultsoftheItalianevaluation.ThestudywascarriedoutaspartofacollaborationprojectinvolvingservicesinthethirdsectorandpublichealthfacilitiesinLombardy,andwasco-fundedbyFondazioneComunitàBresciana.AssociazioneilChiarodelBosco(www.ilchiarodelbosco.it)wastheresearchcontactorganisation. METHODSThecollaborationprojectwhichledtotheItalianevaluationoftheMHRSinvolvedservicesinLombardyprovidedbyfourgovernmentmentalhealthdepartments-UOP23DSMASSTSpedaliCiviliinBrescia,DSMASSTinGarda,DSMASSTinCremaandDSMASSTinVallecamonica-andtwothirdsectororganisations(AssociazioneilChiarodelBosco,andCooperativaLiberamente).ThecollaborationwassetupthroughasharedletterofintentandworkcommencedfollowingextensivetrainingontheuseofMHRSandresearchintotheuseofadditionaltoolsincludedintheproject.ThestudyplaninvolvedthecompletionoftheMHRSwithatleast100patientsincontactwiththepsychiatricfacilitiesbelongingtotheorganisationsthatparticipatedintheproject.Thestudywassplitintotwoevaluations(T0andT1)carriedoutapproximately1monthapartusingthetoolsoutlinedbelow.Socialdemographic/clinicalcharacteristicsandtheClinicalGlobalImpression-CGI(12)weremeasuredforallindividuals,theMHRSwascompleted,andHoNOS(13,14),WHOQOL-B(15)andGAF(16)wereadministered.TheseevaluationtoolswereimplementedwhiletryingtoadheretotheclinicalassessmentroutineforthevariousservicesandenabledcomparisonwithmostoftheareasoutlinedintheMHRS.Oncompletionofthefirstevaluation(T0),theacceptabilityofthetoolbythekeyworkeranduserincompletingtheMHRSwasassessed.Twoitemsspeciallyconstructedona5-pointLikertscalewereused-thefirstratedlevelofsatisfaction(rangingfromNotatAlltoVerySatisfied)andthesecondratedlevelofdifficulty(rangingfromVeryDifficulttoVeryEasy).Finally,thetimerequiredforthejointcompletionoftheMHRSwasnoted.Aftergivingtheirinformedconsent,patientswereconsecutivelyrecruitedfromthosecasesrequiringmanagementwiththecreationofaformalcareplaninaccordancewithLombardRegioncriteria,asoutlinedinthelatestRegionalMentalHealthProject(17).Allrelevantkeyworkers(casemanagers)wereinvolvedinthestudyandtrainedintheuseoftheMHRS.

DescriptionoftheMentalHealthRecoveryStar(MHRS)characteristicsTheMHRSwasdevelopedthroughtheuseofqualitativeandquantitativemethodsinaccordancewithaparticipatoryactionresearchmodeloutlinedbytheauthorsofthetool(10),whichinvolvedresearchers,keyworkersandtheusersofresidentialfacilitiesanddayservicesintheLondonarea.Thetoolisconsideredameasureofpersonalisedholisticoutcomes,withafocusonarecovery-orientatedapproach(18).TheMHRSmeasurestheserviceuser'srecoverypaththroughdiscussionguidedbyscaledescriptionsandavisualmap,toencouragetheidentificationofthepointusersfeeltheyhavereachedintheir'journeyofrecovery'.Furthermore,itenablesindividualstotracktheirownprogressandplantheactionsrequiredtomeettheirobjectivesregardingchange(19,11,18).TherearetwomainelementsoftheMHRS.Thefirstisastar-shaped10-pointdiagramshowinglifedomainsunderlyingtherecoveryprocesswhichareallocatedareading(figure1andbox1).ThesecondistheJourneyofChange(figure2),whichoutlinesfivestagesontheroadto


recovery,eachofwhichissplitintwoanddescribedwithspecificreadingsforeacharea.Attributingareadingtoeachareainvolvesanalysisanddiscussionbetweenthecasemanagerandthepatient,inordertounderstandthecurrentsituationanddefineapersonalisedcareplantogether.Afterdecidinginitialreadingsandagreeingobjectivesforchange,theevaluationiscarriedoutagainafterasuitableperiodoftime.Thisisthereforeamethodforevaluating,agreeingandsupportingpersonalisedpathwaysforusersofpsychiatricservicesthroughtheirdirectinvolvement.Thetoolischaracterisedbyitsuseofsimplelanguagewithnoclinicalterminology,anditsinformalstylewithconcreteexamplesassistedbytheuseofgraphics.ThefullMHRStoolcontainsvariousaids-auserguidecontainingthedescriptionofthe10lifedomainsandthecorrespondingJourneyofChangestages;aguidefororganisationswithcompletioninstructionsandFAQs;TheStardiagramforrecordingreadings;aformforrecordingactionplansandinterventionsinpriorityareasforthepatient.TheMHRSwastranslatedintoItalianfollowingauthorisationfromtheauthors,andwastranslatedandadaptedaccordingtovariousrecommendationsintherelevantliterature(10).ThisprocedureinvolvedaforwardtranslationintoItalianbynativeItalianexpertsinmentalhealth,abacktranslationintoEnglishbynativeEnglishtranslatorssourcedbytheauthorsinLondon,afinalrevisionphase(21-24)anduseoftheofficialMHRSformatprovidedbyTriangleConsulting,whichholdscopyrightforthetool. Twodays'trainingisrequiredtolearnhowtousetheMHRSandenablekeyworkerstoworkdirectlywithserviceusers,asoutlinedbyitsauthors.InItalytheorganisationauthorisedbyTriangleConsultingtodistributethematerialandprovidetrainingonusingtheMHRSistheAssociazioneilChiarodelBosco(www.ilchiarodelbosco.org),whichsetupateamoftrainersconsistingofkeyworkersinmentalhealthservices,inadditiontoserviceusersandtheirrelatives. DataanalysisMeansandstandarddeviationswerecalculatedforthesocialdemographic/clinicalvariablesinthesampleandkeyworkercharacteristics.Inter-raterreliabilitywastestedinaspecialsessionusingthetooloncompletionoftraining,duringwhichthekeyworkersparticipatinginthestudygaveindependentreadingsforaclinicalcasediscussedanddescribedindetail.ReliabilitywasestimatedbycalculatingCohen'skappacoefficientandcomparingpairsofreadingsfromallparticipants.Itwasnotpossibletomeasureadditionalclinicalcases. Thetest-retestreliabilityobtainedinconjunctionwiththeMHRSserviceuserandkeyworkerwasevaluatedusingtheintraclasscorrelationcoefficient,testingthenullhypothesisr=0.70.ConcurrentvaliditywasassessedusingthePearsoncorrelationcoefficient.Finally,thefrequencyanalysiswascarriedouttoestimatelevelsofsatisfaction,difficultyinusingthetool,andadministrationtimes.AllinformationcollectedwasenteredintoadatabaseandanalysedwithSPSSversion26forWindows.RESULTSParticipantcharacteristicsAtotalof11mentalhealthdepartmentswereinvolved,whichincluded4(36%)psycho-socialrehabilitationcentres(localclinics),2(18%)daycentresand5(45%)residentialpsychiatricfacilitieswithsupportlevelsrangingfrommediumtohighintheprovinceofBrescia.42keyworkersfromthesefacilitiescollaboratedinthestudy:20(48%)professionaleducators,14(33%)qualifiednurses,5(12%)psychiatristsand1(2%)psychologist.Theaverageageofthekeyworkerswas40.71


(SD7.47)withanagerangeof26to57yearsold.Averageyearsofservicewas12.46(SD7.36)withlengthofservicerangingfrom2to37years.AllkeyworkersinvolvedintheresearchhadbeentrainedintheuseofMHRS.117serviceusersparticipatedinthestudy,whowereeachprovidedwithachronologicalpersonalisedtreatment/rehabilitationplan.Thepatientsmainlycamefrompsycho-socialrehabilitationcentres(83;70%),daycentres(16;14%)andresidentialpsychiatricfacilities(18;16%).Themainsocio-demographicandclinicalcharacteristicsofthesampleareoutlinedintables1and2respectively.ReliabilityInter-raterreliability(42participants)wasstudiedinpartwiththedataavailable.ThiswasmeasuredthroughCohen'skappacoefficientandwasgreaterthan0.7inallcombinations,withnegligibleerrorvariance.Thisshouldbeconsideredinsufficienthowever,giventheabsenceofadditionalcasestudyevaluations.MHRStest-retestreliabilitywasstudiedusingtwoconsecutivemeasurements.Asshownintable3,thecorrelationbetweenreadingsinthetwoevaluationsissignificant,indicatingtemporalstabilityforallareas.ConcurrentvalidityConcurrentvaliditywastestedusingthePearsoncorrelationcoefficient,withreferencetothejointT0evaluations.SignificantcorrelationswereobservedbetweentheMHRSandthescalesusedinthestudyinsimilar,comparableareas.TheMHRSmentalhealthareacorrelateswiththefollowingfactors:GAF(r=0.25,p<0.01),behaviouralproblems-HoNOS(r=-0.27,p<0.01),symptoms-HoNOS(r=-0.47,p<0.01),socio-environmentalarea-HoNOS(r=-0.44,p<0.01),psychology-WHOQOL-B(r=0.27,p<0.05),socialarea-WHOQOL-B(r=0.30,p<0.05),environmentalarea-WHOQOL-B(r=0.29,p<0.01),physicalarea-WHOQOL-B(r=0.29,p<0.05)andgeneralqualityoflife-WHOQOL-B(r=0.31,p<0.01).TheMHRSself-careareacorrelateswith:GAF(r=0.27,p<0.01),symptoms-HoNOS(r=-0.36,p<0.01),socio-environmentalarea-HoNOS(r=-0.56,p<0.01),psychology-WHOQOL-B(r=0.32,p<0.01),environmentalarea-WHOQOL-B(r=0.29,p<0.05),physicalarea-WHOQOL-B(r=0.26,p<0.05)andgeneralqualityoflife-WHOQOL-B(r=0.28,p<0.01).TheMHRSlifeskillsareacorrelateswith:GAF(r=0.32,p<0.01),socio-environmentalarea-HoNOS(r=-0.35,p<0.01).TheMHRSsocialnetworkareacorrelateswith:GAF(r=0.32,p<0.01),behaviouralproblems-HoNOS(r=-0.30,p<0.01),symptoms-HoNOS(r=-0.38,p<0.01),socio-environmentalarea-HoNOS(r=-0.46,p<0.01),psychology-WHOQOL-B(r=0.34,p<0.01),socialarea-WHOQOL-B(r=0.34,p<0.01),environmentalarea-WHOQOL-B(r=0.35,p<0.01),physicalarea-WHOQOL-B(r=0.33,p<0.01)andgeneralqualityoflife-WHOQOL-B(r=0.37,p<0.01).TheMHRSworkareacorrelateswith:GAF(r=0.22,p<0.05),symptoms-HoNOS(r=-0.27,p<0.05),socio-environmentalarea-HoNOS(r=-0.25,p<0.05),environmentalarea-WHOQOL-B(r=0.25,p<0.05),generalqualityoflife-WHOQOL-B(r=0.29,p<0.01).TheMHRSpersonalrelationshipsareacorrelateswith:GAF(r=0.32,p<0.01),symptoms-HoNOS(r=-0.30,p<0.01),socio-environmentalarea-HoNOS(r=-0.32,p<0.01),physicalarea-WHOQOL-B(r=0.23,p<0.05),psychology-WHOQOL-B(r=0.34,p<0.05),environmentalarea-WHOQOL-B(r=0.24,p<0.05)andgeneralqualityoflife-WHOQOL-B(r=0.81,p<0.01).TheMHRSdependenciesareacorrelateswith:behaviouralproblems-HoNOS(r=-0.38,p<0.01),symptoms-HoNOS(r=-0.29,p<0.01),socialarea-WHOQOL-B(r=0.24,p<0.05),environmentalarea-WHOQOL-B(r=0.83,p<0.05),generalqualityoflife-WHOQOL-B(r=0.30,p<0.01).TheMHRSresponsibilityareacorrelateswith:behaviouralproblems-HONOS(r=-0.42,p<0.01),socio-environmentalarea-HoNOS(r=-0.36,p<0.01).TheMHRSidentity/self-esteemareacorrelateswith:GAF(r=0.23,p<0.05),symptoms-HoNOS(r=-0.43,p<0.01),socio-environmentalarea-HoNOS(r=-0.40,p<0.01),socialarea-WHOQOL-B(r=0.51,p<0.01),generalqualityoflife-WHOQOL-B(r=0.33,p<0.05).The


MHRStrust/hopeareacorrelateswith:symptoms-HoNOS(r=-0.33,p<0.01),socio-environmentalarea-HoNOS(r=0.34,p<0.01),physicalarea-WHOQOL-B(r=0.24,p<0.05),environmentalarea-WHOQOL-B(r=0.23,p<0.05),generalqualityoflife-WHOQOL-B(r=0.31,p<0.01).TheHoNOS-DisabilityfactorwasexcludedcompletelyfromtheanalysisasithasnosimilaritiestotheMHRSareas.AcceptabilityOveralltheMHRSwasdeemedasatisfactorytoolandeasytocompleteforbothkeyworkersandserviceusers.Specifically,thetoolwasjudgedsatisfactory/verysatisfactoryby40(96%)keyworkersand99(85%)serviceusers,neithersatisfactory/unsatisfactoryby2(4%)keyworkersand16(14%)serviceusers,andnotverysatisfactory/unsatisfactorybynokeyworkersand2(1%)users.Furthermore,thetoolwasjudgedeasy/veryeasytocompleteby23(55%)keyworkersand63(54%)serviceusers,neithereasy/difficultby18(43%)keyworkersand38(32%)serviceusers,anddifficult/verydifficultby1(2%)keyworkerand16(14%)users.Thejointkeyworker/serviceuserStarreadingwascarriedoutinlessthan45minutesby101(86%)usersparticipatinginthestudyandbetween45to90minutesintherestofthesample(n=16;14%).DISCUSSIONTheaimofourstudywastoillustratethemaincharacteristicsoftheMHRSanditsacceptability,andtooutlinethepreliminaryresultsoftheItalianevaluationofthetool.Asobservedinotherstudies(11,25),theMHRSmeasurementwasdeemedacceptableformostusersandkeyworkersintermsoflevelsofsatisfactionandbeingeasytocomplete.Onlytwoserviceusersreporteddissatisfactionwiththetool,andafewserviceusersandonekeyworkerfeltitwasdifficulttocomplete.MostofthesamplecompletedthejointStarreadinginlessthan45minutes.Thisdemonstratesthatitwouldalsobesuitableforoutpatientfacilities,wheretheuseofrelativelyquicktoolsthatfitinwithconsultationtimeswouldbeconvenient.Consideringthecollaborativenatureofthetool,thestudyoftest-retestreliabilitywasassessedbyexaminingthereadingobtainedinagreementbetweenthekeyworkerandtheuser,demonstratinggoodtest-retestreliability,aswasfoundinanevaluationstudyintheUnitedKingdom(11).Inter-raterreliabilitywasnotstudiedsufficientlyandrepresentsanimportantconstraintinthisstudy.Killapsyetal.(11)studiedtheinter-raterreliabilityofthetoolsufficientlyandonlytheMHRSworkareademonstratedacceptableinter-raterreliability,demonstratinginsufficientinter-raterreliabilityoverall.TheconcurrentvalidityoftheMHRSappearsacceptable.Mostareasofthetoolcorrelatewithgeneralqualityoflifeandleveloffunctioning.Killapsyetal.(11)alsohighlightedconvergentvaliditywithameasureofsocialfunctioning.Inourstudy,inadditiontotheWHOQOL-B,manyareasoftheMHRSreportedsignificantcorrelationswiththreeofthefourHoNOSfactors.Tothiseffect,Lloydetal.(26)definetheMHRSintermsofoutcomemeasuresusefulforassessinghowanindividualchangesduringrecovery.Thetool'sbottom-upapproachhasfacilitatedatoolstructureaimedatmeetingtherequirementsofserviceusersandprovidinganimportantcollaborativetool,howeverthiscancreateproblemsinrelationtoexpectationsregardingitspsychometricproperties(27).ThereisundoubtedlyasharedneedforimprovedcomprehensionandexaminationofthepsychometriccharacteristicsoftheMHRS,andthereisstillbroaddebatecharacterisedbyopposingoutcomes(11,25,26,28,29).TheapproachusedbyKillaspyetal.(2012a)wascriticisedintermsofmethodology(10,27,30)andwithrespecttotheunderlyingphilosophy(31).Doubtswereraisedontheneedtoapplyinter-raterreliabilitycriteriatovalidateatoolmainlydesignedforjointpatient-usermeasurementratherthanstaffevaluation(29).Dickensetal.(27),thoughnotingverygoodinternalconsistency,observedlowitemredundancyand,aswithotherauthors,notedtheabsenceofasuitableevaluationofthechangescale(11,27).


Onthebasisofthesefactors,reflectionregardingacollaborativetooldesignedtomeasureaconstructwhichisascomplexandsubjectiveasrecovery(27)isrequired,andanattempttoconsidervariouschangestotheconventionalideaofthevalidityandreliabilityofameasure(25).Eynon(31)suggeststhat,whileitsusemaynotbefullyjustifiedasaroutineoutcomemeasure,dismissingtheuseoftheMHRSwouldbeagreatlossduetothetool'svalueinfacilitatingthereconstructionofnarrativeidentityaspartoftherecoveryprocess(32).Furthermore,thedistinctivecollaborativeaspectoftheMHRScouldsupportthedevelopmentofimportanttherapeuticrelationships(33)andenableserviceuserstoplayanactiveroleintheirrecovery(34).CONCLUSIONSTheMHRShasbeenshowntobeasatisfactorytoolforserviceusersandkeyworkersduetoitsuseofpracticalvisualaids.Itcontributestodevelopinguserrecoverypathwaysandencouragesacollaborativeapproachbetweenkeyworkersandusers,whichbeginswithanevaluation,whichthenleadstoplanningtreatment/rehabilitation(35).Thetoolhaslittleoverlapwithothertoolswhichhavetraditionallybeenusedinmentalhealthservices,givenitsfocusonachievingqualityobjectives(theactiveparticipationofuserstogiveself-assessmentsanddecidewhichobjectivestoworkonintheirpersonalisedplan)andquantitativeobjectives(measuringchange).Thisdualaspectisconsideredanddiscussedinexperimentalstudiescarriedoutbyvariousauthors(11,27,32),withconclusionsthatreflecttheinterestofthevariousresearchersinemphasisingonefactororanother.ThisarticlediscussesthefirstquantitativeresearchintothepsychometriccharacteristicsoftheMHRScarriedoutinItaly.Overalltheresultshavebeenencouraging,howeveroverandabovethespecificconstraintinourstudy(ineffectiveevaluationofinter-raterreliability),variousconsiderationsonthetool'spsychometricpropertiescannotbeomitted.EngaginginthetypicalcollaborativenatureoftheMHRSbetweenusersandkeyworkersanditsrecovery-orientatedapproach(27)istobeconsideredahighlyvaluableaspectand,despiteuncertaintyoverthepsychometricaspect,itscontinueduseinmentalhealthservicesisdesirable.Thehopeisthatthisstudy,alongwithinformationreportedintherelevantliterature,maycontributetoraisingawarenessandencouragingfurtherdevelopmentoftheMHRS,givenitssignificantpotentialinclinicalsettingsandtheinvolvementofpatientsintheirownrecoverypathway.Itwouldalsobehopedthatitcouldcontributetopracticesorientatedtowardsco-productioninmentalhealthservicesbecomingwidespread,toencouragetheintegrationofviewpointsfromallstakeholders,forboththewellbeingofourserviceusersandtheimplementationofpatient-focusedorganisations.


Figura1


Box1LedieciareedellaRecoveryStar

1.LagestionedellatuasalutementaleL’areafariferimentoallagestionedellapropriasalutementaleeallacapacitàdisvilupparediunavitasoddisfacenteesignificativa,ancheinpresenzadieventualisintomi.

2.SalutefisicaecuradiséL’areafariferimentoallacuradisé,inparticolaredellapropriasalutefisica,l'igienepersonale,lagestionedellostressealmantenimentodellostatogeneraledibenessere.

3.AbilitàperlavitaquotidianaL’areafariferimentoagliaspettipraticidellavitainautonomia:farelaspesa,cucinare,avereachefareconivicini,tenereinordineilpostoincuisiviveegestireilpropriodenaro.

4.RetisocialiL’areafariferimentoallaretesocialeeall’esserepartediunacomunità.Includelacapacitàdipartecipareadattivitàorganizzatedaserviziedancheadattivitànonistituzionalicomeilvolontariato,partecipareacorsi,associarsiaduncluboauncircolo,parteciparealleattivitàdellascuola,diunachiesaoppurediattivitàpropostedagruppidiamici.

5.LavoroL’areafariferimentoalrapportopersonaleconillavoro.Consideraildesideriodilavorare,l’individuazionediciòchesidesiderafare,svilupparelecompetenzeelequalificheperavereun’occupazione,trovareemantenereunlavoro.Oppure,sepreferitoomaggiormenteindicato,dedicarsiadattivitàdivolontariatoe/oaltreattivitàoccupazionali.

6.RelazionipersonaliL’areafariferimentoallerelazionipersonalisignificative.Siindividuaunarelazioneincuisivorrebbechelecosefosserodiverse(conunfamigliare,unamicostrettoouncompagno/a)esivalutailgradodivicinanzachesidesideraavere.

7.Comportamentolegatoalledipendenzeeall’usodisostanzeL’areafariferimentoaqualsiasicomportamentolegatoall’usodisostanzecomealcool,drogheoaltreformedidipendenza(giocod’azzardo,shopping,etc.).Prendeinconsiderazionelaconsapevolezzaditaliproblemieuneventualeimpegnoperridurneidanni.

8.ResponsabilitàL’areafariferimentoalleresponsabilitàriguardantiilpostoincuisivive(casaoaltrotipodistruttura).Includeilpagamentodell’affitto,andared’accordoconivicinioglialtriospitidellastrutturaeconsideralapresenzadieventualiproblemiconlalegge.

9.IdentitàeautostimaL’areafariferimentoalsensod’identitàpersonaleeall'autostima.Consideralapercezionedisé,laconsapevolezzadellerisorsepersonali,deiproprilimitiepiùingeneraledell'accettazionedisé.

10.FiduciaeaspettativepositiveL’areafariferimentoallapercezionedifiduciapersonaleealleaspettativepositiveperilfuturo.Prendeinconsiderazioneilcredereinsestessi,lafiducianeglialtriel'aspettativaditrovaredellepossibilisoluzioni.

AdattatodaMentalHealthProvidersForum(36)


Figura2LASCALADELCAMBIAMENTO


Tabella1Caratteristichesociodemografiche(n.117)

Sex MF

6651

56%44%

Età Media(ds):41,62(11,1)Min-Max:18-66

Statocivile Celibe/nubileSeparato/divorziatoConiugato/aVedova/o

9213111

79%11%9%1%

Titolodistudio MedieSuperiori/ProfElementariLaurea

5644116

48%38%9%5%

Occupazione NonoccupatoLavoroprotettoCasalingaPensionelavorativaLavorofulltimeLavoroparttimeStudente

7911116333

68%9%9%5%3%3%3%

Invaliditàcivile SiNo

8829

75%25%

Situazioneabitativa Fam.OrigineSoloFam.CostituitaStrutturaresidenzialeAltrasistemazioneabitativa

562020183

48%17%17%15%3%

Tabella2Caratteristichecliniche(n.117)

Diagnosiprincipale(criteriDSMIV) Dist.BipolareISchizofreniaDist.SchizoaffettivoBipolareDist.DepressivoMagg.Altridisturbipsicotici(Dist.Delirante/psicosiNAS)Dist.Personalità(schizotipico/borderline)

532726443

45%23%22%4%4%2%

N.diproblemiinasse4 Media(ds):1.15(1.18)Min-Max:1-5

Familiaritàpsicopatologia SiNo

5463

46%54%

Etàd'esordio Media(ds):23,41(7,71)Min-Max:6-41

Etàprimocontatto Media(ds):25,81(7,28)Min-Max:6-45

CGI Lievemente/ModeratamenteammalatoNotevolmente/gravementeammalato

7146

61%39%


Tabella3Correlazionetraduevalutazionineltempo(attendibilitàtest-retest)dellaMHRSArea Coefficientedicorrelazioneintraclasse(IC95%)

GestionedellasalutementaleCuradisèAbilitàperlavitaquotidianaRetisocialiLavoroRelazionipersonaliDipendenzeResponsabilitàIdentitàel’autostimaFiduciaelasperanza

0,76(0.58-0.88)0,71(0.49-0.83)0,79(0,60-0,87)0,71(0.49-0.84)0,89(0,84-0,92)0,71(0.49-0.84)0,84(0,79-0,90)0,84(0,79-0,90)0,78(0,59-0,85)0,78(0,59-0,85)

>0,7consideratoaccettabileGRUPPOREX.ITUOP23-ASSTSpedaliCiviliBrescia-DeCarliPaola-LussignoliMiriam-SeggioliGiuseppe-TosiDeliaRita-VillaGiovannaDSMASSTdelGarda-FerrazzoliIvanaOrsola-GavelliLaura-MarelliSara-MiglioratiSimonetta-SaviottiFrancescoDSMASSTCrema-PegoraroMarcoDSMASSTVallecamonica-SpandreVincenzo-ZindatoVincenzoAssociazioneLiberamente-LiscidiniIlaria-RadiciRuggeroAssociazioneIlchiarodelbosco-RossellaMicheliRINGRAZIAMENTISiringrazianotuttigliutentichehannopartecipatoallostudio,glioperatorieledirezioni.Lacomunitàbrescianaperilfinanziamentofornitoeunringraziamentoparticolareèrivoltoall'AssociazioneilChiarodelBoscochehafortementesostenutol'interoprogetto.


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