rasds manual version 3 2019 - final

Recovery Assessment Scale – Domains and Stages (RAS‐DS)

Manual Version 3. 2019

©2019TheUniversityofSydney Page2

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.


SUGGESTED CITATION:

Hancock,N.,Scanlan,J.N.,Bundy,A.C.,&Honey,A.(2019).RecoveryAssessmentScale–Domains&Stages(RAS‐DS)Manual‐Version3.Sydney;UniversityofSydney.


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


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


enhancedindividualrecovery,2)consumershavetherighttoreflectandreportontheirpersonalperspectivesofrecoveryprogress(whootherthanthepersonthemselveswouldknowhowhopefultheyfeelforexample?)and3)inclusionofastructurethatenablesconsumerstoactivelyparticipateinthe‘assessment’processisafundamentalfirststeptowardsself‐directedcare(acornerstoneofrecovery‐orientedpractice).


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.


Figure1:ExcerptfromtheRAS‐DS(partofpage1)

(seeAppendixatthebackofthemanualforacompletecopyoftheRAS‐DS)

Figure2:ExcerptfromtheRAS‐DS(partofpage2)


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


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.


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


MasteringMyIllnessRecoveryScore


ConnectingandBelongingRecoveryScore


Help:Wehavedevelopedanexcelspreadsheetwithcalculationfunctionsembedded.Pleasecontactusifyouwouldlikeacopy.


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.


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


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”


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.


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.


CONTACT INFORMATION IfyouhaveanyfurtherquestionsabouttheRAS‐DS,pleasecontactNicolaHancock

DrNicolaHancockSeniorLecturerDisciplineofOccupationalTherapyFacultyofHealthSciencesSydneyUniversityP:+61293519379E:[email protected]‐DSTeamE:[email protected]


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.


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

rasds manual version 3 2019 - final

Documents