Introducing ROSI: Consumer Derived Recovery Oriented System Indicators Measure
Alternatives 2004: Achieving the Promise of Recovery, October 13-17, Denver CO
The National Research Project for the Development of Recovery Facilitating System Performance Indicators
Steven J. Onken, Jeanne M. Dumont, Priscilla Ridgway, Douglas H. Dornan, Ruth O. Ralph
Transforming Systems: The Dream, the Reality
Achieving the Promise: Transforming Mental Health Care in America “envision[s] a future when everyone with a mental illness will recover…” (President’s New Freedom Commission on Mental Health)
“The way mental health services operate now - it’s like putting Band-Aids on severed arms.”
(User Comment on Prototype Survey)
A consumer driven system is the heart of a recovery-oriented system and its criterion of success
Consumer and family member participation in design, implementation, and evaluation
Comprehensive State Recovery Plans
Comprehensive Individualized Recovery Plans
Development of measures of system factors that lead to recovery
Development of measures of consumer self-agency/ personal recovery
Purposes of the What Helps and What Hinders Recovery Research Project
To increase knowledge about what facilitates or hinders recovery from psychiatric disabilities,
To devise a core set of indicators that measure elements of a recovery-facilitating environment, and
To integrate the items into a multi-state “report” of system performance in order to generate comparable data across state and local mental health systems.
Phase One: Qualitative research design guided by grounded theory, purposive variability sample frame, structured content analysis, and member check
Recovery: The ongoing, interactional process/ personal journey and outcome of restoring a positive sense of self and meaningful sense of belonging while actively self-managing psychiatric disorder and rebuilding a life within the community
Dynamic interplay of
the individual (self/ holism; hope/ sense of meaning/ purpose)
the environment (basic material resources; social relationships; meaningful activities; peer support; formal services; formal service staff)
the nature of the exchange (choice; independence/ interdependence).
Findings in Context
Recognition of the steady movement toward evidence-based practice – science matters
Recognition that clinical and rehabilitation needs outstrip present research – experience matters
Recognition that the body and brain are connected – the body matters
Recognition of innate strengths, self-righting capacities, and resiliency – self agency matters
Recognition that the present is always determining the future – dreams/ aspirations matter
Recognition of the influential nature of the dynamics of the exchange – partnership matters
Recognition of the powerful roles of social support, social norms, social meaning and social responsibility – people, families, work, culture, communities matter
Recognition of the importance of meaning-making – religion, spirituality, philosophy matter
Recognition of the critical role of mind-body-spirit integration – the whole matters
Recognition and growth in understanding of multicausality and the need for integrated conceptual frameworks, treatment and system approaches – complexity matters
Recovery Actualization
Occurs within and builds upon the characteristics of the individual, the environment and the exchange
A threefold strategy:
Concept of Self: Building meaning making and recovery knowledge, skills and competencies in the individual
Concept of World: Facilitating recovery enhancing environments (social/ emotional and instrumental supports)
Concept of Self-in-World: Promoting empowering exchanges
Tension Points for System Indicator Development in Phase II
Translating depth to surface
Being holistic in a compartmentalized world
Framing essential needs as mental health needs
Valuing tacit/implicit knowledge where explicit knowledge holds sway
Stressing choice in an environment constrained by limited and lousy options
Resurfacing therapeutic alliance when ‘brief’/‘time limits’ are the operative terms
Phase Two Item Development
Generated items from codebook, findings, member check priorities
Reviewed other measurement efforts
Refined the 73 Self-Report Items
Conducted a “Think Aloud” session
Conducted Flesch-Kincaid Grade Level Check
Conducted Self-Report Prototype Review
Refined the 27 Administrative-Data Items
Conducted crosswalk with MHSIP proposed indicators
Generated measure definitions
Conducted Administrative-Data Survey
Self-Report Prototype Review
Five part survey (7 SMHAs, N = 219) (demographics, item answers, unclear wording, item importance rating, comments)
Each item was evaluated based on
Importance rating
Factor loading values
Response scale distribution & direction
Phase One originating theme/grouping
Clarity of wording
Phase One member check priorities
Cross tabbed demographic variables with item importance mean ratings
Importance of each measure for improving system recovery orientation
Whether or not the data was currently being collected
Specific comments on each measure
Those surveyed included:
10 participating SMHAs (9)
MHSIP Consumer Expert Panel (1)
NAC/SMHA membership (3)
ROSI Administrative-Data Profile
16 Indicators and 23 corresponding Measures
Peer Support/Consumer Operated Services (5)
Choice (3)
Direct Care Staff Ratio (1)
Formal Service System Culture & Orientation (7)
Formal Service System Coercion (4)
Specialized Service Access (3)
Phase Three Steps
Large Scale Pilot Testing
Psychometric Testing
Toolkit Development
Seamlessly gray hair
Concluding Quotes
Recovery is not so much getting mainstreamed, but expanding the mainstream to incorporate the fringes. The goal is not so much as that of becoming normal as to become more deeply, more fully human in whatever unique way one is meant to be (Deegan, 1996).
We can’t stop here but there’s hope in watching the system evolve and the changes that are taking place (OK).