Purpose:

The purpose of this part of SRI 2 is to help practitioners reflect on the service they provide, through a structured process facilitated by the coordinator. These reflections generate discussion and scores that are fed into the SRI 2 website by the coordinator and used later in the creation of the action plan.

Service provider data is one of three acquired through meetings and discussions, the other two being from service users and where possible informal carers.

The service provider data collection sheets are printed from the SRI 2 website and used to record practitioner's ratings and comments. The first page of these data collection sheets contains the following guidance.

SRI 2 Data Collection Sheet - Service Provider

About this data collection sheet

This sheet forms part of the SRI 2 data collection process. Completing this sheet will help your service reflect on whether it is recovery focused.

We recommend that people completing this form have an opportunity to discuss their thoughts on each statement in a group setting prior to recording their individual response on this sheet. It is, however, also possible to complete this form individually without prior group discussion.

In noting a response we encourage that you protect confidentiality by ensuring information recorded is anonymous.

Gathering information

  • In the space provided write examples of how your experience matches the opening statement, e.g. 'We identify and address basic needs.'
  • Based on the extent to which the statement matches your experience make a judgement on a scale of 1 to 5, where 1 is strongly disagree and 5 is strongly agree. If the indicator is not applicable or relevant to your service circle NA.
  • The person co-ordinating should retain all completed sheets for later use. They will enter the scaled responses into the SRI 2 website. Supporting evidence and examples recorded on this sheet will be discussed during the action planning stage.

Recovery Indicators and associated statements

There are ten recovery indicators to be considered in relation to service provision. Each of these has an associated statement that recovery focused services would aspire to, for example the first recovery indicator is; Basic needs are identified and addressed, and the associated statement is; We identify and address basic needs.

The recovery indicators and associated statements are shown below.

Recovery IndicatorAssociated statement to rate between 1 and 5
Basic needs are identified and addressed. We identify and address basic needs.
Goals are identified and addressed. When we plan care we address people's self set goals.
Personalised services are provided. We ensure people receive a personal, unique and tailored service.
Service is strengths based. We consider people's strengths, skills and abilities.
Service promotes social inclusion. We provide a good range of options to promote social inclusion.
Service promotes and acts on service user involvement. Significant changes have taken place as a result of service user involvement.
Informal carers are involved. We fully involve informal carers wherever we can.
Service encourages advance planning and self management. We encourage advance planning and self management.
Staff are supported and valued. Staff are supported and valued and opportunities exist to reflect on practice.
Practice is recovery focused. We are recovery focused practitioners.

Guidance for Rating

This section of the guidance will help the team rate their service provision against the statements by offering suggestions as to what kind of factors influence the rating.

The degree to which practitioners feel their service provision achieves the aspirations of the ten statements will be derived from hard evidence such as actions and outcomes achieved as a result of the assessment and care planning process, as opposed to being guided by a general feeling or subjective opinion.

The rating process will involve a group discussion about service provision in the light of the recovery indicators and statements; this might involve healthy and constructive debate. The individuals then rate each statement on their individual data collection sheet where possible supported by relevant evidence including personal testimony.

If it is impossible for some people to attend the group discussion, they can be given the data collection sheets to complete on their own, although this approach is least favoured as it precludes a team discussion and loses an opportunity for a reflective exploration of service provision.

Statement 1 We identify and address basic needs.

The team will consider the service they provide seeking evidence that basic needs are identified and addressed. Basic needs include housing, nutrition, health, finance, safety, personal care and spirituality. The score awarded reflects the presence or absence of evidence that basic needs are being identified and addressed as standard practice.

Basic Need: Housing

Examples of evidence that the basic need for housing had been identified and addressed would include factual information about what was addressed and how it was addressed including such things as:

  • Security of tenure.
  • Risk of homelessness or currently homeless.
  • Safety and security.
  • How the person feels about their current housing.
  • Affordability.
  • Accommodation being wind and watertight.
  • Overcrowding.
  • Aspects of the housing situation that are a resource for wellbeing.

Basic Need: Nutrition

Food and recovery are closely linked and having a healthy diet helps promote good mental health. A service that identifies and addresses issues around nutrition would promote healthier eating habits, and would perhaps make use of one of the many nutrition screening tools. There would be provision for cultural or religious aspects of diet. The question of whether the person is vegan or vegetarian or has other requirements would also have been considered and addressed.

Basic Need: Health

Service provision dealing with the basic need for health will identify and address issues about physical health, smoking, drinking, drug use, sleep patterns, mobility, breathlessness, weight gain or loss, side effects of medication, and any other health concerns the person may have.

Basic Need: Finance

Money is a basic need; therefore recovery focused service provision will identify and address issues around income, benefits, entitlements, employability, income maximisation, and debt.

Basic Need: Safety

Safety is a basic human need and recovery may not be possible if personal safety is at risk. Service provision scoring highly on this would ask about and seek to address safety concerns. These could be about things such as domestic abuse or anti social neighbours or any other factor that the person feels compromises their safety.

Basic Need: Personal Care

Service provision rating highly against this would identify and address any personal care needs including issues such as:

  • Cooking and cleaning.
  • Help with personal care like washing and using the toilet.
  • Transport or help with getting around.
  • Medical tasks like giving injections or changing a catheter.
  • Shopping, banking and paying bills.

Basic Need: Spirituality

In terms of the basic need for spiritual expression, there would be evidence that as part of the service provision people's spiritual needs were being identified and addressed. Achieving this will involve asking about what gives meaning and value to people's lives. This might include prayer arrangements, visits from faith leaders, access to scripture, and anything else that the person using the service considers to be a spiritual matter. Some might see their mental health experiences as having spiritual significance. Others may see mindfulness, meditation, music, and poetry as spiritual matters. Service providers who rate themselves highly in this area will be comfortable in raising the issue of spirituality and have overcome any reluctance to discuss such matters. Are the service providers able to evidence that spirituality is routinely considered?

Statement 2: When we plan care we address people's self set goals.

The team providing the service will look for evidence including personal testimony that people's self set goals are addressed. It should be evident that the goals were set by the people using the service and not by the practitioners providing the service. Evidence that this actually happens would include some people having attained their goals and others, having had the goals broken into smaller steps, would be making progress towards them. Discussion around this statement might be about service strengths where the aspirations of this statement have been met. The discussion might also generate suggestions for changes designed to tackle those instances where the service fell short against this statement. Such ideas would contribute to the action planning stage of SRI 2.

Statement 3: We ensure people receive a personal unique and tailored service.

This statement will attract a high score if the discussion centres around the many options and choices offered to people using the service. It will be evident that personal preferences are being routinely and intentionally elicited. This would suggest service provision that meets the aspirations of the statement and is flexible, adaptable, and capable of responding to unique needs. A high score would also suggest a person centred and holistic approach ensuring that personal choices around such things as cultural needs, need for privacy, and other preferences have been systematically taken into consideration and addressed. Recovery focused service provision of this nature avoids a 'one size fits all' approach and one manifestation of this is the range of distinct and customised recovery strategies implemented for each individual using the service.

Statement 4: We consider people's strengths skills and abilities.

Service provision that takes account of people's strengths skills and abilities intentionally will score highly on this statement. Evidence of this would include examples where service user strengths have been engaged in support of their recovery journey. Systematically eliciting, considering and utilising people's strengths is evidence of a service which recognises that although people use the service and currently have mental health problems, they are not defined by them. A strengths based service helps people to name their skills and expertise by actively asking about past successes and what people do that allows them to manage and survive the challenges they face and have faced in the past. Services highly rated against this statement are helping provide people with a vocabulary of their strengths for example, wisdom, courage, humanity, justice, resilience, and transcendence. Such services elicit conversations about the person's social and other roles beyond that of 'mental health service user', and in so doing amplify the strengths that support recovery.

Statement 5: We provide a good range of options to promote social inclusion.

Social connectedness is a resource for health and resilience. It refers to friendships, relationships, family, neighbours, and the feeling of belonging to a community. Social connections include community resources that provide access to transport, housing, education, arts, sport, leisure, and recreation. There could also be connections to church or faith groups, interest groups and non mental health community resources such as libraries, community centres and shops. Isolation and loneliness are known to be detrimental to recovery whereas participation and citizenship supports recovery.

Service providers scoring highly on this statement will be able to describe practical examples where the service successfully promoted social inclusion and connection to networks and resources beyond the physical boundaries of the service, and where this process is undertaken systematically and routinely.

Statement 6: Significant changes have taken place as a result of service user involvement

Service providers rating this statement highly will routinely empower people to participate in the plans, decisions, and actions that affect their lives. Through this intentional strategy people using the service will have influenced service design and delivery and will have experienced themselves as collaborators and partners. Having a say in how things are done may have helped them to work towards their aspirations and recovery.

Service providers judging themselves to have met the aspirations of this statement will be able to provide examples of how, when, why and where these significant changes as a result of service user involvement took place. This would include instances in which having supported service user involvement tangible change had resulted.

Statement 7: We fully involve informal carers wherever we can

Service providers scoring highly against this statement will demonstrate that they involve informal carers from the outset and value this involvement. The service providers will routinely promote informal carer involvement and participation, and be able to describe the mechanisms through which they achieve this. These might include:

  • Leaflets or other literature welcoming informal carer participation.
  • A description of the type of involvement opportunities carers can expect from the service.
  • A description of the limits of informal carer involvement.
  • Information on confidentiality and consent.
  • Information on how the informal carers perspective is incorporated.
  • Informal carer needs assessment
  • Clear policies on seeking service user consent.
  • Clear policies on service user confidentiality.
  • Keep carers informed.

A highly rated service will have recognised and planned for the different levels of confidentiality required for information sharing with informal carers, for example between general information, personal information, and sensitive personal information.

Service providers that believe they fully meet the aspirations of this statement will be able to provide examples of how, when, why and where informal carer involvement took place and what benefits this intentional strategy had for the recovery journey. They will also be able to evidence a culture of respect for the expertise and knowledge of informal carers.

Statement 8: We encourage advance planning and self management

Service providers who give themselves a high score here will be able to describe their commitment to involving the people that use the service in planning for their future including periods of poor mental health. This would include systematically providing information about Advance Statements and how these can be used to cover treatment wishes – both refusal and acceptance of treatment.

High scoring service providers will be able to describe how those using the service and their informal carers were informed about their right to make a 'personal statement' covering wider aspects of preferences such as arrangements for pets, contacting relatives, and so on.

Other factors contributing to a high rating against this statement include the service provider being able to describe what kind of advance or self-management plan or WRAP (Wellness and Recovery Action Plans) are in place, where they are kept, how they are enacted, who is involved in the event of incapacity, arrangements for contacting key individuals and so on. It would be evident that such plans were regularly reviewed and updated in partnership with the individual.

If people using the service do not know about WRAP it could be that the service providers appropriately introduces the concept to them and supports them to develop and manage it.

Statement 9: Staff are supported and valued and opportunities exist to reflect on practice

Service providers that rate themselves highly on the aspirations of this statement will firstly feel supported and valued. This feeling will be the product of an organisational or team culture which acts on the belief that supporting and valuing practitioners is crucial to the delivery of recovery focused care. There will be able to describe how supervision is seen as a key conduit for recovery focused practice, for example practitioners having regular supervision with notes being kept and regularly reviewed. This would be linked to appraisal and continued professional development (CPD) with service leadership modelling the type of reflective behaviours that the service would wish to provide to the people who use the service.

Such service providers will be able to convey their emphasis on reflective practice and that they have a service culture that provides protected time and resources for this. As a result of this staff would be able to: articulate their own attitudes, values and beliefs

  • Demonstrate self awareness.
  • Identify their own strengths and development needs.
  • Demonstrate continuous improvement in their knowledge and practice.
  • Describe the principles or recovery.
  • Effectively listen to and empathise with the people who use the service.

They will also be able to demonstrate that they have access to and make use of training, support, supervision, and other development opportunities. Reflective practice would be embedded in the culture of the service and might include group supervision, and soliciting feedback from the people using the service and their carers.

High scoring services will evidence a range of learning and development opportunities on a range of recovery oriented matters including equalities, awareness of culture, gender, and sexuality, trauma informed practice and strengths based practice. There may also be evidence that informal carers and the people who use the service are considered in the training programme too where possible.

High scores would reflect a multi disciplinary recovery focused environment in which it was evident that all practitioners and perspectives were equally valued.

Statement 10: We are recovery focused practitioners

All service providers would wish to score highly in terms of the aspirations of this statement. Evidence justifying this would come from a number of sources including feedback from the people that use the service and their carers, these being the true arbiters of whether or not the practitioners are recovery focused. Practitioners rating themselves highly on their recovery focused practice would have had feedback from the service users by employing a range of methodologies such as questionnaires, satisfaction surveys, reviews, exit interviews, outcome measures, focus groups, follow up letters and so on.

High scoring practitioners and services exemplify a service model that favours negotiation, collaboration and partnership right from first contact through to exit from the service. While recovery is defined and led by the person, the environment that supports and encourages it is provided by the practitioners.

In support of their assertion that they are recovery focused, service providers will have evidence of their ability to avoid a dogmatic approach in tackling mental health problems. This would include systematically and intentionally providing:

  • Cause for hope and optimism.
  • Promotion of autonomy and self determination
  • Tailored care plans for each individual.
  • Person centred and strengths based practice.
  • Equalities proofed and culturally sensitive practice.
  • Support to help people define their goals, dreams, and aspirations.
  • Social inclusion and community participation.
  • Inclusion of carers, family, and significant others

Scoring and rating.

Each statement will be considered and the highest score of 5 awarded where there is clear evidence that the service provider has met the aspirations of the statement.

A score of one would result if it was found that there was little or no evidence that the aspirations of the statement had been met.

Arriving at a fair score between 1 and 5 is a matter of judgement based on reflection, discussion, and the application of reasoning regarding the quality and quantity of evidence.

The N/A (not applicable) option would be recorded in services where the statement is not applicable or relevant to the service or the person using the service.

Audit tools usually identify deficits and do not recognise good practice, but the SRI is different, I’ve never felt more valued or motivated in my entire nursing career.

It provided valuable insights into the service, user opinions and what adds value for them in relation to service provision.