Purpose:

The purpose of this part of SRI 2 is to help practitioners reflect on ten current (or as recent as possible) assessments, through a structured process facilitated by the coordinator. This opportunity for reflective practice generates discussion and scores that are fed into the SRI 2 website by the coordinator and used later in the creation of the action plan.

Assessments are one of the three sources of documentary data, the other two being care plans and service information.

The assessment data collection sheets are printed from the SRI 2 website and used to record practitioner's ratings and comments. You should print one assessment data collection sheet for each assessment being reviewed. For example, if you plan to review ten assessments then you should print ten data collection sheets. The first page of these data collection sheets contains the following guidance.

SRI 2 Data Collection Sheet - Assessments

About the data collection sheets

The following data collection sheets are part of the SRI 2 data collection process. Completing them will help your service reflect on whether the assessments you have selected for review are recovery focused.

Complete one data collection sheet per assessment. Completing ten assessment data collection sheets should take no more than two hours.

In gathering information we recommend:

  • You review ten current or recent assessments.
  • As many of the team as possible are involved in reviewing assessments.
  • You protect confidentiality by ensuring information recorded is anonymous.
  • You only use written evidence from the assessment. Staff interpretation and opinion should not be counted as evidence.

Gathering information

Once you have reviewed an assessment:

  • In the space provided write examples of how the assessment matches the opening statement, e.g. Basic needs are routinely considered.
  • Based on the extent to which you think the assessment matches the statement 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 Relating to Assessment

There are ten recovery indicators, eight of which are considered in relation to assessment. Each of the eight 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 that the team will reflect on is Basic needs are routinely considered.

The ten recovery indicators and associated statements are shown below.

Recovery IndicatorAssociated statement to rate between 1 and 5
Basic needs are identified and addressed. Basic needs are routinely considered.
Goals are identified and addressed. Goals are routinely considered.
Personalised services are provided. Personal choice is routinely considered.
Service is strengths based. Strengths are routinely identified and explored.
Service promotes social inclusion. Social connectedness is routinely considered.
Service promotes and acts on service user involvement. NO DATA REQUIRED
Informal carers are involved. Informal carers' role is routinely considered.
Service encourages advance planning and self management. Advance plans and self management plans are routinely considered.
Staff are supported and valued. NO DATA REQUIRED
Practice is recovery focused. Promotes hope and optimism.

Guidance for Rating

This section of the guidance will help the team rate their assessments against the associated statements, and offer suggestions as to what kind of factors influence the rating.

The degree to which practitioners feel their ten assessments achieve the aspirations of the eight statements will be derived from hard evidence recorded in the assessments, as opposed to being guided by a general feeling or subjective opinion.

High scoring recovery focused assessments include evidence of assessment of strengths, aspirations, dreams, and preferred outcomes. Such assessments develop and can take many sessions to complete, the priorities change with the person's circumstances and wishes. They include information about which other partners, agencies, family, carers, and providers such as housing, are involved in the persons care.

As well as planning for risks and problems, highly rated assessments evidence the following:

  • Ensuring all partners are consulted.
  • Assessing for wellbeing, strengths and resources.
  • Incorporation of self management strategies.
  • Eliciting the person's expertise.
  • Focus on the future and immediate desired outcomes.

Assessments should be reviewed in turn with a rating and supporting evidence recorded on one data collection sheet per assessment. This means that if you review ten assessments you should have ten corresponding data collection sheets. Your rating should be justified by supporting evidence from the assessments. You may prefer for one person to review all assessments or to take a group approach.

Statement 1 Basic needs are routinely considered

The team will look at the ten assessments seeking written evidence suggesting that basic needs have been routinely considered. 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 assessed as standard practice.

Basic Need: Housing

Examples of evidence that the basic need for housing had been considered would include written factual information concerning 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 high scoring assessment covering nutrition would record data about eating habits, and would perhaps make use of one of the many nutrition screening tools. There would be information about 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.

Basic Need: Health

Assessment data about the basic need for health would have information about physical health including diet, 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. The person's health may also have features which are a resource for recovery such as the ability to go running or having a good level of energy. A highly rated assessment would have noted this type of strength based information too.

Basic Need: Finance

Money is a basic need, and a recovery focused assessment would record information about income, benefits, entitlements, employability, income maximisation, and debt. There is an established connection between poverty, debt and poor mental health.

Basic Need: Safety

Safety is a basic human need and recovery may not be possible if personal safety is at risk. Safety concerns could be due things such as domestic abuse or anti social neighbours or any other factor that the person feels compromises their safety.

Basic Need: Personal Care

Assessment of personal care needs includes exploration of 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 in the assessments that people were being asked about what they saw their spiritual needs as being. 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. Spirituality is viewed by some as a resource for living and recovery and something that provides meaning in their lives. High scoring assessments provide evidence indicating that spirituality is routinely being considered.

Statement 2: Goals are routinely considered

The team will look for written evidence across the range of assessments that goals are routinely considered. It should be evident that the goals were set by the people using the service and not by the practitioners conducting the assessments. Sometimes goals and targets seem to reflect the aspirations of the service providers. Eliciting goals and aspirations salient to the individual requires skilled intentional communication and facilitation skills as discussed in this guidance in the introduction. High scoring recovery focused assessments provide clear written evidence that this routinely happens.

Statement 3: Personal choice is routinely considered

Personal choice will evidently have been routinely considered when a range of assessments demonstrate that those using the service are offered options and choices, and that their personal preferences are intentionally elicited. Such assessments will be adaptable and capable of responding to unique needs. A person centred and holistic approach to assessment demonstrates that personal choices around such things as cultural needs, need for privacy, and other preferences have been systematically taken into consideration. Assessments will show variation demonstrating that the service assessment process is flexible and avoids a 'one size fits all' approach.

Statement 4: Strengths are routinely identified and explored

Strengths based practice is a relatively new sphere in mental health thus strengths have not traditionally been the focus of assessment. A focus on strengths does not deny the existence of vulnerability, need and distress. Evidence that strengths are being routinely identified and explored during assessment would include questions designed to elicit and explore strengths. Strengths based assessments record the person's interests, aspirations, skills, and assets. How the person managed to parent children, work, look after pets, sustain a tenancy, form relationships and so on are all identified and explored with a view to utilising these strengths as part of the solution to the current problems. A highly rated set of assessments would have evidence that strengths have been identified and explored across a range of domains.

Statement 5: Social connectedness is routinely considered

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.

Assessments that score highly will have considered social connections systematically and routinely.

Statement 6: Informal carers role is routinely considered

Informal carers include parents and other kin, who may be the single most significant, long term, reliable resource available to the individual. It is therefore vital that with the person using the service's agreement, the informal carer is fully involved and included.

Not all people using services want family or carers involved, and that wish must be respected, but carers are very often an asset and resource for recovery.

Carers groups have expressed wishes that include the following commitments from policy and service providers:

  • Routinely identify and support carers, especially when someone first accesses mental health services and particularly in the case of young carers.
  • Provide mental health carers with information and training to care effectively.
  • Ensure each carer has a written care plan and Carers Assessment.
  • Promote the involvement of mental health carers in training and selection of mental health staff locally.
  • Provide substantial respite to mental health carers in every area.
  • Provide information about the meaning of the diagnosis.
  • Provide information about the treatment plan.
  • Provide answers to questions and concerns.
  • Provide information about the person's rights.
  • Incorporate informal carers perspective in assessment.

Clearly resources may not allow all of these wishes to be fully granted but the fact that they are being raised, discussed and routinely considered is in itself of benefit to the carer.

Statement 7: Advance plans and self management plans are routinely considered

Involving people in the planning of their treatment and care is part of Scottish Government policy. When treatment has been deemed compulsory Advance Statements can be used to cover treatment wishes – both refusal and acceptance of treatment. People can also make a 'personal statement' covering wider aspects of their preferences such as arrangements for pets, contacting relatives, and suchlike.

It may be that the person using the service and their carer does not know about advance plans and in that case information would be provided. Consideration would also be given to practical issues such as the intent of such a plan, who knows about it and where it is kept.

The level of use of advance plans will depend on the knowledge attitudes and expectations of both the service provider and the people using the service. Self management plans can include plans made by the person for the future including periods of poor mental health. One example of this type of plan is WRAP, the Wellness and Recovery Action Plan which is a structured plan developed by the person using the service. The WRAP is a toolbox of strategies which might include positive self-talk, recalling accomplishments, thinking about affirmations, or whatever other recovery focused activities that have proved successful for them in the past.

Statement 8: Promotes hope and optimism

Assessment can be a therapeutic intervention in itself. Conducted with empathy it can provide the person with a sense of being understood and accepted. Such an approach to assessment in itself promotes hope and optimism. Positive states of mind are known to support recovery while hopelessness and pessimism whether in the person or the practitioner are known to hinder recovery. Assessment questions imply outcomes, for example "how do you plan to fill your time now that you have severe and enduring mental ill health" implies a different outcome from "what are your best hopes for your future when you leave this service"? Evidence of the promotion of hope and optimism in the assessment would include a record of such things as:

  • Aspirations, hopes and dreams (to be without dreams is to be without hope).
  • Strengths skills and abilities used to overcome problems and difficulties in the past.
  • Resources of all types (internal, environmental, relational, cultural, spiritual, and so on).
  • Vocational issues and employability possibilities.
  • Acknowledgment that the intervention will end and that there is a future beyond services.

Scoring and rating

Each statement will be considered and the highest score of 5 awarded where there is clear evidence across the range of assessments that the service 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.