The Hope, Agency and Opportunity PROM: A Recovery focused PROM for Mental Health Services Liz Vernon-Wilson, Outcomes Researcher Southern Health NHS Foundation Trust
Overview Hope, Agency & Opportunity, HAO, is a very brief measure of personal recovery and demonstrates satisfactory psychometric qualities. The HAO tool can be used by services users of different tier services to report on and follow their progress towards personal recovery. Such patient reported outcomes enrich information available about clinical effectiveness. HAO use encourages and facilitates communication about recovery, identification of personalized goals and collaborative care planning to achieve personal objectives.
Introduction & Context The Five Year Forward View for Mental Health aims to tackle variation of MH services quality and outcomes. Reaffirms movement towards a MH Payment System that uses outcome measures. Identifies the need for people with lived experience (and their families or carers) to assure MH services are judged on quality and outcomes valued by service users. Southern Health has been working with local CCGs* to develop a PROM relevant to service users that also aligns with service wide Recovery focused objectives. *West Hampshire & Southampton
HAO a Co-produced PROM Co-production goes beyond the idea of citizen engagement or service user involvement to foster the principle of equal partnership. Our PROM came from co-production work at the Recovery College Our aim is to recognise outcomes that matter to service users
Hope, Agency & Opportunity Our PROM is brief & recovery focused Acceptable to service users & multidisciplinary staff Personal comments inform care planning & help develop goals. Tracks individual s progress & the last question tests patient experience.
HAO Validation study Two samples; clinical cohort from secondary mental health services (n=139) non-clinical cohort (n=201). Exploratory factor analysis revealed a one-factor solution for both samples. We term this latent factor Recovery Internal consistency acceptable ; Score for Cronbach s alpha ( =0.7) Test re-test reliability after 2-weeks; intra-class correlation coefficient indicated substantial reliability.
HAO Convergent Validity Strong correlation when compared to with longer questionnaires of wellbeing, outcome and experience; WEMWBS Warwick Edinburgh Mental Wellbeing Scale a 14 item measure (r=0.77, r=0.71) QPR Questionnaire about the process of recovery* a 15 item measure (r=0.79 ) Brief INSPIRE a 5 item measure. Correlation (r=0.56, 0.62) The former two are considered to be PROMs whilst Brief INSPIRE is a measure of patient experience. Clinical sample n=126 *Non-clinical sample didn t complete QPR
Clinical data Implementation in Community & Inpatient settings Used both as OM & engagement tool Emergent use as a prompt for collaborative care planning.
Measuring Recovery Implementation Process or cycle? Scene Setting Getting started Taking Stock Adding Value Introducing Recovery themes Benefits of Patient s perspective and reporting their own outcome The tool Workshops to develop skills through role play Tackling process issues Improvements made to tool Return visits to look for application Build on strengths & address weaknesses Engagement through lived experience and case studies Your teams outcomes from service users perspectives Alignment with other quality indicators and clinician reported outcomes New modes of offer Spreading best practice
Inpatient Implementation Wards have integrated HAO offer into first Recovery Focused conversation (typically within 48 hours of admission). Peer support workers or other staff offer PROM. Decline rate is affected by style of offer and service user s presentation/degree of distress.
Inpatient Outcomes Analysis of 279 admission pairs from 5 wards. Mean duration 65 days (range 10-200 days). Variation in PRO between wards has endorsed peer support workers contribution to care.
Tracking Recovery HAO scores can be used to follow individual s progress towards recovery. AS is a young woman who was initially admitted under MHA 2 with emerging schizoaffective disorder. Initially on an acute ward, AS moved to rehab services where she completed psychological interventions & a WRAP. AS was discharged Jan 2016. She lives in supported accommodation. Her PROM scores show how Hope, then Agency (sense of control) improve over time. Finally sense of opportunity increases The PRO are presented alongside clinician rated scores for severity of hallucinations/delusions.
Community PRO The decline rate is lower in CMHT settings, typically 5% or lower, when offered Variable success offering & completing first PROM effects success in reporting PRO for whole episodes. Improvement Deterioration Here, total HAO scores for 29 initialdischarge pairs & 46 initial-review pairs are shown. There is significant change for discharge pairs Hope p<0.01 Agency p<0.005 Opportunity p<0.05 Comparing paired working relationships scores shows significant difference for both groups p<0.05
Towards Collaborative Care In addition to delivering outcome information, PROM can help identify handover issues & promote personalised, contiguous care goals going forwards into CMHT environment. Your Scores Your Comments Your Goals HOPE Quite a lot Opportunity Not much Agency Somewhat Working relationships Quite a lot My outlook is currently good at present. I feel unable to cope with difficulties for example probation/baliffs I'm not a sociable person and I stay in a lot I do feel supported by mental health services Live with partner and work, keep busy. Reduce alcohol Deal with stress without booze Control hallucinations Downsize flat & pay off arears Voluntary work (gardening)
Our PROM Challenges Better patient facing information More paired data & longitudinal analysis Appropriate contextualisation Interventions Diagnosis CROM, PREM Reflective practice and sharing the good stuff Some days are better than others. Hope can be difficult to find and slips through your fingers like sand
Summary Hope, Agency & Opportunity is a brief, Recovery focused PROM that tracks changing mental health and wellbeing. Acceptable to service users and clinicians Suitable for different care settings Measures a single factor Recovery Promoted engagement and collaborative care planning Outcomes need careful contextualisation against other indicators, E.g. Individuals progress against life events, engagement Aggregated data against diagnosis, intervention, LoS, etc.
Acknowledgements Southern Health Katherine Newman-Taylor (University of Southampton) Lesley Herbert Kate Sault Christie Garner Charlotte McCann University of Southampton Sheen Au-Yeung