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An important challenge facing behavioral health services is the lack of good quality, clinically relevant data at the individual level. The article describes a multinational research effort to develop a comprehensive, multidisciplinary mental health assessment system for use with adults in facilities providing acute, long-stay, forensic, and geriat...
Context in source publication
Context 1
... is, the RAI-MH aims to organize information to support decision making by clinicians, but it does not replace their clinical judgment. Table 1 provides a list of the MHAPs included in the RAI-MH. The MHAPs are intended to deal with a broad range of patient needs, strengths, and preferences, with the aim of supporting optimal functioning. ...
Citations
... Information may be obtained through interview with the patient, caregiver(s), observation of the patient, other clinical staff, and/or review of the medical records. The RAI-MH has demonstrated acceptable inter-rater reliability and convergent validity [27][28][29], but has not been cross-culturally validated. The symptom and behaviour variables presented in Table 1 were summary measures generated from rating scales completed within the RAI-MH. ...
Background
Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission.
Methods
Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009–2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared clinician-rated symptoms and behaviours at admission between first-generation immigrants and refugees and the general population, and adjusted for these variables to ascertain whether the elevated prevalence of involuntary admission persisted.
Results
Immigrants and refugee groups tended to have lower ratings for affective symptoms, self-harm behaviours, and substance use, as well as higher levels of medication nonadherence and poor insight. Immigrant groups were more likely to be perceived as aggressive and a risk of harm to others, and both groups were perceived as having self-care issues. Adjustment for perceived differences in clinical presentation at admission did not attenuate the higher prevalence of involuntary admission for immigrant and refugee groups.
Conclusions
First-generation migrant groups may differ in clinical presentation during the early course of psychotic illness, although these perceived differences did not explain the elevated rates of involuntary admission. Further research using outpatient samples and tools with established cross-cultural validity are warranted.
... The aim of the interRAI instrument family is to support the assessment and planning of care with the elderly, disabled and psychiatric service users [35] and, most recently, with children and youth [36]. In the development of the interRAI instruments for mental health the underlining principles have been rehabilitation, recovery and empowerment [37]. Evidence indicates that the interRAI instruments consider different issues relevant and suitable for service users in different care settings and in different cultures and languages [35,38,39]. ...
Objective: To explore the changes between before and after residential psychiatric rehabilitation in functioning and psychiatric symptoms in young adults with severe mental disorders. Method: Participants (n = 39) were aged 18-29 and had been in residential psychiatric rehabilitation for the period 2011-2017. We gathered data retrospectively from clinical registers, day-today records, rehabilitation plans and interRAI community mental health evaluations. Changes in several outcomes of functioning and psychiatric symptoms were analysed in young adults with severe mental disorders at the end of rehabilitation. Results: Median length of rehabilitation was 29 months. Symptoms of depression (p=0.001), mania (p=0.009), negative symptoms (p=0.017), anhedonia (p=0.012), the risk of harming others (p=0.010) and severity of self-harm (p= 0.015) had decreased from before to end of rehabilitation. In addition, performance in activities of daily living (p=0.016) had improved and the number of persons living independently had increased (p=0.001). Conclusion: Psychiatric rehabilitation may be effective in decreasing psychiatric symptoms, improving functioning and increasing independent living among young adults with severe mental disorders. These results support the need for comprehensive psychiatric rehabilitation with evidence-based interventions. This important research area requires further investigation with larger sample sizes, prospective study settings and longer follow-up times.
... Clinicians can use the results of the inter-RAI ChYMH and the interRAI ChYMH-DD assessment for treatment planning, program evaluation and to determine the allocation of resources. The scales and algorithms within the assessment instruments have been found to have strong construct, concurrent, and predictive validity as well as internal consistency and inter-rater reliability [35][36][37]. A large body of research have demonstrated strong psychometric rigour of the interRAI Child and Youth suite of instruments [34,[38][39][40][41]. ...
This study investigated the prevalence of lifetime concussions, related psychosocial problems, and post-concussion recovery rates in a clinical sample of children and youth. Participants were 24,186 children and youth (M = 11.9 years, SD = 3.5) who completed an interRAI Child and Youth Mental Health Assessment at mental health agencies across Ontario, Canada. In addition to the expected physiological correlates, results found concussions to be more prevalent in children and youth with attention deficit hyperactivity disorders, anxiety disorders, disruptive behaviour disorders, mood disorders, and those involved in self-harm, harm to others, destructive aggression, and internalizing and externalizing symptoms. The results of this study add to our understanding of children and youth’s experiences with concussions. Clinical implications and recommendations are discussed to maximize the effectiveness of evidence-based interventions related to concussion recovery.
... Since 2008 in Ontario, Canada, all psychiatric inpatient service providers are required to assess patients at admission, discharge, and quarterly in the case of extended stays using the Resident Assessment Instrument for Mental Health (RAI-MH). 1 The RAI-MH has well-established reliability and validity (27)(28)(29). RAI-MH admission data provides a snapshot of the demographic, psychosocial and clinical circumstances of individuals within an acute period prior to their hospital admission. Harnessing this data may permit identification of sex-specific factors present at the time of elevated suicide risk in individuals who had suicide plans and/or attempts in the period immediately preceding hospitalization. ...
Background
Individuals requiring inpatient psychiatric care represent a group at higher risk of progressing toward suicide attempt. Using electronic medical record (EMR) data collected from psychiatric inpatient admissions, the objective of this study was to identify sex differences in risk factors for suicide plans and/or attempts within the 30 days preceding hospital admission.
Methods
Resident Assessment Instrument for Mental Health (RAI-MH) intake data were obtained for patients admitted to a Canadian tertiary-care hospital deemed a “threat or danger to self” during a 10-year period (2008–2018). Data was extracted for individuals categorized into three groups: non-suicidal (N = 568), presence of suicide plan (N = 178), and presence of suspected suicide attempt (N = 124) in the 30 days prior to hospital admission. Multivariate logistic regression models were used to examine determinants of suicide risk.
Results
Across all models, diagnosis of depression was the strongest predictor of suicide plan and/or attempt (OR = 5.54, 95% CI = 3.71–8.27, p < 0.001). Comparing clinical symptoms between suicidal and non-suicidal groups at the time of admission, the largest effect sizes were found for hopelessness (p < 0.001, η² = 0.11), and guilt or shame (p < 0.001, η² = 0.09). Female sex was identified as a significant factor for elevated suicidal risk (OR = 1.56, 95% CI = 1.01–2.21, p = 0.01), thus we stratified the regression model by sex to identify specific risk factors for suicide plan and/or attempt for males and females. Among males, having no confidant (OR = 2.13, 95% CI = 1.19–3.80, p = 0.01), presence of recent stressors (OR = 1.95, 95% CI = 1.16–3.29, p = 0.01), and participation in social activities (OR = 1.67, 95% CI = 1.02–2.71, p = 0.04) were important predictors, while among females, younger age (OR = 0.96, 95% CI = 0.94–0.97, p < 0.001) increased odds of suicide plan and/or attempt.
Conclusion
EMR-derived findings highlight different psychosocial and clinical determinants for males and females associated with suicide plan or attempt prior to psychiatric admission. Identifying precipitating factors that elevate imminent suicide risk may inform suicide prevention efforts for psychiatric inpatients.
... In response to the call for an effective mental health information system for adults, interRAI has developed a number of assessment and screening instruments [e.g., (32)]. For an indepth review of the adult mental health suite of instruments, please see our previously published work (33). ...
Various biological, social, psychological, and environmental factors impact children and youth living with mental health problems across their lifespan. To meet the wide-ranging challenges of mental illness, service system integration is needed to improve efficiencies and reduce fragmentation. Unfortunately, the mental health system has been plagued by the lack of coordination across services. There is a general consensus that mental health service delivery must ensure a child or youth’s needs are addressed in a collaborative, coordinated, and seamless manner. A key element to successful integration is the development of a comprehensive standardized screening and assessment system. Numerous assessments have been developed to assess child mental health and functioning, but they typically have a very narrow focus with limited use and utility. Not only does this reduce the ability to take a life course perspective to mental health, but this uncoordinated approach also results in redundancies in information collected, additional resources, and increased assessor burden for children, youth, and their families. The interRAI child and youth mental health assessment suite was developed in response to the need for an integrated mental health system for young persons. This suite includes screening and assessment instruments for in-patient and community settings, emergency departments, educational settings, and youth justice custodial facilities. The instruments form a mental health information system intentionally designed to work in an integrated fashion beginning in infancy, and incorporate key applications such as care planning, outcome measurement, resource allocation, and quality improvement. The design of these assessment tools and their psychometric properties are reviewed. Data is then presented using examples related to interpersonal trauma, illustrating the use and utility of the integrated suite, along with the various applications of these assessment systems.
... Hamilton Depression rating scale is a depression assessment scale. Hirdes et al. (2002) interraI-MH a comprehensive standardised instrument for evaluating the needs, strengths, and preferences of adults with mental illness in in-patient psychiatric settings a mental health assessment instrument that allows for assessment of key domains of function, mental and physical health, social support, and service use. the World Health Organisation Disability assessment schedule is a generic and standardised method for measuring and identifying health issues within the domains of cognition, mobility, self-care, getting along, life-activities and participation in the community. Wing et al. (1999) HonOs the Health of the nation Outcome scales is a set of 12 scales, each measuring groups of problems commonly presented by people with mental health issues. ...
Novice nurses’ mental health assessment practice is characterised by lack of consistency, despite mental health assessment being a core issue in professional nursing and patient safety across health services. This study aimed to identify mental health signs relevant for an assessment tool suitable for student and novice nurses. A document analysis approach was applied, and content analysis was used to analyse data extracted from carefully selected documents. Four main categories of mental health issues were identified: risk issues, symptom issues, psychological issues and self-care issues. Mental health signs were thereafter grouped in ten sub-categories characterising mental health concerns. These were: risk concerns, psychotic concerns, mood, affect and energy concerns, substance use concerns, somatic concerns, perception concerns, communication concerns, cognitive concerns, anxiety concerns and self-care concerns. The identified signs are considered relevant for student and novice nurses to learn and can be further developed into a clinical assessment tool for use in nursing education to strengthen mental health assessment competence in nursing education.
... The interRAI MH is an assessment system for persons hospitalized with mental health issues, to improve care-planning by the identification of problems, risks, and strengths of the patient (12)(13)(14). It is completed by front line clinical staff at each patient's admission to hospital (within the first 3 days in hospital), discharge from hospital, and every quarter (every 3 months) for long-stay patients. ...
... The interRAI MH has numerous advantages, including that it has received extensive psychometric development and evaluation (12,(15)(16)(17)(18)(19). ...
Background: Numerous validation studies support the use of the interRAI Mental Health (MH) assessment system for inpatient mental health assessment, triage, treatment planning, and outcome measurement. However, there have been suggestions that the interRAI MH does not include sufficient content relevant to forensic mental health. We address this potential deficiency through the development of a Forensic Supplement (FS) to the interRAI MH system. Using three forensic risk assessment instruments (PCL-R; HCR-20; VRAG) that had a record of independent cross validation in the forensic literature, we identified forensic content domains that were missing in the interRAI MH. We then independently developed items to provide forensic coverage. The resulting FS is a single-page, 19-item supplementary document that can be scored along with the interRAI MH, adding approximately 10–15 min to administration time.
We constructed the Problem Behavior Scale (PBS) using 11 items from the interRAI MH and FS. The Developmental Sample, 168 forensic mental health inpatients from two large mental health specialty hospitals, was assessed with both an earlier version of the interRAI MH and FS. This sample also provided us access to scores on the PCL-R, the HCR-20 and the VRAG. To validate our initial findings, we sought additional samples where scoring of the interRAI MH and the FS had been done. The first, the Forensic Sample (N = 587), consisted of forensic inpatients in other mental health units/hospitals. The second, the Correctional Sample (N = 618) was a random, representative sample of inmates in prisons, and the third, the Youth Sample (N = 90) comprised a group of youth in police custody.
Results: The PBS ranged from 0 to 11, was positively skewed with most scores below 3, and had good internal consistency (Cronbach's Alpha = 0.80). In a test of concurrent validity, correlations between PBS scores and forensic risk scores were moderate to high (i.e., r with PCL-R Factor two of 0.317; with HCR-20 Clinical of 0.46; and with HCR-20 Risk of 0.39). In a test of convergent validity, we used Binary Logistic Regression to demonstrate that the PBS was related to three negative patient experiences (recent verbal abuse, use of a seclusion room, and failure to attain an unaccompanied leave). For each of these three samples, we conducted the same convergent validity statistical analyses as we had for the Developmental Sample and the earlier findings were replicated. Finally, we examined the relationship between PBS scores and care planning triggers, part of the interRAI systems Clinical Assessment Protocols (CAPs). In all three validity samples, the PBS was significantly related to the following CAPs being triggered: Harm to Others, Interpersonal Conflict, Traumatic Life Events, and Control Interventions. These additional validations generalize our findings across age groups (adult, youth) and across health care and correctional settings.
Conclusions: The FS improves the interRAI MH's ability to identify risk for negative patient experiences and assess clinical needs in hospitalized/incarcerated forensic patients. These results generalize across age groups and across health care and correctional settings.
... The interRAI Emergency Screener for Psychiatry (ESP) is an instrument designed for the use of health and mental health professionals dealing with urgent mental health situations: physicians, psychiatrists, psychologists, nurses, social workers and family physicians (Rabinowitz, Hirdes, Curtin-Telegdi, Martin, & Smith, 2013). The principles of interRAI mental health assessment systems include the evaluation of the person in order to maximize functional capacity and quality of life, identify physical and mental health problems and improve the level of independent functioning (Hirdes & et al., 2020;Hirdes & et al., 2002;Hirdes & et al., 2009). interRAI is a collaborative network of researchers, clinicians, and policy experts in over 35 countries committed to improve care for persons who are disabled or medically complex. ...
Objective: The aim of this study was to carry out the translation and present the evidence of validity of the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP). Method: this is a cross-sectional study conducted in a municipal hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. A total of 161 patients were evaluated in the first 24 hours of emergency arrival using ESP. Exploratory factor analyses of the sections of the instrument and reliability analyses were conducted using Cronbach's alpha and McDonald's Omega. Results: the analyzes suggested a factorial structure adequate to the purpose of the instrument, with two sections (Mental State Indicators and Harm to Self and Others) having a two-factor solution, contrary to the expected one-factorial expectation. However, the two-factor sections have theoretical interpretability and consistency. The factor loadings of the items were adequate, all with values equal to or greater than 0.30. The interpreted factors showed internal consistency, assessed by Cronbach's Alpha and McDonald's Ommega indices, with values ranging between 0.60 and 0.94. Conclusion: the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP) demonstrates adequate psychometric properties through the internal structure of the instrument. Future studies should investigate the relationship of the scores produced by the instrument with clinical diagnosis and with covariates relevant to mental health outcomes.
... It was developed to serve and support a variety of purposes, from clinical assessment to clinical-decision making activities. The current version of the RAI-MH counts approximately 400 items, with a time completion estimated between 60 to 75 min According to the provincial mandate, the completion of the RAI-MH is required within 72 h after the admission, every three months, when there are changes in the clinical status of the patient, and upon discharge [14,15,18,31]. ...
We study violence risk prediction at St. Joseph’s Healthcare Hamilton. Data from January 2016 to December 2017 have been anonymized and collected, for a total of 870 episodes of inpatient aggressions perpetrated by 337 patients. We examine the predictive performance of a clinical indicator embedded in a mandatory assessment tool for psychiatric facilities in Ontario, the Resident Assessment Instrument for Mental Health (RAI-MH): the Risk of Harm to Others Clinical Assessment Protocol (RHO CAP). The RHO CAP’s performance is studied among two groups of patients. Moreover, an analysis of the most important risk factors associated with harmful incidents is presented. The RHO CAP has demonstrated a better performance in discriminating which patients were more at risk to commit some type of aggression than at identifying the risk of harm among those who will commit aggression.
... Further, the interRAI Child and Youth Algorithm for Mental Health and Psychiatric Services [16] can be generated. The internal reliability and validity of several of the embedded scales within the interRAI Child and Youth Suite have previously been assessed [19][20][21][22][23][24]. An empirical investigation used data collected (N = 1297) from 15 mental health agencies throughout Ontario to assess inter-item reliability of several of the scales on the ChYMH 1 3 (i.e., Aggressive/ Disruptive Behaviour Scale, Social Disengagement Scale (previously the Anhedonia Rating Scale), Anxiety Scale, Caregiver Distress Scale, Communication Scale, Cognitive Functioning Scale, Depressive Symptoms Scale, Distractibility/Hyperactivity Scale, Peer Conflict Scale, Sleep Difficulties Scale). ...
... As predicted, ChYMH subscales correlated well with relevant criterion measures. These findings supported the clinical utility of the ChYMH for use among clinically referred children and were consistent with previous research using the interRAI adult assessment instruments [24][25][26] which demonstrated strong internal consistency and criterion validity. While ChYMH subscales demonstrate strong psychometric properties in previous review, an evaluation of these subscales within the screener version of the ChYMH has yet to be conducted. ...
... Finally, the use of the ChYMH over time allows for a consistent, standardized, and psychometrically sound assessment system [23,24]. Therefore, as the use of the interRAI assessments grows, it will enable the creation of a large longitudinal database to examine the progression of child psychopathology into adulthood beginning in infancy. ...
Mental health concerns among children are pervasive, with one in five in North America experiencing a mental health issue. Unfortunately, only about a quarter will receive the support they need. interRAI is an organization of expert researchers and clinicians who develop integrated assessment systems to improve evaluation for vulnerable populations. The interRAI Child and Youth Mental Health Screener (ChYMH-S) is a brief screener that provides an initial assessment for early identification, triaging, and prioritization of services. This study assesses the psychometric properties of the ChYMH-S. Data from children aged 4–18 years across Ontario mental health agencies were obtained. The screener demonstrated strong inter-item reliability on all measured scales and good convergent validity with the Behaviour Assessment System for Children, with all hypothesized comparisons demonstrating positive, significant correlations. Overall, results provide initial support for the reliability and convergent validity of the ChYMH-S in detecting mental health concerns in child populations.
