Exploring the impact of common assessment instrumentation on communication and collaboration in inpatient and community-based mental health settings: a focus group study

Abstract

BackgroundRecognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. However, actually bringing fully integrated services to life has eluded most health care organizations. Mental health has followed the rule, rather than the exception, when it comes integrating services. The lack of effective mechanisms to evaluate the needs of persons across mental health care services has been an important barrier to communication between professionals involved in care. This study sought to understand communication among inpatient and community-based mental health staff during transfers of care, before and after implementation of compatible assessment instrumentation.MethodsTwo focus groups were held with staff from inpatient (n = 10) and community (n = 10) settings in an urban, specialized psychiatric hospital in Ontario (Canada) – prior to and one year after implementation of compatible instrumentation in the community program. Transcripts were coded and aggregated into themes.ResultsVery different views of current communication patterns during transfers of care emerged. Inpatient mental health staff described a predictable, well-known process, whereas community-based staff emphasized unpredictability. Staff also discussed issues related to trust and the circle of care. All agreed that compatible assessments in inpatient and community mental health settings would facilitate communication through use of a common assessment language. However, no change in communication patterns was reported one year post implementation of compatible instrumentation.ConclusionsThough all participants agreed on the potential for compatible instrumentation to improve communication during transfers of care, this cannot happen overnight. A number of issues related to trust, evidence-based practice, and organizational factors act as barriers to communication. In particular, staff noted the need for the results of comprehensive mental health assessments to be transformed into meaningful, user-friendly clinical summaries to facilitate uptake of assessment information, and consequently use of a common assessment language across mental health settings.

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

“…The interRAI Mental Health (MH) assessment (157,158) supports care plan development in 20 domains, and is used in in-patient mental health settings at admission, discharge (if more than 7 days after admission), every 90 days (for long-stay patients), and when there is a clinically significant change in the person's status that is not a self-limiting and could require modifications to the care plan. The instrument is available in English, Canadian and Belgian French, Flemish, Icelandic, and Finnish.…”

“…The assessment can be used at intake, discharge, every 6 months depending on length of stay, and after a change in the person's status that requires care plan modification. If the person is admitted to the community agency from an inpatient setting using the MH, the discharge MH assessment is shared to support continuity of care (161) to allow additional time for community staff to establish a clinical relationship with the person. The target audience for the CMH is also adults aged 18 years and older, including a broad range of service recipients.…”

Methodological challenges in the use of focus groups with people with severe mental illness

“…In the last ten years, focus groups have been increasingly used in mental health research 20,28,29,30 to investigate different themes, such as: the illness experience and the recovery process 30,31,32,33,34,35 ; social stigma 26,30,36,37 ; evaluation of psychosocial services/interventions 28,38,39,40 , of primary care services 41 and training programs 42 , for developing measures 43,44 or validation of structured questionnaires 21 . However, few studies discuss focus group potentials and limitations when conducted with people with psychosocial disabilities.…”