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

Abstract

The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection

“Establishing the criterion validity of the interRAI Check-Up Self-Report instrument”

“…All adult instruments are built on a minimum set common set of common items, as well as specialised items relevant to particular contexts and patient groups, and are designed to track persons longitudinally over time and across multiple care settings. These instruments have been continuously improved and validated against other commonly used instruments for use in long-term care, acute and post-acute care, home care, mental health, palliative and community settings [16][17][18][19][20][21][22][23][24][25]. The item domains of these instruments have been shown to have good interrater reliability [16] and have been adopted internationally, including countries in North America, Europe, the Middle East, Australasia and East and South East Asia [26,27].…”

Development and psychometric validation of the interRAI ChYMH externalizing subscale

“…The interRAI assessment has over 20 instruments (e.g. pediatric, homecare, palliative care, mental health) built with the same core set of items with identical definitions, time frame observation period, and method of scoring to assess and monitor symptoms and treatment outcomes across the lifespan (Hirdes et al, 2020). While some items are shared across instruments, every interRAI instrument has sector-specific items that were developed based on extensive literature review and relevant symptoms within the sector (Hirdes et al, 2020).…”

“…To increase efficiency, the public sector called for a low cost, standardized, and comprehensive assessment instrument that provides continuity of care to decrease burden of repeated intake assessment on children and their families across service providers (Stewart et al, 2015). The international Resident Assessment Instrument (interRAI) was developed as a collaborative project across 30 countries to develop standardized assessment tools that promote a seamless transition across and within different service sectors (Hirdes et al, 2020). The interRAI assessment has over 20 instruments (e.g.…”

“…pediatric, homecare, palliative care, mental health) built with the same core set of items with identical definitions, time frame observation period, and method of scoring to assess and monitor symptoms and treatment outcomes across the lifespan (Hirdes et al, 2020). While some items are shared across instruments, every interRAI instrument has sector-specific items that were developed based on extensive literature review and relevant symptoms within the sector (Hirdes et al, 2020). Previous research demonstrated acceptable reliability across the interRAI family suite with an overall kappa mean of .75 for 160 shared items in two or more instruments, and over 60% of items on the interRAI family suites had a kappa mean above .70 (Hirdes et al, 2020).…”

Establishing the criterion validity of the interRAI Check-Up Self-Report instrument

“…All adult instruments are built on a minimum set common set of common items, as well as specialised items relevant to particular contexts and patient groups, and are designed to track persons longitudinally over time and across multiple care settings. These instruments have been continuously improved and validated against other commonly used instruments for use in long-term care, acute and post-acute care, home care, mental health, palliative and community settings [16][17][18][19][20][21][22][23][24][25]. The item domains of these instruments have been shown to have good inter-rater reliability [16] and have been adopted internationally, including countries in North America, Europe, the Middle East, Australasia and East and South East Asia [26,27].…”