Development and validation of the Needs in Recovery Assessment (NiRA): A clinical tool for assessing the needs of individuals recovering from a first episode of mental illness

Effectiveness of museum-based participatory arts in mental health recovery

The World Health Organization encourages mental health services to adopt a strategic intersectoral approach by acknowledging the potential of the arts and the value of culture on the process of mental health recovery. The aim of this study was to evaluate the impact of participatory arts in museums on mental health recovery. A quasi-experimental, pre-post and multicentre study was carried out. By using a mixed methods evaluation at baseline and at 3 months, quantitative outcome measures were used to assess the changes in recovery and social support and qualitative interviews to explore the self-perceived impact on five processes of recovery. One hundred mental health service users participated for 3 years in the face-to-face programme RecuperArte, of which the data of 54 were analysed. The results indicate a significant increase in recovery measured with the QPR-15-SP (42 vs. 44; p = 0.034) and almost significant in functional social support measured with the DUKE-UNC (41.50 vs. 43.50; p = 0.052), with almost large (r = 0.29) and medium (r = 0.26) effect sizes, respectively. Participants perceived mostly an impact on the recovery process of Meaning in life 30/54 (55.56%), Hope and optimism about the future 29/54 (53.7%) and Connectedness 21/54 (38.89%), followed by Identity 6/54 (11.11%) and Empowerment 5/54 (9.26%). The findings contribute to the growing evidence of the potential of the arts as a therapeutic tool, the value of museums as therapeutic spaces and the role of nurses in intersectoral coordination, between the mental health and cultural sectors, as facilitators and researchers of these evidence-based practices.

Measuring mental health recovery: Cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP)

Mental health services need reliable and valid instruments to measure mental health recovery outcomes, and the only available one in Spanish is arduous. Adapting an instrument is more efficient than creating a new one as it enables international comparison research. The aim of this study was to conduct a cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery. Fifty-four participants engaged in a five-stage systematic and standardized process carried out from November 2019 to November 2020. Professional translators (n = 4) from the Translation Service Center for Foreign Languages of the Universidad de Alcalá participated in the direct translation, synthesis and back translation stages, and mental health professionals (n = 33) and service users (n = 17) from the Hospital Regional Universitario de Málaga and the Hospital Universitario Virgen de la Victoria in Andalucía (Spain), with an average of 19.2 (SD 12.86) years of experience in mental health, participated in the committee of experts and pilot debriefing stages. Additionally, legibility was assessed. Out of the 15-items of the questionnaire, three (20%) were equal amongst translations, three items (20%) of the back translations matched the original questionnaire and discrepancies identified were adapted accordingly. Seven items (46.7%) were approved online by experts and consensus of alternative translations was reached for the rest. The average time spent completing the questionnaire by service users during the face-to-face pilot was 4.12 min (SD 2.25). Internal consistency obtained was ω = 0.95 and α = 0.91. Debriefing findings reported the questionnaire as comprehensible (97.1%), adequate in wording (91.2%), formal in language (55.9%) and adequate in terms of length (100%). The questionnaire scored 65.53, 'normal' readability, on the Inflesz scale. The adapted instrument has conceptual, linguistic, cultural and metric equivalence to the original instrument.

Introducing the Needs in Recovery Assessment (NiRA) into clinical practice: protocol for a pilot study investigating the formal and systematic assessment of clinical and social needs experienced by service users at a tertiary, metropolitan mental health service

Background

The Needs in Recovery Assessment (NiRA) is a newly developed needs assessment tool, designed to identify the needs of people recovering from mental illness. This tool has been evaluated outside of the clinical context for validity and reliability. The aim of this study is to introduce the NiRA into clinical practice and to evaluate the value of the NiRA as an adjunct to service delivery from the perspectives of stakeholders and to evaluate the barriers and facilitators of embedding the NiRA in a mental health service.

Methods

The establishment of the NiRA in a tertiary mental health unit over a 6-month period will be evaluated using a multi-methods approach. Quantitative data will be collected using the NiRA itself and the Recovery Self-Assessment (RSA). Face-to-face interviews with service users and clinicians will be conducted following the initial completion of the NiRA, with a follow-up interview for service users on discharge from the service. Regular informal follow-up with clinicians throughout the study will support the introduction of the NiRA. Descriptive statistics will be used to analyse quantitative data, and descriptive qualitative methods will be used to analyse data from interviews.

Discussion

Aligning mental health services with recovery-oriented frameworks of care is imperative. The NiRA is a tool that has been designed in accordance with recovery principles and may assist services to be more recovery-oriented. If the NiRA is able to achieve the aims and objectives of this project, a larger implementation study will be conducted.

Trial registration

Australian and New Zealand Clinical Trial Registry (ANZCTR), ACTRN12621000316808

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00919-8.

Evaluating the Reliability of the Needs in Recovery Assessment (NiRA) with Simulated Patients

The Needs in Recovery Assessment (NiRA) is a tool designed to support recovery-oriented and person-centred approaches in mental health services through facilitating the identification and prioritisation of needs. The aim of this study was to evaluate the interrater reliability of the NiRA. Method: Ten mental health clinicians from various professional backgrounds used the NiRA to facilitate assessment interviews with Simulated Patients. Completed and semi-completed NiRA forms, questionnaires, and audio-visual recordings of assessment interviews were collected for analysis. The interrater reliability of the NiRA was calculated using percent agreement and Gwet's Agreement Coefficient (AC)¹. Results: Percent agreement across all items of the finalised tool was 0.84 (item range: 0.55 to 1.0). Overall interrater reliability (Gwet's AC¹) was 0.70 (95% CI 0.64-0.76) with items ranging from -0.08 to 1.0. Conclusion: The NiRA is a reliable tool and is ready to be trialled in a feasibility study in clinical settings. It is anticipated that the NiRA will facilitate a deeper understanding of service users' needs and a more targeted approach to meeting unmet needs.