Using the Resident Assessment Instrument-Mental Health (RAI-MH) to Determine Levels of Care for Individuals with Serious Mental Illness

Abstract

This paper outlines the development of an algorithm to determine appropriate levels of care (LOC) for individuals with a serious mental illness (SMI). The algorithm, drew on several domains of the Resident Assessment Instrument-Mental Health (RAI-MH) to support a statistical model that would explain a maximum of variance with the gold standard, a consensus-based global rating of required LOC. The RAI-MH model explained 67.5% of the variance. The validity of the model was further examined by determining how the discrepancy between the current and predicted levels of care related to psychiatric outcomes. The results demonstrated that undersupported clients experienced significant negative psychiatric outcomes compared to clients receiving adequate care. Although the model based on the RAI-MH is not perfect, the results warrant further research to determine its usefulness in predicting required LOC.

Need and use of services by persons with co-occurring substance use and mental disorders within a community mental health system

“…Consistent with previous research (Gibbons et al, 2008;Hanson et al, 2007), this study revealed that a non-trivial proportion of study participants were receiving less care than recommended. It is possible that the algorithm used to calculate current level of care underestimated the amount of support actually being provided to individuals.…”

“…It is possible that the algorithm used to calculate current level of care underestimated the amount of support actually being provided to individuals. This is a limitation of the current study -one that has been identified in similar research (Gibbons et al, 2008). For example, it is possible that clients of the formal system were also accessing informal supports not captured by the SSP.…”

The use of a brief mental health screener to enhance the ability of police officers to identify persons with serious mental disorders

“…The RAI-MH instrument collects information from patients on more than 400 individual items measuring mental and physical health symptoms, sociodemographic characteristics, substance abuse, risk of harm to self or others, functional characteristics, and service utilization. Second, the instrument has good reliability and validity in inpatient psychiatry settings (Gibbons et al, 2008;Seto, Harris, & Rice, 2004;Urbanoski, Mulsant, Willett, Ehtesham, & Rush, 2012), with inter-rater agreement averaging 80% or more (Hirdes et al, 2002(Hirdes et al, , 2008. Third, with more than 41,000 individual mental health assessments available for analysis, the RAI-MH data represent a large population upon which to identify, analyze, and validate items as candidates for inclusion on a screener.…”

“…Third, as a pilot study, it was not possible to gather data from a randomized or matched control sample of police interactions with PSMD elsewhere in the province, although the results do compare favorably with other studies and data collected from different jurisdictions. Fourth, it was not possible to measure inter-rater reliability and obtain estimates of validity due to limited project resources and the relatively small sample size, although the individual items included on the screener as based on those in the RAI-MH have demonstrated good validity and reliability across diverse inpatient hospital settings (Gibbons et al, 2008;Seto et al, 2004;Urbanoski et al, 2012). Finally, the dependent variables were limited to police escort to hospital and admission, which does not reflect the current broad range of dispositions available to both police officers and clinicians.…”

A Care Planning Strategy for Traumatic Life Events in Community Mental Health and Inpatient Psychiatry Based on the InterRAI Assessment Instruments

“…The community pilot did not have a mandatory time to initial assessment, and it was used as part of normal clinical practice for new intakes or persons scheduled for routine reassessment only. The RAI-MH has been shown to have strong inter-rater reliability and convergent validity (Hirdes et al 2002(Hirdes et al , 2008Gibbons et al 2008), The Ontario Ministry of Health and Long-term Care mandated its use for all adult inpatient psychiatric beds as of October 2005. The interRAI CMH has been pilot tested in 12 community mental health programs in Ontario as well as by the Department of Community Services in Newfoundland (Martin et al 2008).…”