Instrument/Scale – Resident Assessment Instrument For Mental Health (RAI-MH)
Description
The RAI-MH is a comprehensive assessment instrument designed for adult inpatient psychiatry settings. Using a minimum data set approach, important health domains are assessed and recorded. These data can be used for care planning, quality indicators, outcome measurement, case-mix-based funding, and determining eligibility for services.
Author/Sponsor
The RAI-MH was completed in 2002 through the collaborative efforts of the Ontario Joint Policy and Planning Committee’s Psychiatric Working Group (JPPC; a partnership of the Ontario Ministry of Health and Long Term Care and the Ontario Hospital Association) and interRAI (a not-for-profit international research group with substantial experience in creating comprehensive assessment instruments for nursing homes, home care, acute care, assisted living, palliative care, and rehabilitation settings).
Prevalence
The RAI-MH has been mandated for all inpatient psychiatric beds in Ontario, since October 2005. It is also being pilot tested in British Columbia, Alberta, Manitoba, and Newfoundland as well as some jurisdictions in the United States.
Population
The RAI-MH was designed for use for all adults aged 18 and over in in-patient psychiatric settings, including acute, chronic, forensic and geriatric psychiatry.
Subject
The RAI-MH is completed by a facility’s interdisciplinary team as part of a comprehensive assessment.
Provider Setting
An assessment is completed at admission and then on a quarterly basis as long as the person remains in-hospital. An assessment is also completed if there is a significant change in a person’s status while in-hospital and outside the regular quarterly cycle. Finally, an assessment is completed at discharge.
Derived
The RAI-MH is neither derived nor a component of another instrument. However, the instruments in the interRAI series of instruments contain a standard core group of items, which are identical and, so, facilitate comparison across sectors.
Validity and Reliability Testing
Yes. See references.
Specific vs. Multiple Domain
The RAI-MH assesses a person’s functional status through the following domains and relevant items (i.e. – CCD topics):
· Mental status or competency - memory, decision-making, delirium, cognitive decline, Cognitive Performance Scale (CPS)
· Activities of Daily Living (ADLs) – personal hygiene, walking, wheeling, toilet use, eating, ADL decline, stamina
· Prior living situation
· Ability to care for self – meal preparation, managing medications, transportation, managing finance, phone use
· Social activity – contact, participation
· Occupation activity - employment status, risk of unemployment
· Communication ability – ability to make self understood
· Sensory – hearing, vision
· Mobility (see ADLs) – balance, falls, stamina
· Mental Status (see Mental status or competency)
· IADL - meal preparation, managing medications, transportation, managing finance, phone use
· Social Support – living arrangement, help with child care, supervision for personal safety, crisis support, and support for ADLs or IADLs, dysfunction in family, social relationships and interpersonal conflict
· Environment – financial trade-offs, abuse (sexual, physical, emotional)
· Social relationships activities – contact, participation, employment, interpersonal conflict
· Mood/depression – 14 mood indicators, Anhedonia, loss of interest, lack of motivation, reduced interaction, Depression Ratting Scale (DRS)
· Behaviour – wandering, verbal abuse, physical abuse, inappropriate behaviours, resisting care, elopement attempts, extreme behaviour disturbance, Aggressive Behaviour Scale (ABS)
· Pain – frequency, intensity
· Incontinence – bladder, bowel
· Nutrition – height, weight, weight loss/gain, fluid/food intake, indicators of eating disorder, Polydipsia
· Lifestyle – alcohol use, tobacco use, withdrawal symptoms, gambling, use of inhalants, hallucinogens, cocaine/crack, stimulants, opiates, cannabis
Verbal or Observation Based
The RAI-MH is completed by a facility’s interdisciplinary team using all available resources, including the person’s medical record, direct observation, direct questioning, and the questioning of family and friends.
Are Calculated Scores Included
Calculated scores include:
· Depression Rating Scale (DRS)
· Cognitive Performance Scale (CPS)
· Aggressive Behaviour Scale (ABS)
· Activities of Daily Living Scale (ADL)
· Instrumental Activities of Daily Living Scale (IADL)
· Changes in Health, End-stage disease and Signs and Symptoms (CHESS)
· Positive Symptoms Scale
· Negative Symptoms Scale
As well, Quality Indicators and Case-Mix Indices are determined based upon the scoring of various data elements on the RAI-MH
Extended Use
The RAI-MH is not used outside of the original target population. However, it does articulate with other interRAI instruments that are used in other target populations/sectors.
Versions
interRAI Mental Health (2006) is an updated version of the 2002 instrument.
Public Domain
The copyright for the RAI-MH is held by interRAI who freely grant licences for jurisdictional use.
References
Hirdes JP, Marhaba M, Smith, TF et al. (2001) Development of the Resident Assessment Instrument - Mental Health (RAI-MH), Hospital Quarterly, 4(2), 44-51
Hirdes JP, Smith TF, Rabinowitz T, et al. (2002) The Resident Assessment Instrument - Mental Health (RAI-MH): Inter-Rater Reliability and Convergent Validity, Journal of Behavioral Health Services and Research 29(4): 419-432
www.interRAI.org
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