BACKGROUND/RATIONALE:
Recovery-oriented acute inpatient mental health services support Veterans' recovery from mental illness and/or addictions by encouraging illness self-management, facilitating access to evidence-based treatments, and increasing patient involvement in outpatient services. The VA has recently issued guidelines regarding the implementation of such services. The proposed study will examine Veteran and staff perspectives of recovery-oriented inpatient services and the relationship between these services and Veteran outcomes (e.g., engagement in outpatient services and relapse). Results will be used to support further implementation of recovery-oriented services as well as refine methods for measuring implementation.
In 2013, VHA issued the Inpatient Handbook, to standardize acute inpatient mental healthcare with a focus on "recovery-oriented clinical care that encompasses staff engagement, patient engagement and empowerment, and instilling a sense of hope." In 2014, the Office of Mental Health Operations operationalized the elements of recovery-oriented inpatient care and provided guidelines for implementation. However, little is known regarding the uptake of these guidelines, the process sites have used to implement these services, or the impact that implementation has had on Veterans or staff.

OBJECTIVE(S):
The aims of this study are to: 1) Examine the implementation of recovery-oriented services within VHA; 2) Describe the implementation process, including challenges and strategies to overcome them; and 3) test the hypothesis that Veterans served by high recovery units will be more engaged in outpatient services and experience lower relapse rates than Veterans served by low recovery units.

METHODS:
The study will use a concurrent triangulation, mixed-methods design. Data regarding implementation of recovery-oriented elements, implementation processes, and Veteran outcomes will be collected using on-site observation, administrative data, and stakeholder interviews (staff and Veterans).

FINDINGS/RESULTS:
None yet.

IMPACT:
Improved quality of care for Veterans; findings will inform OMHO in:
inpatient program monitoring and evaluation
targeted quality improvement processes such as site visits
future policy decisions or recovery-oriented care on inpatient units, and connections to outpatient recovery-oriented services
creation of supports for sites with lower levels of recovery-orientated care.

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External Links for this Project

NIH Reporter

Grant Number: I01HX002093-01A2
Link: https://reporter.nih.gov/project-details/9292786

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PUBLICATIONS:

Journal Articles

1. Shue SA, Traylor M, Kukla M, Salyers MP, Rollins AL, Henry N, Eliacin J, Garabrant J, McGuire AB. Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units. Administration and policy in mental health. 2023 Mar 1; 50(2):283-295. [view]
2. Eliacin J, Carter J, Bass E, Flanagan M, Salyers MP, McGuire A. Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation. BMJ open. 2022 May 30; 12(5):e057300. [view]
3. McGuire AB, Flanagan ME, Kukla M, Rollins AL, Myers LJ, Bass E, Garabrant JM, Salyers MP. Inpatient Mental Healthcare before and during the COVID-19 Pandemic. Healthcare (Basel, Switzerland). 2021 Nov 23; 9(12). [view]
4. McGuire AB. Introduction to the special section on recovery-oriented services in crisis settings. Psychiatric Rehabilitation Journal. 2021 Dec 1; 44(4):303-304. [view]
5. McGuire AB, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Myers LJ, Flanagan ME, Hunt MG, Iwamasa GY, Bauer SM, Carter JL, Salyers MP. Recovery-oriented acute inpatient mental health care: Operationalization and measurement. Psychiatric Rehabilitation Journal. 2021 Dec 1; 44(4):318-326. [view]
6. McGuire AB, Flanagan ME, Myers LJ, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Hunt MG, Iwamasa GY, Carter JL, Salyers MP. Recovery-oriented inpatient mental health care and readmission. Psychiatric Rehabilitation Journal. 2022 Dec 1; 45(4):331-335. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Implementation, TRL - Applied/Translational
Keywords: Best Practices, Cognitive Therapy, Implementation
MeSH Terms: none