Evaluation of Recovery-oriented Acute INpatient Mental Healthcare (RAIN-MH)

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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 processes sites have used to implement these services, or the impact that implementation has had on Veterans or staff. 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. The study will use a concurrent triangulation, mixed-methods design. High and low recovery units will be identified using an on-line survey. 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).