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RESEARCH TEAM
Steven J. Onken, Ph.D.
Jeanne M. Dumont, Ph.D.
Priscilla Ridgway, Ph.D.
Douglas H. Dornan, M.S.
Ruth O. Ralph, Ph.D.
PARTICIPATING STATES
Arizona
Colorado
Hawai‘i
New York
Oklahoma
Rhode Island
South Carolina
Texas
Utah
Washington
SPONSORS
Center for Mental Health
Services
Colorado Mental Health
Services
Columbia University
Center for the Study of
Social Work Practice
Human Services Research
Institute
Mental Health
Empowerment Project
Missouri Institute of
Mental Health
Nathan Kline Institute
Center for Study of Issues
in Public Mental Health
National Association of
State Mental Health
Program Directors
New York State Office of
Mental Health
Oklahoma Department of
Mental Health and SAS
Piloting the Recovery Oriented System Indicators (ROSI) Measure
ROSI Consumer Self-Report Survey
ROSI Administrative Data Profile
The ROSI is the work of the Mental Health Recovery: What Helps and What
Hinders? A National Research Project for the Development of Recovery
Facilitating System Performance Indicators. This research project evolved
from collaborative efforts among a team of consumer and non-consumer
researchers, state mental health authorities (SMHAs), and a consortium of
sponsors working to operationalize a set of mental health system performance
indicators for mental health recovery. Conceptualized and directed by five
member research team (the majority of whom are primary consumers) as a
three phase process (i.e., grounded theory inquiry concerning the phenomenon
of recovery, creation of prototype systems-level performance indicators, and
large scale pilot testing), Phase One and Two have been completed. This
briefing summarizes the research.
Phase One involved a grounded theory, multi-site qualitative design to
identify the person-in-environment factors that help or hinder recovery for
people experiencing serious and prolonged psychiatric disorders. Nine
SMHAs used purposive sampling to recruit 115 consumers that participated in
10 structured focus groups. Researchers used rigorous, constant and
comparative analytic methods involving qualitative coding, codebook
development, cross coding and recoding of the focus group transcripts to
develop a single set of findings. All nine SMHAs conducted member checks
with focus group participants regarding the coding report for their respective
focus group. Fifty-nine (51%) of the original focus group members
participated. The research achieved a “confirmability index” (agreement that
the coding captured the original content) of 99%.
A conceptual paradigm for organizing and interpreting mental health recovery
emerged from the findings. While recovery is a deeply personal journey, there
are many commonalities in people’s experiences. Recovery is facilitated or
impeded through the dynamic interplay of many forces that are complex,
synergistic and linked. Recovery is a product of dynamic interaction among
characteristics of the individual (self-agency, holism, hope, a sense of
meaning and purpose), characteristics of the environment (basic material
resources, social relationships, meaningful activities, peer support, formal
services and staff), and the characteristics of the exchange (hope, choice,
empowerment, referent power, independence, interdependence). Each of these
emergent domains/themes contain a rich and complex network of helping and
hindering elements.
Piloting the ROSI Measure Handout, January 2007, page 2
In Phase Two, the Research Team used these findings to develop recovery oriented performance
indicators. Two sets emerged, 73 consumer self-report data items and 27 administrative data items. In
partnership with the participating states, the team refined the self-report set based on consumer review (a
Think Aloud process), state input and a readability check and then conducted a prototype indicator test
involving a diverse cross-section of 219 consumer/survivors in seven states. The Research Team then
used the prototype self-report data results to evaluate each item as to: (a) importance rating, (b) factor
loading values within a varimax rotated component matrix, (c) response scale distribution and direction,
(d) Phase One originating theme, (e) items assessing similar content, (e) clarity of wording, and (f)
Phase One member check priorities.
The Research Team also generated specific measure definitions (i.e., numerators and denominators) for
the 27 administrative data items, yielding 19 administrative data indicators with 30 corresponding
measures. The 10 participating states and all state Directors of Consumer Affairs were then surveyed on
the administrative data items as to (a) the feasibility of implementing each, (b) the importance of each
for improving system recovery orientation, (c) whether or not the data articulated in the definition was
currently being collected and (d) specific comments on each.
These analyses led to further refinement with a concentrated effort towards parsimony, resulting in 42
self-report items being crafted into an adult consumer self-report survey and 16 indicators and 23
corresponding administrative-data measures being crafted into an authority/provider profile for the
Recovery Oriented System Indicators (ROSI) measure. A reliability coefficient was computed for the
reduced set of 42 items on the adult consumer self-report survey, resulting in a Chronbach’s alpha of
.95. (Only 48 surveys could be included as the remaining surveys had one or more item responses
missing or marked as “Does Not Apply to Me.”) A factor analysis of the 42 self-report items resulted in
domains of Person-Center Decision-Making & Choice, Invalidated Personhood, Self-Care & Wellness,
Basic Life Resources, Meaningful Activities & Roles, Peer Advocacy, Staff Treatment Knowledge, and
Access. The 16 indicators and 23 corresponding administrative-data measures include the
domains/themes of Peer Support, Choice, Staffing Ratios, System Culture and Orientation, Consumer
Inclusion in Governance, and Coercion.
The ROSI bridges the gap between the principles of recovery and self-help - choice, hope, purpose,
relationships, self-determination, empowerment, citizenship, resources, opportunities - and the real-
world application of these principles in the everyday work of staff and service systems. The ROSI
measure is ready for large-scale pilot testing. The work of the Research Team, the research results, and
the ROSI measure are helping to inform the efforts of the Mental Health Statistics Improvement
Program Quality Report Version 2.0, the Decision Support 2000+ initiative and other national data
collection efforts and requirements that support comparable data collection across state and local, as
well as public and private mental health systems.
The Phase Two Research Report, Mental Health Recovery: What Helps and What Hinders? A National
Research Project for the Development of Recovery Facilitating System Performance Indicators: Phase
II Technical Report: Development of the Recovery Oriented System Indicators (ROSI) Measures to
Advance Mental Health System Transformation, is available online in PDF format at the following
website: <http://www.nasmhpd.org/>. Click on “publications,” scroll to “National Technical Assistance
Center for State Mental Health Planning (NTAC) Publications and Reports,” scroll to and click on
“Technical Reports” and the report and appendices are under the 2006 listing. The Phase One Research
Report, Mental Health Recovery: What Helps and What Hinders? A National Research Project for the
Development of Recovery Facilitating System Performance Indicators: A National Study of Consumer
Piloting the ROSI Measure Handout, January 2007, page 3
Perspectives on What Helps and Hinders Recovery, is available at the same website under the 2002
listing.
Using the ROSI
The Research Team makes the following requests of any person or agency that chooses to move forward
on using the ROSI in the near future:
First, inform the Research Team of your wish to use the ROSI. This notification can be done by
contacting the Research Team through either Steven Onken <so280@columbia.edu> or Jeanne
Dumont <jdumont@lightlink.com>.
Second, use the measures as currently developed, do not shift the items around, change the wording
of any of the items, or shorten the measures by only gathering data on a subset of items.
Third, design your use in such a way that the data could be shared with the Research Team. The
local site would continue to ‘own’ the data, but would share the data set in de-identified form with
the Research Team. The Research Team’s request will be subject to approval by the local site’s
research review, confidentiality and IRB processes as necessary.
Fourth, gather a small set of additional data that includes self-report survey respondent demographic
variables, agency and authority-level descriptors, and methods of data collection.
By agreeing to these conditions, those using the ROSI measure will help advance recovery research in
several ways. The data gathered will be added to the data from other pilot sites to: 1) improve the
analysis of the statistical properties of the measure (psychometric testing); 2) improve the field’s
understanding of how program-/site-/systems-level variables influence findings; 3) build a data base on
how differing sub-populations may differ in their responses to the ROSI; and 4) create a set of national
norms that will help in setting benchmarks for improvements in programs and systems. The larger the
data base that the Research Team can acquire, the better the chances of conducting a thorough and sound
analysis.
Guidelines for the ROSI
The ROSI is developed from and grounded in the lived experiences of adults with serious and prolonged
psychiatric disorders. Thus, the ROSI consumer self-report survey and administrative profile are
designed to assess the recovery orientation of community mental health systems for adults with serious
and prolonged psychiatric disorders.
Using the 42-item ROSI consumer self-report survey without the allied use of the ROSI administrative
profile is not recommended. The 42-item consumer self-report survey is complemented by the
administrative data profile. Data that are generated by doing the self-report survey alone are incomplete.
The administrative profile gathers data on important indicators of the recovery orientation of a system
that are not covered on the consumer survey.
The ROSI consumer self-report survey currently does not have sub-scales and thus all 42 items should
be administered.
Piloting the ROSI Measure Handout, January 2007, page 4
It is important that you follow your process of human subject review in regards to securing approval for
conducting the ROSI consumer self-report survey and for being in compliance with HIPAA regulations.
As you determine the level of human subject review to complete, you will need to identify whether you
need a written or verbal consent, what are the risks and benefits for participants, and what participant
incentive, if any, you will provide.
You will need to develop a definition sheet for some of the terms used in the 42 items of the ROSI
consumer self-report survey. In this sheet, you will explain or define for the participants what and whom
you are asking them to evaluate. Thus, the definition sheets needs to be tailored to your specific mental
health service delivery system. What do you mean when an item uses the term “program” (see item #21
for example). Do you mean programs operated by the local public mental heath center or all local mental
health programs regardless who operates them? Or are you limiting it to one program? A similar set of
questions also applies to the term “staff” and how do you want to define “mental health services.” The
clearer you are in your definition sheet, the easier it is for participants to complete the survey (and the
easier for the survey administrator to answer participants’ questions).
When administering the ROSI consumer self-report survey, please point out to the participants that some
of the items are negatively worded, for example, “Staff do not understand my experience as a person
with mental health problems.” Please instruct the participants to read each item carefully in order to
answer the negatively worded items accurately.
While the Research Team retained consumer’s phrasing in some individual items, as well as reduced the
average reading level for the 42-item ROSI consumer self-report survey; some of the individual items
require a high reading level. Some consumers may not have the literacy level needed to read or to
understand some items. The Research Team strongly recommends that someone (such as a volunteer or
peer specialist) be available to respondents during administration of the measure. This person can
provide reading support and assistance, as well as answer questions. If the measure is administered by
mail or internet, please provide such support through a toll free number.
The NY Office of Mental Health has translated the 42-item ROSI consumer self-report survey into
Spanish. Because of differences in regional Spanish dialects and respondent literacy levels, the Research
Team strongly recommends that an interpreter be available to Spanish speaking respondents during the
administration of the survey. The 42-item ROSI consumer self-report survey is not available in other
languages at this time, but the Research Team is open to working with interested parties in such efforts.
The Research Team has developed a set of definitions for the terms used in the 23 indicators of the
ROSI administrative data profile. For example, we defined what we mean by “Independent
Peer/Consumer Operated Programs” in indicator #1. You will need to review these as some terms may
need to be tailored to your specific mental health service delivery system. You must, however, document
any deviations from the given definitions to be able to more accurately compare indicators over time or
across systems.
It is very important that you record how you administered the ROSI using the ROSI Process Form,
noting any variations that occurred (e.g., “x” number were completed in a group setting, “x” number
were completed one-on-one, an English translator was available, etc.).
If you have questions, please contact the Research Team through either or Jeanne Dumont
<jdumont@lightlink.com> or Steven Onken <onken@hawaii.edu>. Thank you!
Piloting the ROSI Measure Handout, January 2007, page 5
RECOVERY ORIENTED SYSTEM INDICATORS (ROSI) PROCESS FORM
Administering Entity:
Address:
1. ROSI measures completed:
a. Consumer Self-Report Survey b. Administrative Data Profile
2. Date data collection began: (day/month /year) / / / - / / / - / / /
Date data collection ended: (day/month /year) / / / - / / / - / / /
3. Type of process used to collect consumer self-report data (check all that apply and include the
response rate, i.e., ___ %, if available)
a. Consumer Self-Administered (___ %) g. Program Staff Interviewers (___ %)
b. Mail Administration (___ %) h. Consumer Interviewers (___ %)
c. Phone Administration (___ %) i. On-Line Data Collection (___ %)
d. Face To Face Administration (___ %) j. Quality Assurance Interviewers (___ %)
e. Individual Data Collection (___ %) k. External Evaluation Interviewers (___ %)
f. Group Data Collection (___ %) l. Other: (___ %)
4. If a sample was used, what sample methodology was involved?
a. Convenience Sample c. Stratified Sample
b. Random Sample d. Other:
5. Purpose for utilizing ROSI (check all that apply)
a. Quality Assurance Activity d. Research
b. Program Audit e. Other:
c. Program Evaluation
6. Provide any important feedback concerning the performance, usefulness, process, and findings based
upon your use of the ROSI measures
7. Contact Information for a person knowledgeable about the survey process
Thank you!
Piloting the ROSI Measure Handout, January 2007, page 7
Recovery Oriented System Indicators (ROSI) Consumer Survey
Purpose: To provide the best possible mental health services, we want to know what things helped or hindered your
progress during the past six (6) months. Please follow the directions and complete all four sections.
Section One Directions: Please read each statement and then circle the response that best represents your situation
during the past six months. These responses range from “Strongly Disagree” to “Strongly Agree.” If the statement was
about something you did not experience, circle the last response “Does Not Apply To Me.”
1. There is at least one person who believes in me. Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
2. I have a place to live that feels like a comfortable home to
me.
Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
3. I am encouraged to use consumer-run programs (for
example, support groups, drop-in centers, etc.).
Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
4. I do not have the support I need to function in the roles I
want in my community.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
5. I do not have enough good service options to choose from. Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
6. Mental health services helped me get housing in a place I
feel safe.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
7. Staff do not understand my experience as a person with
mental health problems.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
8. The mental health staff ignore my physical health. Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
9. Staff respect me as a whole person. Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
10. Mental health services have caused me emotional or
physical harm.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
11. I cannot get the services I need when I need them. Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
Piloting the ROSI Measure Handout, January 2007, page 8
Please circle the response that best represents your situation during the past six months.
12. Mental health services helped me get medical benefits that
meet my needs.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
13. Mental health services led me to be more dependent, not
independent.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
14. I lack the information or resources I need to uphold my
client rights and basic human rights.
Strongly
Disagree
Disagree
Agree Strongly
Agree Does Not
Apply To Me
15. I have enough income to live on. Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
16. Services help me develop the skills I need. Strongly
Disagree Disagree Agree Strongly
Agree Does Not
Apply To Me
Section Two Directions: Please read each statement and then circle the response that best represents your situation
during the past six months. The responses range from “Never/Rarely” to “Almost Always/Always.” If the statement was
about something you did not experience, circle the last response “Does Not Apply To Me.”
17. I have housing that I can afford. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
18. I have a chance to advance my education if I want to. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
19. I have reliable transportation to get where I need to go. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
20. Mental health services helped me get or keep employment. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
21. Staff see me as an equal partner in my treatment program. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
22. Mental health staff support my self-care or wellness. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
23. I have a say in what happens to me when I am in crisis. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
24. Staff believe that I can grow, change and recover. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
Piloting the ROSI Measure Handout, January 2007, page 9
Please circle the response that best represents your situation during the past six months.
25. Staff use pressure, threats, or force in my treatment. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
26. There was a consumer peer advocate to turn to when I
needed one. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
27. There are consumers working as paid employees in the
mental health agency where I receive services. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
28. Staff give me complete information in words I understand
before I consent to treatment or medication. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
29. Staff encourage me to do things that are meaningful to me. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
30. Staff stood up for me to get the services and resources I
needed. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
31. Staff treat me with respect regarding my cultural
background (think of race, ethnicity, religion, language, age,
sexual orientation, etc).
Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
32. Staff listen carefully to what I say. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
33. Staff lack up-to-date knowledge on the most effective
treatments. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
34. Mental health staff interfere with my personal relationships. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
35. Mental health staff help me build on my strengths. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
36. My right to refuse treatment is respected. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
37. My treatment plan goals are stated in my own words. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
38. The doctor worked with me to get on medications that were
most helpful for me. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
Piloting the ROSI Measure Handout, January 2007, page 10
Please circle the response that best represents your situation during the past six months.
39. I am treated as a psychiatric label rather than as a person. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
40. I can see a therapist when I need to. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
41. My family gets the education or supports they need to be
helpful to me. Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
42. I have information or guidance to get the services and
supports I need, both inside and outside my mental health
agency.
Never/Rarely Sometimes Often Almost Always/
Always Does not
apply to me
Section Three Directions: Are there other issues related to how services help or hinder your recovery? Please explain.
Piloting the ROSI Measure Handout, January 2007, page 11
Section Four Directions: We are asking you to provide the following information in order for us to be able to have a
general description of participants taking this survey. Please check the answer that best fits your response to the question
or write in the answer in the line provided. Only answer those items you wish to answer. Please do not write your name
or address on this survey. This keeps your identity confidential.
1. What is your gender? a. Female b. Male
2. What is your age? (Write your current age in the two boxes.)
3. What is your racial or ethnic background? (Check the one that applies best.)
a. American Indian/ Alaska Native d. Native Hawaiian/ Other Pacific Islander f. More than one race
b. Asian e. White/Caucasian g. Other: ____________________________
c. Black or African American
Do you consider yourself Hispanic or Latino/a? a. Yes b. No
4. Your level of education is: (Check the highest level you reached or currently are in.)
a. Less than High School c. College/Technical Training e. Other: ____________________________
b. High School/GED d. Graduate School
5. How long have you been receiving mental health services?
a. Less than 1 year c. 3 to 5 years
b. 1 to 2 years d. More than 5 years
6. Which services have you used in the past six months? (Check all that apply.)
a. Counseling/Psychotherapy e. Assertive Community Treatment (ACT) i. Case Management
b. Housing/Residential Services f. Psychosocial Rehabilitation j. Clubhouse
c. Medication Management g. Employment/Vocational Services k. Other: ____________________________
d. Self-help/Consumer Run Service h. Alcohol/ Drug Abuse Treatment
Piloting the ROSI Measure Handout, January 2007, page 12
[To survey administrator: Please collect this additional background information (if possible).]
7. The town, city or community you live in is mostly:
a. Urban c. Rural
b. Suburban d. Remote/Frontier
8. What type of place do you live in?
a. Living in my own home or apartment
b. Living in supervised/supported apartment
c. Living in a residential facility
d. Living in a boarding house
e. Homeless or homeless shelter
f. Other: ___________________________________
9. Are you a person who currently has both mental health and substance abuse (alcohol, drug addition) problems?
a. Yes b. No
Piloting the ROSI Measure Handout, January 2007, page 13
ROSI Administrative-Data Profile: Authority Characteristics
Authority: Date ___________
1. What is your organization’s legal structure?
a. Public c. Private for Profit
b. Private Nonprofit d. Other:
2. Geographic Location:
Country:
State/ Province:
3. What geographic area do your cover?
4. Geographic Setting (check all that apply):
a. Urban d. Rural
b. Small City e. Remote/Frontier
c. Suburban
5. What the total number of mental health catchment or service areas?
_______________
6. How many mental health catchment or service areas in your network provided data for this ROSI
Administrative-Data Profile?
_______________
7. How many mental health provider agencies are in your network (unduplicated)?
_______________
8. How many mental health provider agencies in your network provided data for this ROSI
Administrative-Data Profile?
_______________
9. What populations do you serve? (Check all that apply.)
a. Children General Mental Health f. Elderly Serious Mental Illness
b. Adult General Mental Health g. Children Substance Abuse
c. Elderly General Mental Health h. Adult Substance Abuse
d. Adult Serious Mental Illness i. Other: ____________________________
e. Children Serious Emotional Disorders
Thank You!
Piloting the ROSI Measure Handout, January 2007, page 14
ROSI Administrative Data Profile – Authority Level
Directions: Please respond to each item as thoroughly as possible. Please report data for your current
activities or your most recently completed fiscal year. When the available data does not fully meet the
specified item definition, please define the data used for that item on the form and continue to the next
item. When data is not available, please indicate this on the form and continue to the next item.
1. Independent Peer/Consumer Operated Programs
1a. Numerator: The total number of mental health catchment or service areas
responding that have independent peer/consumer operated programs:
1a. ____________
1b. Denominator: The total number of mental health catchment or service areas
responding: 1b. ____________
1c. Indicator: The percentage of mental health catchment or service areas
responding that have independent peer/consumer operated programs.
(Numerator 1a. divided by denominator 1b.) 1c.________%
2. Peer/Consumer Delivered Service Funding
2a. Numerator: For the reporting period, the amount of program funds in the state
mental health budget allocated for peer/consumer delivered services:
2a. ____________
2b. Denominator: For the reporting period, the total amount of program funds in the
state mental health budget: 2b. ____________
2c. Indicator: For the reporting period, the percentage of state program funds
allocated for peer/consumer delivered services.
(Numerator 2a. divided by denominator 2b.) 2c.________%
3. Medicaid Funded Peer/Consumer Delivered Services.
3a. Numerator: For the reporting period, the amount of Medicaid reimbursement for
services delivered in peer/consumer operated programs and by peer specialists.
3a. ____________
3b. Denominator: For the reporting period, the total amount of Medicaid
reimbursement for behavioral health care. 3b. ____________
3c. Indicator: For the reporting period, the percentage of Medicaid funding
reimbursed for peer/consumer delivered services.
(Numerator 3a. divided by denominator 3b.) 3c.________%
Piloting the ROSI Measure Handout, January 2007, page 15
4. Consumer Employment in Mental Health Systems
4. Indicator: The number of annual slots specifically funded for training primary
consumers in relevant educational and training programs and institutes to
become mental health providers.
Number of Annual Slots 4.________
5. Affirmative Action Hiring Policy
5a. Numerator: The number of local mental health provider agencies responding
that have an affirmative action hiring policy regarding primary consumers.
5a. ____________
5b. Denominator: The total number of local mental health provider agencies
responding. 5b. ____________
5c. Indicator: The percentage of local mental health provider agencies responding
that have an affirmative action hiring policy regarding primary consumers.
(Numerator 5a. divided by denominator 5b.) 5c.________%
6. Advance Directives
6a. Numerator: The number of local mental health provider agencies responding
that have an established mechanism to help clients develop advance directives.
6a. ____________
6b. Denominator: The total number of local mental health provider agencies
responding.
6b. ____________
6c. Indicator: The percentage of local mental health provider agencies responding
that have an established mechanism to help clients develop advance directives.
(Numerator 6a. divided by denominator 6b.) 6c.________%
7. Direct Care Staff to Client Ratio
7a. Numerator: For the reporting period, the total number of direct care staff
(unduplicated) of local mental health provider agencies responding.
7a. ____________
7b. Denominator: For the reporting period, the total number of clients
(unduplicated) of local mental health provider agencies responding.
7b. ____________
7c. Indicator: For the reporting period, the ratio of direct care staff to clients for all
local mental health provider agencies responding.
(Numerator 7a to denominator 7b.) 7c.________
8. State Recovery Oriented Mission Statement
8. Indicator: The state mental health authority’s mission statement explicitly
includes a recovery orientation.
Piloting the ROSI Measure Handout, January 2007, page 16
Yes No
If yes, please describe the initiatives for implementing this recovery orientation:
9. Local Agency Recovery Oriented Mission Statement
9a. Numerator: The number of local mental health provider agencies responding
whose mission statement includes a recovery orientation. 9a. ____________
9b. Denominator: The total number of local mental health provider agencies
responding.
9b. ____________
9c. Indicator: The percentage of local mental health provider agencies responding
whose mission statements explicitly include a recovery orientation.
(Numerator 9a. divided by denominator 9b.) 9c.________%
10. Consumer Involvement in Provider Contract Development
10a. Numerator: The number of authority level provider agency performance
contracts reported that document primary consumer involvement in their
development/yearly review. 10a. ____________
10b. Denominator: The total number of authority level provider agency performance
contracts reported. 10b. ____________
10c. Indicator: The percentage of authority level provider agency performance
contracts reported that have primary consumer involvement in their
development/yearly review (i.e., specifying services, outcomes, target numbers,
etc).
(Numerator 10a. divided by denominator 10b.) 10c.________%
11. State Office of Consumer Affairs
11a. Numerator: For this reporting period, the number of staff (unduplicated) in the
state office of consumer affairs who are disclosed primary consumers.
11a. ____________
11b. Denominator: For this reporting period, the total number of staff (unduplicated)
in the state office of consumer affairs. 11b. ____________
11c. Indicator: For the reporting period, the percentage of staff in the state office of
consumer affairs who are disclosed primary consumers.
(Numerator 11a. divided by denominator 11b.) 11c.________%
Piloting the ROSI Measure Handout, January 2007, page 17
12. Regional/Local Office of Consumer Affairs
12a. Numerator: For this reporting period, the number of regional mental health
offices/local mental health authorities (or equivalent) responding that have an
office of consumer affairs. 12a. ____________
12b. Denominator: For this reporting period, the total number of regional mental
health offices/local mental health authorities (or equivalent) responding.
12b. ____________
12c. Indicator: For the reporting period, the percentage of regional mental health
offices/local mental health authorities (or equivalent) responding that have an
office of consumer affairs.
(Numerator 12a. divided by denominator 12b.) 12c.________%
13. Consumer Representation on State Planning Council
13a. Numerator: For the reporting period, the number of disclosed primary
consumers (unduplicated) who are state planning council members.
13a. ____________
13b. Denominator: For the reporting period, the total number of state planning
council members (unduplicated). 13b. ____________
13c. Indicator: For the reporting period, the percentage of state mental health
authority planning council members who are disclosed primary consumers.
(Numerator 13a. divided by denominator 13b.) 13c.________%
14: Consumer Representation on Local Boards
14a. Numerator: For the reporting period, the number of disclosed primary
consumers (unduplicated) who serve on boards of local mental health provider
agencies responding. 14a. ____________
14b. Denominator: For the reporting period, the total number of board members
(unduplicated) of local mental health provider agencies responding.
14b. ____________
14c. Indicator: For the reporting period, the percentage of board membership that are
disclosed primary consumers of local mental health provider agencies
responding.
(Numerator 14a. divided by denominator 14b.) 14c.________%
15. Involuntary Inpatient Commitments
15a. Numerator: For the reporting period, the number of involuntary inpatient
admissions in the public and private inpatient units responding.
15a. ____________
Piloting the ROSI Measure Handout, January 2007, page 18
15b. Denominator: For the reporting period, the total number of inpatient admissions
in the public and private inpatient units responding. 15b. ____________
15c. Indicator: For the reporting period, the percentage of involuntary admissions in
the public and private inpatient units responding.
(Numerator 15a. divided by denominator 15b.) 15c.________%
16. Involuntary Outpatient Commitments
16a. Numerator: For the reporting period, the number of clients (unduplicated) on
involuntary outpatient commitment status (new and continuing) of the local
mental health provider agencies responding. 16a. ____________
16b. Denominator: For the reporting period, the total number of clients
(unduplicated) who received outpatient services from the local mental health
provider agencies responding. 16b. ____________
16c. Indicator: For the reporting period, the percentage of clients (unduplicated)
under involuntary outpatient commitments of the local mental health provider
agencies responding.
(Numerator 16a. divided by denominator 16b.) 16c.________%
17. Seclusion Hours
17a. Numerator: For the reporting period, the total number of hours that all clients
spent in seclusion at the inpatient units responding. 17a. ____________
17b. Denominator: For the reporting period, the sum of the daily census (excluding
clients on leave status) for each day (client days) multiplied by 24 hours for the
inpatient units responding. 17b. ____________
17c. Indicator: For the reporting period, the hours of seclusion as a percentage of
client hours for the inpatient units responding.
(Numerator 17a. divided by denominator 17b.) 17c.________%
18. Seclusion of Clients
18a. Numerator: For the reporting period, the total number of clients (unduplicated)
who were secluded at least once in the inpatient units responding.
18a. ____________
18b. Denominator: For the reporting period, the total number of unduplicated clients
who were inpatients of the inpatient units responding. 18b. ____________
Piloting the ROSI Measure Handout, January 2007, page 19
18c. Indicator: For the reporting period, the percentage of clients secluded at least
once at the inpatient units responding.
(Numerator 18a. divided by denominator 18b.) 18c.________%
19. Restraint Hours
19a. Numerator: For the reporting period, the total number of hours that all clients
spent in restraint at the inpatient units responding. 19a. ____________
19b. Denominator: For the reporting period, the sum of the daily census (excluding
clients on leave status) for each day (client days) multiplied by 24 hours for the
inpatient units responding.
19b. ____________
19c. Indicator: For the reporting period, the hours of restraint as a percentage of
client hours of the inpatient units responding.
(Numerator 19a. divided by denominator 19b.) 19c.________%
20. Restraint of Clients
20a. Numerator: For the reporting period, the total number of clients (unduplicated)
who were restrained at least once at the inpatient units responding.
20a. ____________
20b. Denominator: For the reporting period, the total number of unduplicated clients
of the inpatient units responding.
20b. ____________
20c. Indicator: For the reporting period, the percentage of clients restrained at least
once at the inpatient units responding.
(Numerator 20a. divided by denominator 20b.) 20c.________%
21. Diversion from Criminal/Juvenile Justice Systems
21a. Numerator: The total number of mental health catchment or service areas
responding that have jail diversion services. 21a. ____________
21b. Denominator: The total number of mental health catchment or service areas
responding.
21b. ____________
21c. Indicator: The percentage of mental health catchment or service areas
responding that have jail diversion services.
(Numerator 21a. divided by denominator 21b.) 21c.________%
22. Integrated Substance Abuse and Mental Health Services
22a. Numerator: The total number of mental health catchment or service areas
responding that have integrated substance abuse and mental health services.
22a. ____________
Piloting the ROSI Measure Handout, January 2007, page 20
22b. Denominator: The total number of mental health catchment or service areas
responding.
22b. ____________
22c. Indicator: The percentage of mental health catchment or service areas
responding that have integrated substance abuse and mental health services.
(Numerator 22a. divided by denominator 22b.) 22c.________%
23. Trauma Service Provision
23a. Numerator: The total number of mental health catchment or service areas
responding that have trauma services. 23a. ____________
22b. Denominator: The total number of mental health catchment or service areas
responding.
23b. ____________
23c. Indicator: The percentage of mental health catchment or service areas
responding that have trauma services.
(Numerator 23a. divided by denominator 23b.) 23c.________%
Piloting the ROSI Measure Handout, January 2007, page 21
ROSI Administrative-Data Profile: Mental Health Provider Characteristics
Provider Organization Date ___________
1. What is your organization’s legal structure?
a. Public c. Private for Profit
b. Private Nonprofit d. Other:
2. Geographic Location:
Country:
State/Province:
County:
3. Geographic Setting (check all that apply):
a. Urban d. Rural
b. Small City e. Remote/Frontier
c. Suburban
4. How many consumers does your organization serve in mental health services each year
(unduplicated)?
_______________
5. How many full time equivalents (FTEs) do you have on staff who directly provide mental health
services at this time?
_______________
6. Which mental health services do you provide at this time? (Check all that apply.)
a. Counseling/Psychotherapy g. Assertive Community Treatment (ACT)
b. Case Management h. Clubhouse
c. Housing/Residential Services i. Alcohol/ Drug Abuse Treatment
d. Medication Management j. Employment/Vocational Services
e. Self-help/Consumer Run Service k. Other: _____________________________
f. Psychosocial Rehabilitation
Thank You!
Piloting the ROSI Measure Handout, January 2007, page 22
ROSI Administrative Data Profile – Mental Health Provider Level
Directions: Please respond to each item as thoroughly as possible. Please report data for your current
activities or your most recently completed fiscal year. When the available data does not fully meet the
specified item definition, please define the data used for that item on the form and continue to the next
item. When data is not available, please indicate this on the form and continue to the next item.
1. Independent Peer/Consumer Operated Programs
1 Indicator: There is at least one independent peer/consumer operated program in
our mental health catchment or service area.
Yes No
2. Peer/Consumer Delivered Service Funding
2a. Numerator: For the reporting period, the amount of program funds in our
agency’s mental health budget allocated for peer/consumer delivered services:
2a. ____________
2b. Denominator: For the reporting period, the total amount of program funds in our
agency’s mental health budget: 2b. ____________
2c. Indicator: For the reporting period, the percentage of our agency’s program
funds allocated for peer/consumer delivered services.
(Numerator 2a. divided by denominator 2b.) 2c.________%
3. Medicaid Funded Peer/Consumer Delivered Services.
3a. Numerator: For the reporting period, the amount of Medicaid reimbursement
our agency has received for services delivered in peer/consumer operated
programs and by peer specialists. 3a. ____________
3b. Denominator: For the reporting period, the total amount of Medicaid
reimbursement our agency has received for behavioral health care.
3b. ____________
3c. Indicator: For the reporting period, the percentage of Medicaid funding our
agency has been reimbursed for peer/consumer delivered services.
(Numerator 3a. divided by denominator 3b.) 3c.________%
4. Consumer Employment in Mental Health Systems
4. Indicator: The number of annual slots our agency specifically funded for
training primary consumers in relevant educational and training programs and
institutes to become mental health providers.
Number of Annual Slots 4.________
5. Affirmative Action Hiring Policy
5. Indicator: Our agency has an affirmative action hiring policy regarding primary
consumers.
Piloting the ROSI Measure Handout, January 2007, page 23
Yes No
6. Advance Directives
6 Indicator: Our agency has an established mechanism to help clients develop
advance directives.
Yes No
7. Direct Care Staff to Client Ratio
7a. Numerator: For the reporting period, the total number of direct care staff
(unduplicated) of our agency. 7a. ____________
7b. Denominator: For the reporting period, the total number of clients
(unduplicated) served by our agency. 7b. ____________
7c. Indicator: For the reporting period, the ratio of direct care staff to clients for our
agency.
(Numerator 7a to denominator 7b.) 7c.________
8. State Recovery Oriented Mission Statement
8. Indicator: The state mental health authority’s mission statement explicitly
includes a recovery orientation. (SKIP)
9. Local Agency Recovery Oriented Mission Statement
9 Indicator: Our agency has a mission statement that explicitly includes a
recovery orientation.
Yes No
If yes, please describe the initiatives for implementing this recovery orientation:
10. Consumer Involvement in Provider Contract Development
10a. Numerator: The number of our agency’s performance contracts with outside
mental health service vendors that document primary consumer involvement in
their development/yearly review. 10a. ____________
10b. Denominator: The total number of our agency’s performance contracts with
outside mental health service vendors. 10b. ____________
10c. Indicator: The percentage of our agency’s performance contracts with outside
mental health service vendors that have primary consumer involvement in their
development/yearly review (i.e., specifying services, outcomes, target numbers,
etc).
(Numerator 10a. divided by denominator 10b.) 10c.________%
Piloting the ROSI Measure Handout, January 2007, page 24
11. State Office of Consumer Affairs
11 Indicator: For the reporting period, the percentage of staff in the state office of
consumer affairs who are primary disclosed consumers. (SKIP)
12. Regional/Local Office of Consumer Affairs
12. Indicator: Our regional mental health office or local mental health authority has
an office of consumer affairs.
Yes No
13. Consumer Representation on State Planning Council
13. Indicator: For the reporting period, the percentage of state mental health
authority planning council members who are disclosed primary consumers.
(SKIP)
14: Consumer Representation on Local Boards
14a. Numerator: For the reporting period, the number of disclosed primary
consumers (unduplicated) who serve on our agency’s board of directors.
14a. ____________
14b. Denominator: For the reporting period, the total number of our agency’s board
members (unduplicated). 14b. ____________
14c. Indicator: For the reporting period, the percentage of our agency’s board
membership that are disclosed primary consumers.
(Numerator 14a. divided by denominator 14b.) 14c.________%
15. Involuntary Inpatient Commitments
15a. Numerator: For the reporting period, the number of involuntary inpatient
admissions in our agency’s inpatient units. 15a. ____________
15b. Denominator: For the reporting period, the total number of inpatient admissions
in our agency’s inpatient units. 15b. ____________
15c. Indicator: For the reporting period, the percentage of involuntary admissions in
our agency’s inpatient units.
(Numerator 15a. divided by denominator 15b.) 15c.________%
16. Involuntary Outpatient Commitments
16a. Numerator: For the reporting period, the number of our agency’s clients
(unduplicated) on involuntary outpatient commitment status (new and
continuing). 16a. ____________
Piloting the ROSI Measure Handout, January 2007, page 25
16b. Denominator: For the reporting period, the total number of our agency’s clients
(unduplicated) who received outpatient services. 16b. ____________
16c. Indicator: For the reporting period, the percentage of our agency’s clients
(unduplicated) under involuntary outpatient commitments.
(Numerator 16a. divided by denominator 16b.) 16c.________%
17. Seclusion Hours
17a. Numerator: For the reporting period, the total number of hours that all of our
agency’s clients spent in seclusion at our agency’s inpatient units.
17a. ____________
17b. Denominator: For the reporting period, the sum of the daily census (excluding
clients on leave status) of our agency’s inpatient units for each day (client days)
multiplied by 24 hours. 17b. ____________
17c. Indicator: For the reporting period, the hours of seclusion as a percentage of
client hours for our agency’s inpatient units.
(Numerator 17a. divided by denominator 17b.) 17c.________%
18. Seclusion of Clients
18a. Numerator: For the reporting period, the total number of clients (unduplicated)
who were secluded at least once at our agency’s inpatient units.
18a. ____________
18b. Denominator: For the reporting period, the total number of unduplicated clients
in our agency’s inpatient units. 18b. ____________
18c. Indicator: For the reporting period, the percentage of clients secluded at least
once at our agency’s inpatient units.
(Numerator 18a. divided by denominator 18b.) 18c.________%
19. Restraint Hours
19a. Numerator: For the reporting period, the total number of hours that all clients of
our agency’s inpatient units spent in restraint. 19a. ____________
19b. Denominator: For the reporting period, the sum of the daily census (excluding
clients on leave status) of our agency’s inpatient units for each day (client days)
multiplied by 24 hours.
(Note: Same as 17b) 19b. ____________
19c. Indicator: For the reporting period, the hours of restraint as a percentage of
client hours of our agency’s inpatient units.
(Numerator 19a. divided by denominator 19b.) 19c.________%
Piloting the ROSI Measure Handout, January 2007, page 26
20. Restraint of Clients
20a. Numerator: For the reporting period, the total number of clients (unduplicated)
who were restrained at least once at our agency’s inpatient units.
20a. ____________
20b. Denominator: For the reporting period, the total number of unduplicated clients
of our agency’s inpatient units.
(Note: Same as 18b) 20b. ____________
20c. Indicator: For the reporting period, the percentage of clients restrained at least
once at our agency’s inpatient units.
(Numerator 20a. divided by denominator 20b.) 20c.________%
21. Diversion from Criminal/Juvenile Justice Systems
21. Indicator: Jail diversion services are available in our mental health catchment or
service area for mental health consumers.
Yes No
22. Integrated Substance Abuse and Mental Health Services
22. Indicator: Integrated substance abuse and mental health services are available in
our mental health catchment or service area for mental health consumers.
Yes No
23. Trauma Service Provision
23. Indicator: Trauma services are available in our mental health catchment or
service area for mental health consumers.
Yes No
Piloting the ROSI Measure Handout, January 2007, page 27
DEFINITIONS
Primary Consumer
Current draft:
A person who has applied for, is eligible for or who in the past received or presently is receiving
mental health services or is a person who identifies as survivor of a mental disorder and is involved
in self-help.
Disclosed Primary Consumers
Current draft:
A person who is open about having received psychiatric treatment/mental health services and/or
managing significant mental health problems.
Peer Specialist
Current draft:
A person who is a disclosed primary consumer and is hired to provide supportive services, such as
case management, advocacy, personal assistance, etc., in part based on understanding another’s
situation through shared experiences.
Peer/Consumer Delivered Services
Current draft:
Peer/Consumer Delivered Services include both (a) Independent Peer/Consumer Operated Programs
as well as (b) services that may be sponsored by an umbrella organization but are delivered by
consumers/ survivors. Examples include paid consumers/ survivors working as peer specialists,
support group facilitators, drop-in center staff, case managers, recovery educators, etc. as well as
funding for the services, such a consumer drop-in centers, club houses, support groups, etc. This
includes Medicaid match funds for such services.
Independent Peer/Consumer Operated Program
Current draft:
Independent Peer/Consumer Operated Program is an organization where primary consumers and
survivors form the majority of those in governance, management, and leadership (e.g., budget,
policies, procedures, personnel decisions, etc.). The majority of staff who operate the program and
deliver direct services consist of consumers/survivors.
Advance Directives
Current draft:
Piloting the ROSI Measure Handout, January 2007, page 28
Written instructions the consumer/survivor makes that directs the types of treatment the individual
wants and does not want to get under circumstances where the individual is unable to make informed
decisions about psychiatric treatment.
Mental Health Catchment or Service Areas
Current draft:
The geographic boundaries for providing mental health services.
Local Mental Health Provider Agencies
Current draft:
The legally established organizations where people go to get mental health services or treatment.
Provider Agency Performance Contracts
Current draft:
A binding agreement between two parties to meet specified goals, deliver specified services and/or
achieve specified outcomes.
Involuntary Outpatient Commitment
Current Draft:
A court order that compels a person to comply with outpatient treatment/services.
Restraint
Current draft (MHSIP):
Restraint is any involuntary method of physically restricting a client’s freedom of movement,
physical activity, or normal access to his or her body. Incidents in which clients are simultaneously
secluded and restrained, only the most restrictive intervention, restraint, should be reported.
Seclusion
Current draft (MHSIP):
Seclusion is the involuntary confinement of a client alone in a room where the client is physically
prevented from leaving. Incidents in which clients are simultaneously secluded and restrained, only
the most restrictive intervention, restraint, should be reported.
Jail Diversion Services
Piloting the ROSI Measure Handout, January 2007, page 29
Current draft:
Jail diversion programs are programs that divert individuals with a mental illness from the criminal
justice system to community-based services. The diversion program should be integrated with
existing systems of care and foster collaboration between the systems (criminal justice, mental health
and substance abuse).
Integrated Substance Abuse and Mental Health Services
Current draft:
Integrated dual disorders services are for people who have co-occurring disorders – mental illness
and addiction. This treatment approach helps people recover by offering mental health and
substance abuse services and supports together in one setting.
Trauma Services
Current draft:
Services and supports aimed at acknowledging and relieving painful experiences of interpersonal
events or threats including sexual abuse, physical abuse, severe neglect, loss, and/or the witnessing
of violence, terrorism and disasters. This definition includes trauma induced by the mental health
system.