Abstract
BackgroundNo standardised tools for assessing the quality of specialist mental health supported accommodation services exist. To address this, we adapted the Quality Indicator for Rehabilitative care-QuIRC-that was originally developed to assess the quality of longer term inpatient and community based mental health facilities. The QuIRC, which is completed by the service manager and gives ratings of seven domains of care, has good psychometric properties.MethodsFocus groups with staff of the three main types of supported accommodation in the UK (residential care, supported housing and floating outreach services) were carried out to identify potential amendments to the QuIRC. Additional advice was gained from consultation with three expert panels, two of which comprised service users with lived experience of mental health and supported accommodation services. The amended QuIRC (QuIRC-SA) was piloted with a manager of each of the three service types. Item response variance, inter-rater reliability and internal consistency were assessed in a random sample of 52 services. Factorial structure and discriminant validity were assessed in a larger random sample of 87 services.ResultsThe QuIRC-SA comprised 143 items of which only 18 items showed a narrow range of response and five items had poor inter-rater reliability. The tool showed good discriminant validity, with supported housing services generally scoring higher than the other two types of supported accommodation on most domains. Exploratory factor analysis showed that the QuIRC-SA items loaded onto the domains to which they had been allocated.ConclusionsThe QuIRC-SA is the first standardised tool for quality assessment of specialist mental health supported accommodation services. Its psychometric properties mean that it has potential for use in research as well as audit and quality improvement programmes. A web based application is being developed to make it more accessible which will produce a printable report for the service manager about the performance of their service, comparison data for similar services and suggestions on how to improve service quality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0799-4) contains supplementary material, which is available to authorized users.
Highlights
No standardised tools for assessing the quality of specialist mental health supported accommodation services exist
This paper reports on the first work package (WP1), the adaptation of an existing quality assessment tool for mental health supported accommodation services
It was agreed that since floating outreach services are not “building based” but provide visiting support to people living in an independent tenancy, the items relating to the Living Environment of the service were not relevant and the adapted quality indicator for rehabilitative care (QuIRC) would not be able to provide a rating on this domain for these services
Summary
No standardised tools for assessing the quality of specialist mental health supported accommodation services exist. Mental health rehabilitation services focus on people with severe and complex problems, many of whom have a diagnosis of psychosis with associated ‘negative’ symptoms that impair their motivation and organisational skills to manage everyday activities and put them at risk of self-neglect [1,2,3] This group often require lengthy treatment and graduated support from specialist inpatient and community based rehabilitation services to facilitate their recovery and successful community living. Supported housing is usually provided in shared or individual tenancies with staff based on-site up to 24 h a day These tend to be time limited placements with an average of 10–15 residents and a focus on rehabilitation, with the expectation that the person will be supported to gain skills to move on to a more independent tenancy. In the UK, individuals will often move through this pathway, graduating from a placement with higher to lesser support every few years as their skills and confidence improve, with the ultimate aim of successfully managing an independent tenancy without the need for floating outreach support
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