Measuring recovery-oriented rehabilitation language in clinical documentation to enhance recovery-oriented practice

Veronica De Monte; Angus Veitch; Frances Dark; Carla Meurk; Marianne Wyder; Maddison Wheeler; Kylie Carney; Stephen Parker; Steve Kisely; Dan Siskind

doi:10.1192/bjo.2023.14

Measuring recovery-oriented rehabilitation language in clinical documentation to enhance recovery-oriented practice

BJPsych Open. 2023 Feb 15;9(2):e36. doi: 10.1192/bjo.2023.14.

Authors

Affiliations

¹ Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia.
² Department of Media and Communications, Swinburne University of Technology, Melbourne, Victoria, Australia.
³ Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia; and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁴ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Queensland Centre for Mental Health Research, The Park, Wacol, Queensland, Australia.
⁵ Research and Learning Network, Metro South Addiction and Mental Health Service, Mt Gravatt, Queensland, Australia.
⁶ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Research and Learning Network, Metro South Addiction and Mental Health Service, Mt Gravatt, Queensland, Australia.
⁷ Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Woolloongabba, Queenland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; and Queensland Centre for Mental Health Research, The Park, Wacol, Queensland, Australia.

Abstract

Background: Mental health services are encouraged to use language consistent with principles of recovery-oriented practice. This study presents a novel approach for identifying whether clinical documentation contains recovery-oriented rehabilitation language, and evaluates an intervention to improve the language used within a community-based rehabilitation team.

Aims: This is a pilot study of training to enhance recovery-oriented rehabilitation language written in care review summaries, as measured through a text-based analysis of language used in mental health clinical documentation.

Method: Eleven case managers participated in a programme that included instruction in recovery-oriented rehabilitation principles. Outcomes were measured with automated textual analysis of clinical documentation, using a custom-built dictionary of rehabilitation-consistent, person-centred and pejorative terms. Automated analyses were run on Konstanz Information Miner (KNIME), an open-source data analytics platform. Differences in the frequency of term categories in 50 pre-training and 77 post-training documents were analysed with inferential statistics.

Results: The average percentage of sentences with recovery-oriented rehabilitation terms increased from 37% before the intervention to 48% afterward, a relative increase of 28% (P < 0.001). There was no significant change in use of person-centred or pejorative terms, possibly because of a relatively high frequency of person-centred language (22% of sentences) and low use of pejorative language (2.3% of sentences) at baseline.

Conclusions: This computer-driven textual analysis method identified improvements in recovery-oriented rehabilitation language following training. Our study suggests that brief interventions can affect the language of clinical documentation, and that automated text-analysis may represent a promising approach for rapidly assessing recovery-oriented rehabilitation language in mental health services.

Keywords: Recovery; community mental health teams; documentation; language; rehabilitation.

Grants and funding

1194635/National Health and Medical Research Council