Data collection with recovery in mind: involve service users as much as possible.

Are you looking for another way to move your programs and services further into a recovery framework? Take a look at your data-collection system. It can help focus your organizational energy on data compatible with, instead of inconsistent with, the vision of recovery.

Since a data-collection system touches nearly every service user and employee, each data-collection form and process could guide the organization toward a recovery orientation. Some of the information funding sources and licensing and accrediting bodies require isn't compatible with the recovery approach, but there is a lot you can do to transform the overall data-collection system.

Let's review how the data-collection system at Recovery Innovations in Phoenix was transformed to support recovery values. This medium-sized behavioral health agency struggled with all the data-collection problems most agencies face. The problems were magnified once the agency began to shift into a recovery orientation.

During the shift it became painfully obvious that the data-collection system was working against the new philosophy of recovery, instead of supporting it. The system needed to pay attention to people's strengths and allow them to participate in the data-collection process.

Jeff Norris is the IT guy at Recovery Innovations. He had spent years developing a state-of-the-art data-collection system for the agency that worked great until the organization made a sharp right turn toward recovery. Now the system didn't capture the right data elements and didn't reflect the new values because it didn't focus on strengths and didn't have ways for people receiving services to participate in the data-collection process. So Jeff rose to the challenge of starting over and coming up with a new approach.

Jeff developed an approach that integrates a paper-based data-collection process with an electronic process. It starts with the service user completing his own progress notes on a paper form. Staff members can add to it, and they must sign off on it, but the person's own words become the progress note. This reflects the shift we want to happen in recovery--the record becomes grounds for a partnership and is not a secret document that clinical staff control.

Paper forms are scanned into the IT system and routed to the data-processing folks. In some programs, clinical staff complete the documentation electronically, getting as much input from the service user as possible. Questions on clinicians' data-collection forms (whether paper or electronic) require staff to think and talk in recovery concepts. The data-processing team turns the data into information required by licensing and funding sources, including electronic billing information.

Recovery Innovations' data-collection forms and processes employ the following characteristics, which promote recovery attitudes and responses from both staff and service users.

Be friendly and welcoming. Funding sources usually require forms that inform people using services of their rights. These forms, which have to be signed, dated, and included in the record, often use imposing and unfriendly legalistic language. Subsequently, staff members and service users do not read them.

We suggest reformatting this form into a friendly welcome letter that in a few short sentences transmits the key points in a user-friendly manner. The letter sets the tone for staff, guiding them to approach the person in a cordial, communicative manner. Here's an example of how to word an introduction: "Welcome. We are so glad you chose to use our services. Here are some things we want to make sure you know about so you can speak up if you think we are getting off track."

You might think such forms have to be legalistic, but they don't. Unfortunately, organizations often copy the required language from regulations onto forms that people have to sign, although they don't make sense and no one reads them.

Use recovery language. Language is an important aspect of promoting recovery outcomes (see our April 2006 column). Using long medical and diagnostic terms will guide staff to focus on illnesses instead of strengths and abilities. Be sure your data-collection system gives equal weight to strengths, abilities, and past successes, along with the usual problem and diagnosis requirements.

Convey "We believe in you." Whether the people using services are completing paper forms or staff members are entering data into an electronic system, questions that convey this message can guide them toward focusing on strengths. This reinforces an optimistic attitude of partnership instead of compliance. One way to convey this message is to provide as many choices as possible, so the person understands that you have confidence in him and see him as a credible source of information.

Give people receiving services choices and options. Since choice is a key element in the recovery process, it's important to have forms that clearly guide both the staff and the service user to look at choices and options, instead of having staff make decisions. This is a real opportunity to reinforce the importance of choice to both staff and service users. If the person receiving services is filling out a paper form, it should provide options for each response. For example, people could choose medications that have worked best for them; select programs of their choice; and indicate who they want as their main supporters.

Encourage service users' participation. The more the person receiving services can fill out forms himself, the better, because this helps establish him as the leader in his recovery process and provides evidence of participation.

Reinforce the importance of empowerment. A simple way of transferring power to the person receiving services is to use uncomplicated forms that allow him to have a feeling of accomplishment when he interfaces with them. Otherwise, he has no choice but to surrender and leave choices up to staff. Some forms are so complicated that many staff don't know how to complete them, so we can imagine how it would be for the person trying to recover. Thus, if the service user enters information himself, keep forms simple and easy to understand. This will help clinicians too.

Capture data that show progress toward goals. Another way of providing empowerment is to clearly show service users' progress toward their goals. Most funding sources require this, so you may already track this, but are you regularly sharing this with the person receiving services? It's a great way to provide evidence that he is getting better and an opportunity to celebrate accomplishments.

Enhance a recovery environment. The forms we use and the data we collect set the tone for our service-delivery environment. For an environment to be recovery-oriented, it needs to feel safe enough for service users to relax and open up to new possibilities. Can people receiving services easily access their records? Do records show a nonjudgmental attitude from staff and the organization? Do they convey joint ownership? Design data-collection systems with these questions in mind. People do have a right to see their records, so make it easy and simple to do so.

Ask service users for their advice. You may not get very solid responses at first because you have never asked them for this before. Be patient. Give them a lot of chances to tell you. Show them some of the options they can choose between. Once you have a clear understanding of what's important to them, include it in your data-collection process.

Ask direct-service staff what they need to collect data important to people using services. Go right to the line level so you hear directly from the staff members doing hands-on work.

Test new data-collection forms and processes with both people using services and staff. Make sure the level of complexity matches the level of expertise of both your staff and your service users. A great data-collection system is useless if people are frustrated by trying to use it. Our resounding theme is keep it as simple as possible. Provide ongoing technical assistance to both staff and service users so they can continue to learn ways of being more accomplished partners.

Your data-collection system will either work for you and move you closer toward your goals, or will work against you and hold you in the past. As you reengineer your programs to reflect recovery values, get as much mileage as you can out of what they have to offer as a vehicle for positive change.

Lori Ashcraft, PhD, directs the Recovery Education Center at Recovery Innovations, Inc., in Phoenix. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University. To contact the authors, e-mail lori.ashcraft@metaservices.com.

BY LORI ASHCRAFT, PHD, AND WILLIAM A. ANTHONY, PHD