GRiST for self assessment: getting
started
Please note that these
instructions are geared towards the full tool when it is integrated with the
website properly. When this has been
achieved, assessments can be saved, repeated, and viewed, with reports generated
from them for easy reading. For the moment, we are only asking you to comment
on the way the software collects the data, including the question order,
wording, and formatting. Sometime over the summer, we will have the full web
program where you can save and manage all assessments over time.
Thank you for your continuing help and we will do all we can to ensure
the tool develops in accordance with your suggestions and requirements
Known issues with the tool
The current tool is under development, of course, and there
are a few things we already know about and are fixing:
- The
tool opens with the screening questions that clinicians want for efficient
data collection. These may not be suited to self assessment and will
probably be removed. The screening questions are associated with the root
mental-health risk node (the one at the very top of the tree) so you can
revisit them by selecting that node. If you select any other node, the
screening questions are replaced by the questions associated with the new
node selection. - Many
of the buttons at the bottom of the tool are more concerned with
collecting information by clinicians rather than for self-assessments so
these will be changed.- The
Evaluate button has been
deactivated because the tool does not provide risk evaluations yet. It
needs further validation before these are fully reliable. - The
Finish button takes you to the
final “summary” screen but because the tool is not connected to the
database yet, it cannot be exited. So to exit, simply close the whole
window down. - The
Full Screen button runs the
program outside the browser window, which is fine but the feedback button
is not then available. It is easy to return the tool into the window,
though. - The
Preferences button may cause
problems with buttons when the font size is changed within the browser
window. - The
colours for answers do not follow the level of risk when the question has
been reworded so that the risk is reversed (i.e. 10 means minimum risk).
We know which questions this applies to and will fix it.
- The
- Changing
the font size when the tool is running within
the browser window messes up the buttons. If you run the tool in
full-screen mode, this does not happen. - The
feedback button is only available when the tool is running within the
browser window rather than in full-screen mode. Also, it is is only
visible if the browser window is made wide enough to see it.
What is GRiST for service users?
There are two versions of
GRiST – one for service users and one for clinicians. They are designed to help
service users and clinicians to talk about risks associated with mental health
problems more easily.
To give you a bit of
background, GRiST for clinicians is a risk screening tool recommended by the
Department of Health (DH) in their document ‘Best Practice in Managing
Risk’. It is used in several areas of
the UK,
and there are versions for adults of working age, older people, and children
and adolescents. If you would like to
find out more about GRiST and how it was developed, please visit the website: www.galassify.org/grist
This service user version of GRiST (GRiST-SU) is designed for
mental health service users to self-assess their own levels of risk. It covers risks of self neglect, self harm,
vulnerability, harm to others or damage to property, and suicide. Only some of these risks may be relevant to
you at any one time, and you only need to answer the questions that are
relevant.
How can it help me?
GRiST-SU can help you to understand how different things in your
life can have an impact on your mental health, and on how safe you feel. It can help you to monitor any changes in the
way that you are feeling, recognise when you are at risk and help you to manage
those risks (by doing things differently or seeking help, for example).
Information about your past (historical information) can be stored
within GRiST-SU, so that each time you come to use it, you don’t need to enter
that information again. If you wish, you
can share your historical information with staff if you start to use a new
mental health service, so that there is no need for you to repeat your story
all over again. You can send a report from your latest self-assessment to your
GP or mental health clinician before your appointment, so that they can see how
you have been feeling.
General
advice about using GRiST-SU
GRiST-SU is designed to
save the information that you enter that will not change, for example the date
that something happened. This means that
the next time you log-in, if you have saved your answers to this type of
question, they will still be there and you won’t have to answer them
again. For questions about things that
can change, for example how you are feeling, you will be able to enter new
answers. Your old answers will always be there when you login though, so you
can see what has changed since the last time you used GRiST.
Because GRiST collects a lot of information about you, it can take
quite a while to complete the whole assessment the first time, especially if you
are recording your history and personal details (you will only need to do this
once). There is no need to complete it
all in one go – you can leave it and come back to it later. How to do this is explained below.
For some people, thinking about how they are feeling or about
things that have happened in the past can be upsetting or make you feel
anxious. For this reason we advise that
the first time you fill in GRiST-SU, it may be best to either do it when there
are other people at home with you, or at a place that you feel comfortable, and
you know that there are people around to support you should you need it. It is probably also a good idea to make sure
that you have contact numbers available so that you can get in touch with your
usual sources of support if you need to.
Finding your way around GRiST-SU
GRiST-SU is divided into
sections that relate to the different types of risk. You can see the different risks in the panel
on the left hand side.
GRiST-SU is organised in
layers, starting with some general questions about each risk area (e.g. “are
you worried that either yourself or others are not looking after you as well as
usual?”). If you answer ‘yes’ to any of
these screening questions, you can then fill in more detailed information about
that particular risk as more questions appear underneath (explained below). You
don’t need to click on folders or answer questions about risks that you don’t
think are relevant to you, and you don’t have to go through all the relevant
sections each time, just what you feel is important to you at the time.
Once you have clicked on a
folder, the screen will react to the
answers that you give to the questions.
It will do this by:
- Opening
additional questions that ask for more detailed information if you have
answered ‘yes’ to some questions. If you
answer ‘no’ these questions won’t appear and you don’t need to answer them.
- Changing the
colour of the question box to suit your response. The colours run from yellow (no or low risk),
through green and blue and on to purple as risk increases, so dark purple
indicates that there is a high risk for this particular item. The colours help you see quickly where higher
and lower risk areas are, and to decide what action, if any, you need to take.
- Some of the
folder icons also change colour in the same way.
Additional features:
- All of the
questions have a blue speech bubble
on the right hand side. If you click on
the bubble, a comment box will open up.
You can use this to add any thoughts, details or comments about that
question and your answer to it. This can act like a diary for you. If a comment
has been added to a question, the bubble turns orange. If you want to look at the comment, or change
it, click on the bubble and the box re-opens.
There is a button on the comment box that allows you to remove the
comment if you wish.
- Some questions
also have a blue information button
on the right hand side (a white i in a blue circle). If you hover over the information button with
the cursor, you can see the ‘help’ for this question. Sometimes this is extra instructions about
how to answer the question (e.g. about the scale) and sometimes it is extra
things for you to think about when answering the question.
Towards the end of the
questions in each folder, there are some general questions about how you are
feeling, and some information to complete about yourself. These questions appear in all of the folders,
but you only need to answer them once – your answers will then automatically be
recorded in all of the risk folders.
This is because it is important to know this information for all types
of risk.
How to complete the questions
- Yes/no/DK (don’t know) questions:
Click on the round button
next to your chosen answer. A black dot
will appear.
- Multiple choice questions
Click on the round button
next to your chosen answer. A black dot
will appear.
- Date questions
Click
on the arrow in the day, month and year boxes to select the correct date.
Fill
in the full date, or only the month and year if that’s all that’s known.
Just
enter the year if this is all the information available.
(If
none of this information is available, click the “dk” button).
- Number of times questions
Type
the number of times in numbers, i.e. 5,
not five.
You
can then use the up and down buttons to change the numbers
Fill in the number of times
something has happened if you can remember, or your best estimate if you’re not
completely sure.
- Scale questions
min low
medium high max
0 1
2 3 4 5 6
7 8 9
10 dk
Click on the button next
to the number on the scale that best fits your answer – a black spot will
appear and the bar colour will change.
Don’t worry or spend a lot of time deciding what to put, just put the
number you think is the best fit, based on your initial feelings.
Saving and finishing
You don’t need to complete
all of the questions at once if you don’t want to. If you would like to leave the assessment
partly completed and come back to it later:
- Click on the ‘Save answers’ button on the bottom right
of the screen, and then the ‘Finish’
button. - A small screen
will open. Click on the ‘Suspend Assessment’ button. Your answers will have been saved and you can
continue later.
When you have answered all
of the questions that you feel are relevant to you:
- Click on the ‘Summing up’ button at the bottom of
the screen. - Thinking about
the answers you have given during the assessment, complete each scale to
indicate how much you think you are at risk in each of the risk areas. For
example if you were sure that you were not at any risk of failing to care for
yourself properly, you might click on 0 on that scale. - If you want to
add a comment to any of the scales, type your comment into the box that opens
up and then click ‘OK’. - You will then see a summary of your risk in each
area and the comment that you made about it.
Buttons
If you would like to let
the GRiST-SU developers know what you think about using GRiST-SU, you can click
on the ‘Feedback on GRiST’ button at
the top right. You can’t see this button
when you are in full screen mode. You
can provide feedback anonymously if you prefer.
The search button allows you to find questions about particular
topics.
- Click on search – a small window will open.
- Delete ‘enter
search string’ and type in the word you are searching for. - The folders
containing those topics will show green. - Click on the
labels and you will be taken to the set of questions that contain your
searched-for topic. You may have to
answer ‘yes’ to the top level question in order to see the ones you are looking
for.
The preferences button allows you to change the font size.
- Click on it –
a new window opens. - Use the arrow
to increase or decrease the font size. - Click ‘apply’
The full screen button changes the size of the viewing screen so that
it is larger and easier to see.
- Click on full
screen. - The larger
screen opens in a new window. The
smaller screen is still there behind this. - You will see a
warning about closing the screen. This
means that if you close the smaller background screen, the large screen will
also close and you will lose your answers if you haven’t saved them.
We hope this document has
helped you find your way around the GRiST software but please let us know if
there are any areas that are still unclear or where we can make improvements.
There is a feedback button at the top right of the program where you can send
us some comments as you use the tool. You may have to stretch the browser
window so that it is wide enough to see the button though.