Maria Monroe-DeVita1, Gary Morse1, Kim T Mueser1, Gregory J McHugo1, Haiyi Xie1, Kevin A Hallgren1, Roselyn Peterson1, Joris Miller1, Christopher Akiba1, Mary York1, Susan Gingerich1, Bryan Stiles1. 1. Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania.
Abstract
OBJECTIVE: In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS: A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS: Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS: Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.
OBJECTIVE: In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS: A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS: Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS: Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.
Entities:
Keywords:
Assertive community treatment; Community mental health services; Illness Management and Recovery; Psychoses; Schizophrenia; Serious Mental Illness
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