Implementing Illness Management and Recovery Within Assertive Community Treatment: A Pilot Trial of Feasibility and Effectiveness

• Published in: Psychiatric services (Washington, D.C.) Vol. 69; no. 5; pp. 562 - 571
• Main Authors: Monroe-DeVita, Maria, Morse, Gary, Mueser, Kim T, McHugo, Gregory J, Xie, Haiyi, Hallgren, Kevin A, Peterson, Roselyn, Miller, Joris, Akiba, Christopher, York, Mary, Gingerich, Susan, Stiles, Bryan
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01.05.2018; American Psychiatric Publishing, Inc
• Subjects: Adult; Bipolar Disorder - therapy; Clinical outcomes; Community; Community Mental Health Services - methods; Curricula; Disease Management; Feasibility Studies; Female; Humans; Male; Mental disorders; Middle Aged; Outcome Assessment, Health Care; Patient care planning; Pilot Projects; Psychotic Disorders - therapy; Recovery (Medical); Schizophrenia - therapy; Schizophrenia; Assertive community treatment; Serious Mental Illness; Illness Management and Recovery; Psychoses; Community mental health services
• ISSN: 1075-2730; 1557-9700; 1557-9700
• DOI: 10.1176/appi.ps.201700124

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.