Michelle Salyers
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The ACT Center has been working since 2001 to conduct research and provide training and consultation that supports recovery in adults with severe mental illnesses. Some of the models of care include Assertive Community Treatment (ACT) and Illness Management and Recovery (IMR) programs, which seek to enhance services that support people with mental illness to lead productive lives in their own communities rather than accessing jail, homeless shelters and more costly medical care.
The ACT Center began as a collaboration of the Department of Psychology at Indiana University-Purdue University Indianapolis (IUPUI) and Adult & Child Mental Health Center of Indianapolis. The ACT Center partnership has grown to include a number of other schools on campus, researchers at other universities, and a variety of clinical settings including the Roudebush VA, Four County Counseling Center, and Midtown Mental Health Center. ACT Center collaborators include researchers, clinicians, consultants, educators, consumers, and family members.
The ACT Center has federal funding from a variety of sources, including NIH, PCORI, SAMHSA, and VA. The ACT Center is also an IUPUI designated Signature Center through the School of Science. In addition to research and training, the ACT Center also informs policy makers about methods for funding services that seek to help consumers utilize less costly services and lead productive lives. This translational research exemplifies taking many years of research findings and incorporating models into everyday practice that has a direct impact on people with mental illness and the communities in which they live.
Professor Salyers' work with the ACT Center is yet another way IUPUI faculty are TRANSLATING their RESEARCH INTO PRACTICE.
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Item Clinical and Psychological Correlates of Two Domains of Hopelessness in Schizophrenia(2008-12) Lysaker, Paul H.; Salyers, Michelle P.; Tsai, Jack; Spurrier, Linda Yorkman; Davis, Louanne W.Hopelessness is a widely observed barrier to recovery from schizophrenia spectrum disorders. Yet little is known about how clinical, social, and psychological factors independently affect hope. Additionally, the relationships that exist between these factors and different kinds of hope are unclear. To explore both issues, we correlated two aspects of hope, expectations of the future and agency, with stigma, clinical symptoms, anxiety, and coping preferences in 143 persons with a schizophrenia spectrum disorder. Multiple regressions revealed that hope for the future was predicted by lesser alienation, lesser preference for ignoring stressors, and lesser emotional discomfort and negative symptoms, accounting for 43% of the variance. A greater sense of agency was linked to lesser endorsement of mental illness stereotypes, fewer negative symptoms, lesser social phobia, and lesser preference for ignoring stressors, accounting for 44% of the variance. Implications for research and interventions are discussed.Item The Role of Patient Activation in Psychiatric Visits(2009-11) Salyers, Michelle P.; Matthias, Marianne S.; Spann, Crystal; Lydick, Jennifer; Rollins, Angela L.; Frankel, Richard M.OBJECTIVE: This study identified ways that consumers of mental health services are active participants in psychiatric treatment. METHODS: Four providers (three psychiatrists and one nurse practitioner) were recruited, and ten consumers with severe mental illness were recruited per provider (40 total). Consumers completed questionnaires on patient activation, illness self-management, and medication attitudes on the day of a psychiatric visit. The visit was audiotaped, transcribed, and thematically analyzed. Providers gave information on diagnosis, substance use disorder, and medication adherence. RESULTS: Consumer-rated patient activation was positively related to illness self-management and negatively related to substance use disorder. Transcripts of the psychiatric visit showed that consumers were active in partnership building, seeking and displaying competence, and directing treatment; however, the relationship was weak between consumer-reported activation and observed activation behaviors. CONCLUSIONS: Consumers were found to be active participants in treatment in a variety of ways, but similar to other populations, the relationship between observed patient activation and consumer-reported desire for involvement was not direct.Item Recovery from Severe Mental Illness – Pilot Research Paving the Way(Office of the Vice Chancellor for Research, 2010-04-09) Kim, Hea-Won; Rollins, Angela L.; Salyers, Michelle P.The ACT Center of Indiana is a research and training center devoted to helping organizations provide services to adults with severe mental illness that are based on the best research evidence and promote recovery. We briefly highlight 5 recent pilot studies that ultimately may help improve care. These involve measuring factors that promote recovery (pilot #1), strategies to involving family members in recovery (pilot #2), ensuring active participation of consumers (pilot#3), reducing burnout in staff (pilot #4), and cost-effective ways to measure program implementation (pilot #5).Item Coping with Positive and Negative Symptoms of Schizophrenia(2010-08) Rollins, Angela L.; Bond, Gary R.; Lysaker, Paul H.; McGrew, John H.; Salyers, Michelle P.Objective: Although coping with positive symptoms of schizophrenia has been studied widely, few studies have examined coping with negative symptoms. This study compares the appraisal of stressfulness and coping patterns in response to positive and negative symptoms experienced by clients with schizophrenia attending a community mental health center. Methods: Clients were interviewed to assess symptom severity, appraisal of symptom stressfulness, and coping strategies used for selected symptoms rated as severe and reported as stressful. Open-ended responses from clients regarding coping strategies were coded according to an a priori coding scheme. Results: Clients reported negative symptoms as less stressful, and they used fewer coping strategies in response than they did for positive symptoms. Clients used some types of coping more than others: behavioral more than cognitive, nonsocial more than social, emotion-focused more than problem-focused, and avoidant more than nonavoidant. Conclusions: Clients more often report positive symptoms as stressful compared with negative symptoms, though negative symptoms are still reported as stressful to a certain degree, indicating a need to improve our ability to help clients cope with negative symptoms. Clients are less likely to use coping strategies to counteract negative symptoms compared with positive symptoms. Implications are discussed for developing interventions tailored to promoting awareness of and ways of coping with negative symptoms.Item Housing Preferences and Choices Among Adults with Mental Illness and Substance Use Disorders: A Qualitative Study(2010-08) Tsai, Jack; Bond, Gary R.; Salyers, Michelle P.; Godfrey, Jenna L.; Davis, Kristin E.Housing is a crucial issue for adults with severe mental illness and co-occurring substance use disorders, as this population is particularly susceptible to housing instability and homelessness. We interviewed 40 adults with dual disorders, living in either supervised or independent housing arrangements, to examine housing preferences, decision making processes surrounding housing choices, and perceived barriers to housing. We found that many clients indicated their housing preferences had changed over time, and some clients related housing preferences to recovery. Although the majority of clients preferred independent housing, many also described benefits of supervised housing. Clients' current living situations appeared to be driven primarily by treatment provider recommendations and availability of housing. Common barriers to obtaining desired housing were lack of income and information. These findings have implications for supported housing models and approaches to providing housing for clients.Item Integrating Assertive Community Treatment and Illness Management and Recovery for Consumers with Severe Mental Illness(2010-08) Salyers, Michelle P.; McGuire, Alan B.; Rollins, Angela L.; Bond, Gary R.; Mueser, Kim T.; Macy, Veronica R.This study examined the integration of two evidence-based practices for adults with severe mental illness: Assertive community treatment (ACT) and illness management and recovery (IMR) with peer specialists as IMR practitioners. Two of four ACT teams were randomly assigned to implement IMR. Over 2 years, the ACT–IMR teams achieved moderate fidelity to the IMR model, but low penetration rates: 47 (25.7%) consumers participated in any IMR sessions and 7 (3.8%) completed the program during the study period. Overall, there were no differences in consumer outcomes at the ACT team level; however, consumers exposed to IMR showed reduced hospital use over time.Item Staff Turnover in Statewide Implementation of ACT: Relationship with ACT Fidelity and Other Team Characteristics(2010-09) Rollins, Angela L.; Salyers, Michelle P.; Tsai, Jack; Lydick, Jennifer M.Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.Item Recovery-Oriented Training and Staff Attitudes Over Time in Two State Hospitals(2010-12) Tsai, Jack; Salyers, Michelle P.; Lobb, Angela L.Recovery attitudes and concepts are often promoted to community mental health staff through educational and in-service trainings, but no study found has examined this in state hospitals. The current observational study aimed to examine the types of recovery-oriented trainings that occurred at two state hospitals over 1 year and subsequent changes in staff recovery attitudes. A total of 184 state hospital staff completed questionnaires assessing their personal optimism, consumer optimism, and agency recovery orientation at baseline and 1 year later. The types of recovery-oriented trainings staff received were categorized as general/inspirational or specific/practical training. Results found that the majority of staff at the two state hospitals received some recovery-oriented training, mostly general/inspirational training. Staff who received specific/practical training had a greater increase in agency recovery attitudes than staff who received only general/inspirational training or no training. However, the more trainings staff had, the higher their consumer optimism. These results suggest state hospitals are incorporating recovery-oriented staff trainings, but more specific trainings may be needed and all staff involved in different levels of care need to be included.Item A Review of Consumer-provided Services on Assertive Community Treatment and Intensive Case Management Teams: Implications for Future Research and Practice(2011-01) Wright-Berryman, Jennifer L.; McGuire, Alan B.; Salyers, Michelle P.Background—Assertive community treatment (ACT) is an evidence-based practice that provides intensive, in vivo services for adults with severe mental illness. Some ACT and intensive case management teams have integrated consumers as team members with varying results. Methods—We reviewed the literature examining the outcomes of having consumer providers on case management teams, with attention devoted to randomized controlled trials (RCTs). Results—We identified 16 published studies, including 8 RCTs. Findings were mixed, with evidence supporting consumer-provided services for improving engagement, and limited support for reduced hospitalizations. However, evidence was lacking for other outcomes areas such as symptom reduction or improved quality of life. Conclusion—Including a consumer provider on an ACT team could enhance the outreach mechanisms of ACT, using a more recovery-focused approach to bring consumers into services and help engage them over time. More rigorous research is needed to further evaluate integrating consumer providers on teams.Item BREATHE: A Pilot Study of a One-Day Retreat to Reduce Burnout Among Mental Health Professionals(2011-02) Salyers, Michelle P.; Hudson, Candice; Morse, Gary; Rollins, Angela L.; Monroe-DeVita, Maria; Wilson, Cynthia; Freeland, LeahOBJECTIVE: Staff burnout is a frequent problem for mental health providers and may be associated with negative outcomes for providers, consumers, and organizations. This study tested an intervention to reduce staff burnout. METHODS: Community mental health providers were invited to participate in a day-long training session to learn methods to reduce burnout. A Web-based survey was given at time of registration, before the intervention, and again six weeks later. RESULTS: Eighty-four providers participated in the training, and follow-up data were available for 74. Six weeks after the day-long training, staff reported significant decreases in emotional exhaustion and depersonalization and significant increases in positive views toward consumers. There were no significant changes in providers' sense of personal accomplishment, job satisfaction, or intention to leave their position. Ninety-one percent of the staff reported the training to be helpful. CONCLUSIONS: This brief intervention is feasible, is acceptable to staff, and may improve burnout and staff attitudes.