Browsing by Subject "illness management and recovery"
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Item The “Critical” Elements of Illness Management and Recovery: Comparing Methodological Approaches(Springer, 2016-01) McGuire, Alan B.; Luther, Lauren; White, Dominique; White, Laura M.; McGrew, John H.; Salyers, Michelle P.; Department of Psychology, School of ScienceThis study examined three methodological approaches to defining the critical elements of Illness Management and Recovery (IMR), a curriculum-based approach to recovery. Sixty-seven IMR experts rated the criticality of 16 IMR elements on three dimensions: defining, essential, and impactful. Three elements (Recovery Orientation, Goal Setting and Follow-up, and IMR Curriculum) met all criteria for essential and defining and all but the most stringent criteria for impactful. Practitioners should consider competence in these areas as preeminent. The remaining 13 elements met varying criteria for essential and impactful. Findings suggest that criticality is a multifaceted construct, necessitating judgments about model elements across different criticality dimensions.Item Development and Reliability of a Measure of Clinician Competence in Providing Illness Management and Recovery(2012-08) McGuire, Alan B.; Stull, Laura G.; Mueser, Kim T.; Santos, Meghan; Mook, Abigail; Rose, Nicole; Tunze, Chloe; White, Laura; Salyers, Michelle P.Objective: Illness management and recovery (IMR) is an evidence-based, manualized illness self-management program for people with severe mental illness. This study sought to develop a measure of IMR clinician competence and test its reliability and validity. Methods: Two groups of subject matter experts each independently created a clinician-level IMR competence scale based on the IMR Fidelity Scale and on two unpublished instruments used to evaluate provider competence. The two versions were merged, and investigators used the initial version to independently rate recordings of IMR sessions. Ratings were compared and discussed, discrepancies were resolved, and the scale was revised through 14 iterations. The resulting IMR Treatment Integrity Scale (IT-IS) includes 13 required items and three optional items rated only when the particular skill is attempted. Four independent raters then used the IT-IS to score tapes of 60 IMR sessions and 20 control group sessions. Results: The IT-IS showed excellent interrater reliability (.92). A factor analysis supported a one-factor model that showed good internal consistency. The scale successfully differentiated between IMR and control groups. Reliability and validity of individual items varied widely. Conclusions: The IT-IS is a promising measure of clinician competence in providing IMR. The scale could be used for research and quality assurance and as a supervisory feedback tool. Future research is needed to examine item-level changes, predictive validity of the IT-IS, discriminant validity compared with other more structured interventions, and the reliability and validity of the scale for nongroup IMR.Item Factors Affecting Implementation of an Evidence-Based Practice in the VA: Illness Management and Recovery(APA, 2015-12) McGuire, Alan B.; Salyers, Michelle P.; White, Dominique A.; Gilbride, Daniel J.; White, Laura M.; Kean, Jacob; Kukla, Marina; Department of Psychology, School of ScienceObjective: Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Methods: Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Results: Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. Conclusions and Implications for Practice: IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)Item Illness management and recovery in community practice(American Psychological Association, 2016-12) McGuire, Alan B.; Roudebush, Richard L.; Bartholomew, Tom; University, Rutgers; Anderson, Adrienne I.; Bauer, Sarah M.; McGrew, John H.; White, Dominique A.; Luther, Lauren; Rollins, Angela; Roudebush, Richard L.; Pereira, Angela; Salyers, Michelle P.; Psychology, School of ScienceObjective To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. Methods IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR treatment integrity scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). Results Average IMR competence scores were in the “Needs Improvement” range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. Conclusions and Implications for Practice IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed.Item Illness management and recovery in community practice(American Psychological Association, 2016-12) McGuire, Alan B.; Roudebush, Richard L.; Bartholomew, Tom; University, Rutgers; Anderson, Adrienne I.; Bauer, Sarah M.; McGrew, John H.; White, Dominique A.; Luther, Lauren; Rollins, Angela; Roudebush, Richard L.; Pereira, Angela; Salyers, Michelle P.; Psychology, School of ScienceObjective To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. Methods IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR treatment integrity scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). Results Average IMR competence scores were in the “Needs Improvement” range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. Conclusions and Implications for Practice IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed.Item Impact of Illness Management and Recovery Programs on Hospital and Emergency Room Use by Medicaid Enrollees(2011-05) Salyers, Michelle P.; Rollins, Angela L.; Clendenning, Daniel; McGuire, Alan B.; Kim, EdwardObjective—Illness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization. Methods—This was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations, for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status. Results—Consumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers. Conclusions—This is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT.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 Investigating the reliability and validity of the Dutch versions of the illness management and recovery scales among clients with mental disorders(Taylor & Francis, 2016) Goossens, Peter J. J.; Beentjes, Titus A. A.; Knol, Suzanne; Salyers, Michelle P.; de Vries, Sjoerd J.; Department of Psychology, School of ScienceBackground: The Illness Management and Recovery scales (IMRS) can measure the progress of clients’ illness self-management and recovery. Previous studies have examined the psychometric properties of the IMRS. Aims: This study examined the reliability and validity of the Dutch version of the IMRS. Method: Clients (n = 111) and clinicians (n = 40) completed the client and clinician versions of the IMRS, respectively. The scales were administered again 2 weeks later to assess stability over time. Validity was assessed with the Utrecht Coping List (UCL), Dutch Empowerment Scale (DES), and Brief Symptom Inventory (BSI). Results: The client and clinician versions of the IMRS had moderate internal reliability, with α = 0.69 and 0.71, respectively. The scales showed strong test–retest reliability, r = 0.79, for the client version and r = 0.86 for the clinician version. Correlations between client and clinician versions ranged from r = 0.37 to 0.69 for the total and subscales. We also found relationships in expected directions between the client IMRS and UCL, DES and BSI, which supports validity of the Dutch version of the IMRS. Conclusions: The Dutch version of the IMRS demonstrated good reliability and validity. The IMRS could be useful for Dutch-speaking programs interested in evaluating client progress on illness self-management and recovery.Item A randomized controlled trial of Illness Management and Recovery with an active control condition(2014-08) Salyers, Michelle P.; McGuire, Alan B.; Kukla, Marina; Fukui, Sadaaki; Lysaker, Paul H.; Mueser, Kim T.Objective The purpose of the study was to rigorously test Illness Management and Recovery (IMR) against an active control group in a sample that included veterans. Methods A total of 118 participants with schizophrenia spectrum disorders, 56 of whom were veterans, were recruited from a Department of Veterans Affairs medical center and a community mental health center in the same city and were randomly assigned to an IMR group (N=60) or a weekly problem-solving group intervention (N=58). Groups met weekly for nine months. Blinded assessments were conducted at baseline, nine months, and 18 months on measures of symptoms, functioning, illness self-management, medication adherence, subjective recovery experiences, and service utilization. Results No significant differences were found between IMR and problem-solving groups. Participants in both groups improved significantly over time in symptom severity, illness management, and quality of life and had fewer emergency department visits. Participation rates in both interventions were low. Only 28% of consumers assigned to IMR and 17% of those assigned to the problem-solving group participated in more than half the scheduled groups, and 23% and 34%, respectively, attended no sessions. Conclusions This is the first randomized controlled trial of IMR to report negative findings. Given the inclusion of an active control group and the low participation rates, further research is needed to understand factors affecting IMR effectiveness. Increased attention may need to be paid to facilitate more active participation in IMR, such as individual follow-up with consumers and the integration of IMR with ongoing treatment.Item The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs(Springer, 2015) McGuire, Alan B.; White, Dominique A.; Bartholomew, Tom; Flanagan, Mindy E.; McGrew, John H.; Rollins, Angela L.; Mueser, Kim T.; Salyers, Michelle P.; Department of Psychology, School of ScienceProvider competence may affect the impact of a practice. The current study examined this relationship in sixty-three providers engaging in Illness Management and Recovery with 236 consumers. Improving upon previous research, the present study utilized a psychometrically validated competence measure in the ratings of multiple Illness Management and Recovery sessions from community providers, and mapped outcomes onto the theory underlying the practice. Provider competence was positively associated with illness self-management and adaptive coping. Results also indicated baseline self-management skills and working alliance may affect the relationship between competence and outcomes.