Evidence-Based Practices in Mental Health: Ready or Not
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Transcript Evidence-Based Practices in Mental Health: Ready or Not
Evidence-Based Practices in Mental Health:
Ready or Not, Here They Come
Session VII: “Illness
Management and Recovery”
Michael Flaum
Iowa Consortium for Mental Health
Michelle P. Salyers, Ph.D.
ACT Center of Indiana
October 7, 2004
National EBP Project:
6 Selected Practices
Family Psycho-education
Supported Employment
Medication Management Approaches in
Psychiatry (MedMAP)
Assertive Community Treatment
Integrated Treatment of Co-occurring
Disorders
Illness Management and Recovery
Stated Objectives
Core components of model
Evidence base for effectiveness
Extent of implementation
Barriers to implementation and
strategies to overcome them
Is “recovery” a part of any one
model?
Family Psycho-education and Recovery
Supported Employment and Recovery
Medication Management Approaches in
Psychiatry (MedMAP) and Recovery
Assertive Community Treatment and
Recovery
Integrated Treatment of Co-occurring
Disorders and Recovery
Illness Management and Recovery
Clarification of terms
What do we mean by…
Illness Management?
Recovery?
Illness management and Recovery
(IMR)
Wellness management and Recovery
(WMR)
Illness Management – Definition used in
the IMR model
“Illness management is a broad set of
strategies designed to help individuals
with serious mental illness…
collaborate with professionals
reduce their susceptibility to the illness
cope effectively with their symptoms”
Source: Mueser et al, Illness Management and Recovery:
A Review of the Research
Psychiatric Services 53: 1272-1284, 2002
Professional vs. Peer-Based Illness
Management
Complementary?
Hierarchical vs. non-hierarchical
Responsibility for care vs. sharing of
personal experience
Recovery – Definition used in this
model
“Recovery occurs when people with
mental illness discover, or rediscover,
their strengths and abilities for
pursuing personal goals and develop a
sense of identity that allows them to
grow beyond their mental illness”
Source: Mueser et al, Illness Management and Recovery:
A Review of the Research
Psychiatric Services 53: 1272-1284, 2002
Recovery – Other Perspectives
“Recovery involves the development of
new meaning and purpose in one’s life
as one grows beyond the catastrophic
effects of mental illness”
Anthony, WA: Recovery from mental illness: the guiding
vision of the mental health service system in the 1990’s.
Psychosocial Rehabilitation Journal 16: 11-23, 1993
Recovery – Other Perspectives
“Recovery” is a process, a way of life, an
attitude and a way of approaching the day’s
challenges. It is not a perfectly linear
process. At times our course is erratic and we
falter, slide back, regroup, and start again…”
“…The need is to re-establish a new and
valued sense of integrity and purpose within
and beyond the limits of the disability; the
inspiration to live, work, and love in a
community in which one makes a significant
contribution.”
Patricia Deegan, 1998
Key Recovery Concepts
Hope
Personal Responsibility
Self Advocacy
Education
Support
Mary Ellen Copeland, MA, MS
Characteristics of Recovery
Defined and accomplished by the one
who is living with a mental illness
Viewed as a process and outcome
Involves personal and social success
Universal human experience
Includes themes of hope, selfconfidence, enjoyment, well-being, &
optimism
Development of the IMR program
National evidence-based practices project
Reviewed 40 randomized controlled studies
Identified four effective components of illness
management
Committee developed toolkit
Evidence for Effectiveness of “Illness
Management” for Adults with SMI
Summary of Results from Review of 40
Randomized Controlled Trials
Components
Outcome(s)
Psycho-education
Improves knowledge of mental
illness
Behavioral Tailoring
Helps people take medication as
prescribed
Relapse Prevention
Programs
Reduce symptom relapses and rehospitalizations
Coping Skills Training
Reduces the severity and distress
(Cognitive - Behavioral) of persistent symptoms
Mueser et al, Psychiatric Services 53: 1272-1284, 2002
Illness Management and Recovery
(a la National EBP Project)
Michelle Salyers, Ph.D.
ACT Center of Indiana
What is Illness Management and
Recovery?
A structured program that helps people
seek meaningful goals for themselves
acquire information and skills to develop
more control over their psychiatric illness
make progress towards their own personal
recovery
Overarching Goals of IMR
Inspire people to become hopeful about their
recovery
Prepare people to be informed decisionmakers about their own treatment
Help people gain more sense of control over
their mental illness
Free people up to spend less time dealing
with their illness and more time enjoying life
Specific Goals
Help people set and make progress towards
personal recovery goals
Teach people about psychiatric illness and its
treatment
Teach people how to use medication effectively
Help people develop relapse prevention plans
Teach people strategies for coping with and
reducing persistent symptoms and other
problems
Core Values of IMR model
Hope is the key ingredient
The person is the expert
Personal choice is a must
Practitioners of IMR are partners
Practitioners demonstrate not dictate
Respect is always present
Components of IMR Program
Structured curriculum of 9 modules
Individual or small group format
4 to 8 months of weekly sessions with
trained practitioner
People set personal goals and pursue
them
Components of IMR Program,
cont’d
People practice strategies and skills in
sessions
People have home assignments to practice
strategies and skills in the real world
Significant others are invited to participate in
sessions and homework
EVERYTHING IS TAILORED TO THE
INDIVIDUAL
Topics of Modules
1. Recovery Strategies
2. Practical Facts about Mental Illness
3. The Stress-Vulnerability Model
4. Building Social Support
5. Using Medication Effectively
Topics of Modules
6. Reducing Relapses
7. Coping with Stress
8. Coping with Problems and Symptoms
9. Getting Your Needs Met in the Mental
Health System
For Each Module
Educational handout for consumer
Practitioners’ guidelines for clinician
Teaching Strategies
Motivational
Educational
Cognitive-Behavioral
Structure of IMR Sessions
Review previous session
Review home assignment
Follow up on personal goals
Set agenda for current session
Teach and practice new material
Agree on home assignment
Summarize progress made in session
Who is IMR For?
Anyone can benefit
When people learn more about their
symptoms and develop skills for coping with
problems, they often feel more confident and
can be more effective at resolving some of
their life stresses
Clients can benefit regardless of how long
they have had their mental illness or where
they are in their recovery process
IMR is good clinical practice
Gives practitioners tools
Creates a partnership between
consumer and practitioner
Is consumer-directed, with their goals
the focus of every session
Brings together recovery and evidencebased interventions
Indiana’s initial experiences with IMR
Pilot study integrating ACT and IMR
Consumer peer specialist hired for this
role
Part-time, but full team member
Primarily does IMR
Individual sessions
Developed support group to pursue common
interests
Randomized study of ACT- IMR underway
Pilot feedback
14 consumers had started IMR prior to
April 2004
Pre-post recovery and knowledge
Qualitative interviews in April 2004
Consumers (14) and Staff (16)
Change as a result of IMR
Most helpful/least helpful
Impact of peer specialist
Preliminary results
Pre-post sample too small to examine
yet (6 complete so far)
Interviews were very positive about
IMR experiences
Staff views
Consumer benefits:
more confidence, trying new things
more involved in meaningful activity
managing their own illness better
Staff benefits:
better understanding of consumer
goals/needs
less “protective,” more recovery focused
“In 15 years, this is the first new thing
that's made a huge impact.”
Consumer views
Feel more hopeful, confident
Doing more meaningful activities
Increased vocational activity
“She's gone through the same thing. I
can relate to her better. If she can do it,
why can't I do it?”
IMR in other settings
Working with 3 agencies to implement IMR
Clubhouse, case management services,
partial hospitalization program
Clubhouse trying IMR in groups and
individually
Groups more difficult to implement, needs to
be small to focus on personal goals, takes
longer, peers get more ideas and support from
each other
Implementing IMR
Program leader and practitioners
identified
Training (2-day intensive)
Follow-up consultation (monthly visits)
Ongoing technical support as needed
Program evaluation (fidelity and
outcomes)
Administrative supports
Important for IMR practitioners to:
Have IMR as part of their job
description
Receive PROTECTED time for training,
preparing for sessions, and completing
necessary documentation
Receive weekly supervision
Have accountability for providing IMR
IMR coordinator/program leader is
critical
IMR coordination is part of job description
A specific portion of their time is
designated to devote to IMR coordination
Receives training in IMR & works with
some consumers
Supervises IMR practitioners
Establishes and monitors methods for
referring consumers to IMR
Monitors program quality
Closing Thoughts
“Having strategies for coping with mental
illness is extremely important. It’s hard to enjoy
your life if you are constantly sick with mental
illness…”
“…however, believing in yourself, having hope
that things will continue to get better and
looking forward to your future are also vital in
overcoming mental illness. Our hopes and
dreams are not delusions. Our hopes and
dreams are what make us human.”
David Kime, artist, writer, floral designer, person in
recovery from bipolar disorder.
Iowa Recovery Initiatives
Iowa “Recovery”- oriented initiatives
IAPSRS / USPRA
International Association of Psychosocial Rehabilitation
Services, recently renamed U.S. Psychiatric Rehabilitation
Association
Wellness Recovery Action Plan (WRAP) trainings
NAMI’s “Peer to Peer” program
IPR - Intensive Psych Rehab Consumer
Resource and Outreach Project
Iowa PEERS
Recovery, Inc.
Many others
WMR Technical Assistance Center
Supported by MBC – Community
Reinvestment
Collaboration between ICMH and North
East Iowa CMHC
Steering Committee
ICMH, Patrick Smith, Brenda Burke,
Virginia Liedel
Mary Hughes
Recasting Terms and Goals
Initial intent was to pilot IMR model
Renamed IMR to WMR: Wellness
Management and Recovery
Recast goals
Provide a forum for recovery initiatives
Speaking with a more unified voice
WRAP trainings
WRAP
Wellness Recovery Action Plans
WRAP training
Level I
Level II
Level III
Goal in year 1: expose 100
individuals statewide
Year 2 goals and activities
Continue to support Statewide Advisory
Board
Morph into an Alliance for Recovery in Iowa?
Expand executive steering committee
Develop “Support and Education”
Component
White paper
More “level 1” WRAP trainings
Support and Education Component
Ongoing organization, coordination,
education, and support of consumer
educators
Curriculum development and
refinement
Quality Assurance methods
Dissemination to stakeholders
Recovery initiatives as “bottom up”
evidence-based practices
Specify target population
Specify target outcomes
Methods to assess achievement of
outcomes
Manualization
Replicability across sites
Fidelity Assessments
Why move towards an evidence-based
culture?
Optimize outcomes
Optimize Value (Outcomes / Cost)
Not waste scarce resources on ineffective practices
Put relatively more of available resources into more
effective practices
Advance the practice
Continually translate experience into knowledge
Allow for sharing of experience and knowledge
Have a system that learns
Sponsors and Partners
Community Mental Health Block Grant
Feds – SAMHSA, CMHS
Iowa – DHS, Mental Health Planning Council
University of Iowa College of Medicine
Department of Psychiatry
Telemedicine Resource Center
Magellan Behavior Care of Iowa
State Public Policy Group
ACT Center of Indiana