Integration of Illness Management and Recovery Within ACT

NCT03075800 | Completed

• 1 other identifier: 40487-C
• Study Type: interventional
• Target: 101
• Locations: 0 countries
• Sites: N/A

Brief Summary

Integrating Illness Management and Recovery (IMR) into Assertive Community Treatment (ACT) has great promise for improving the symptomatic, functional, and recovery outcomes for people with Serious Mental Illness (SMI), especially those individuals who have the greatest needs. In addition to these positive consumer outcomes, system benefits may also accrue due to more rapid graduation of consumers from ACT (with IMR) programs to less intensive levels of care. However, before these benefits can be realized, research and development are needed to design and pilot test a treatment manual that is feasible and acceptable to consumers and staff for integrating IMR and ACT.

Conditions

Severe Mental Illness; Schizophrenia; Bipolar Disorder

Keywords

Assertive Community Treatment (ACT) Only; Assertive Community Treatment (ACT) + Illness Management and Recovery (IMR)

Outcome Measures

Primary Outcomes (1)

• Illness Self-Management - The Clinician and Client Versions of the IMR Scale

  evaluate illness self-management across 15 items rated on 5-point behaviorally anchored scales, with higher scores indicating better illness management. Overall scores are averages of the 15 items (ranging from 15 to 75).

  baseline, 6, and 12 months

Secondary Outcomes (5)

• Brief Psychiatric Rating Scale (BPRS)

  baseline, 6, and 12 months

• Daily Living Activities Scale (DLA-20), the Global Assessment of Functioning (GAF), and the Quality of Life Scale-Abbreviated (QLSA)

  baseline, 6, and 12 months

• Recovery Assessment Scale (RAS)

  baseline, 6, and 12 months

• Community Integration Measure (CIM)

  baseline, 6, and 12 months

• Emergency mental health services

  baseline, 6, and 12 months

Study Arms (2)

Assertive Community Treatment (ACT) - Only

NO INTERVENTION

ACT is a multidisciplinary, team-based approach to providing a range of treatment, rehabilitation, and support services to high-need, high-risk people with severe mental illness who tend not to use clinic-based services; most services are provided on an outreach basis (e.g., in the person's home) and services are available 24 /7(27).

Assertive Community Treatment+Illness Management and Recovery

EXPERIMENTAL

IMR follows a manualized curriculum to help clients pursue personal recovery goals and to teach them information, strategies, and skills over 11 modules (e.g., using medications, coping with stress) to manage their psychiatric illness. IMR can be provided in individual or group formats. The integrated ACT+IMR model was developed and manualized prior to the start of this evaluation (27). The model incorporates the following key features: a) ACT staff provide IMR in office-based group and/or individual sessions in office or community settings; b) regular community follow-up by ACT staff to assist clients with practicing IMR skills and achieving their goals; c) regular communication within ACT team (e.g., during daily meetings) on IMR client goals and progress; and d) supervision and consultation on IMR within ACT.

Behavioral: Assertive Community Treatment (ACT) + Illness Management and Recovery (IMR)

Interventions

Assertive Community Treatment (ACT) + Illness Management and Recovery (IMR) BEHAVIORAL

The integrated ACT+IMR model was developed and manualized prior to the start of this evaluation (27). The model incorporates the following key features: a) ACT staff provide IMR in office-based group and/or individual sessions in office or community settings; b) regular community follow-up by ACT staff to assist clients with practicing IMR skills and achieving their goals; c) regular communication within ACT team (e.g., during daily meetings) on IMR client goals and progress; and d) supervision and consultation on IMR within ACT.

Also known as: ACT+IMR

Assertive Community Treatment+Illness Management and Recovery

Eligibility Criteria

• Age: 23 Years - 69 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

Eight ACT teams in two states were recruited, with four teams in each state. Selection criteria included: 1. no prior IMR training; and 2. good fidelity to ACT, defined as a score \> 3.5 (out of 5.0) on the Tool for Measurement of Assertive Community Treatment during state-sponsored fidelity assessments in 2012.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• University of Washington: lead

MeSH Terms

Conditions

Mental Disorders; Schizophrenia; Bipolar Disorder

Interventions

Community Mental Health Services; Salvage Therapy

Condition Hierarchy (Ancestors)

Schizophrenia Spectrum and Other Psychotic Disorders; Bipolar and Related Disorders; Mood Disorders

Intervention Hierarchy (Ancestors)

Mental Health Services; Behavioral Disciplines and Activities; Community Health Services; Health Services; Health Care Facilities Workforce and Services; Therapeutics

Study Officials

• Maria Monroe-DeVita, PhD

  Co-PI, University of Washington, Seattle, WA

  PRINCIPAL INVESTIGATOR

• Gary Morse, PhD

  Co-PI, Places for People, St. Louis, MO

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: A pilot, cluster randomized controlled trial was conducted in which ACT teams were randomized to provide either IMR within ACT (ACT+IMR) or standard ACT treatment (ACT-only). The impact of ACT+IMR vs. ACT-only on illness management and recovery outcomes was based on assessments conducted on a subset of randomly selected clients from each team, conducted at baseline, six months, and one year. Randomization to ACT+IMR or ACT-only was stratified by state and by team size, resulting in one large team and one small team assigned to each condition in each state.

Study Record Dates

• First Submitted: March 3, 2017
• First Posted: March 9, 2017
• Study Start: June 7, 2011
• Primary Completion: March 31, 2015
• Study Completion: March 31, 2015
• Last Updated: March 9, 2017

Record last verified: 2017-03

Data Sharing

• IPD Sharing: Will not share