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Randomized Controlled Trial
. 2018 May 1;69(5):562-571.
doi: 10.1176/appi.ps.201700124. Epub 2018 Feb 15.

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

Maria Monroe-DeVita  1 , Gary Morse  1 , Kim T Mueser  1 , Gregory J McHugo  1 , Haiyi Xie  1 , Kevin A Hallgren  1 , Roselyn Peterson  1 , Joris Miller  1 , Christopher Akiba  1 , Mary York  1 , Susan Gingerich  1 , Bryan Stiles  1
Affiliations
Randomized Controlled Trial

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

Maria Monroe-DeVita et al. Psychiatr Serv. .

Abstract

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.

Keywords: Assertive community treatment; Community mental health services; Illness Management and Recovery; Psychoses; Schizophrenia; Serious Mental Illness.

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