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Promoting recovery and independence

November 1, 2009
by Dan Arens and Mike McKasson
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Evidence-Based Practices

Adult and Child Mental Health Center, Inc., is an Indianapolis-based community mental health center serving adults with serious mental illnesses and children with serious emotional disturbances in Central Indiana. During the past seven years, Adult and Child Center has been an early adopter of several SAMHSA-identified evidence-based practices (EBPs), including Assertive Community Treatment (ACT), Supported Employment (SE), Illness Management and Recovery (IMR), and Integrated Dual Disorders Treatment (IDDT), as well as the implementer of a trained peer-support specialist program. In fact, for our innovative implementation of IMR across our adult service line, SAMHSA recognized us with a 2008 Science and Service Award.

Promoting independence

Adult and Child Center organizes most of its adult services using ACT teams. Three teams meet strict state ACT certification standards, and an additional four community treatment teams share many of the fundamental aspects of the ACT model but are not ACT certified. The community treatment teams provide EBPs, based on the ACT model, to adults not eligible for certified ACT teams according to state regulations.

The target population for these teams includes adults with severe mental illness who meet at least one additional criterion related to hospitalization, emergency room use, justice system involvement, or homelessness. ACT typically is reserved for people with the most severe problems, providing intensive and assertive services for as long as people need them. To avoid fostering consumer dependence on the provider, Adult and Child Center saw the IMR model as an ideal way to help consumers and teams move toward independence and recovery.

IMR uses motivational, educational, and cognitive-behavioral interventions to help consumers manage their illnesses more independently and pursue self-defined recovery goals.1 By providing consumers with tools to address their mental health needs more effectively, we give them the ability to pursue meaningful goals supporting recovery and life outside the mental health system.

Adult and Child Center also saw the opportunity to engage consumers at the peer level. We chose to implement IMR primarily by introducing peer-support specialists (mental health consumers trained as service providers), who can instill hope and enhance engagement because they have lived the experience of recovery.

IMR has a short-term impact of improved self-management, resulting in fewer hospitalizations and crises. IMR also addresses personal recovery goals, which result in more people being employed, pursuing education, and being involved in satisfying personal relationships and other meaningful activities. This enhances ACT teams' work and allows them to move beyond maintenance and into the realm of recovery-focused care. In addition, the IMR package provided by peer-support specialists shifts staff views to be more in accord with consumers' recovery.

Measuring results

In 2003, Adult and Child Center conducted a nine-month IMR pilot in which a consumer with mental illness was hired and trained to provide IMR.2 She received 40 hours of IMR education at the ACT Center of Indiana. At the end of the pilot, we found that 14 consumers had begun the IMR program facilitated by the peer-support specialist, and four had completed it. Based on interviews with 16 staff members and the IMR consumers, our researchers determined that the program helped consumers feel more hopeful about their future and built confidence in their abilities to manage illness and participate in meaningful activities (e.g., computer classes and volunteer positions).

After collecting data on the first 17 people entering IMR we found that 11 completed the program, three are continuing, and three have dropped out. Among the first 11 completers, all were Caucasian; 47 percent were female; and the average age was 42.2 years old. Most (77 percent) had a diagnosis of schizophrenia/schizoaffective disorder.

The researchers assessed consumers' change in knowledge about mental illness and in self-reported perceptions of recovery using the Recovery Assessment Scale.3 The mean percentage correct on knowledge about mental illness was 83 percent prior to IMR and 90 percent after IMR (t = -2.01, p = 0.07). Recovery scores were significantly improved from a mean of 3.7 prior to IMR to 4.1 following IMR (t = -2.39, p = 0.04) on a five-point scale (Cohen's d effect size = 0.88).

The pilot's success led Adult and Child Center to place additional peer-support specialists on most of its service-delivery teams. We now employ nine peer-support specialists, who have administered part or all of IMR to approximately 125 consumers. One peer-support specialist writes:

IMR has helped me to understand just what recovery means to me and helped me to identify a better way of life. It really helped me to understand my illness better. For my clients…it has helped them to better identify a way to live with a mental illness so their illness doesn't have to be all-consuming. It helps them identify that they can still have a rewarding life. It gives them a sense of empowerment.