Randomized Controlled Trial of Illness Management and Recovery in Multiple-Unit Supportive Housing

Center for Urban Community Services, 198 E. 121st St., 5th Floor, New York, NY 10035, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 12/2009; 60(12):1629-36. DOI: 10.1176/
Source: PubMed


This study evaluated the effects of the illness management and recovery program on mental illness and functional outcomes of persons with serious mental illness who were receiving supportive housing services.
A randomized controlled trial was conducted with 104 persons with serious mental illness who were assigned either to illness management classes for six months or to a waitlist control group, with follow-up assessments conducted six months posttreatment. Assessments included self-reports, nonblinded clinical ratings, and blinded interview ratings and included the domains of illness management, symptoms, psychosocial functioning, hospitalizations, and substance abuse and dependence.
Participants assigned to the program showed significantly greater improvements than the control group in self-reported and clinician ratings of illness management, interview-based ratings of symptoms on the Brief Psychiatric Rating Scale, and interview-based ratings of psychosocial functioning on the abbreviated Quality of Life Scale. Participants in both groups improved in self-ratings of symptom distress and had low rates of hospitalization and substance abuse over the course of the study.
The results suggest that the program was effective at improving illness management and functional outcomes for persons with serious mental illness who were receiving supportive housing services.

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    • "The effects of the adapted IMR program on improved illness self-management in inpatients are consistent with the benefits found in similar areas, such as knowledge, insight, or self-or clinician ratings on the IMR Scales (Mueser & Gingerich, 2005; Sklar, Sarkin, Gilmer & Groessl, 2012), in previous controlled studies of the full-length IMR program with stabilized outpatients (Färdig et al., 2011; Hasson-Ohayon et al., 2007; Levitt et al., 2009). The findings are also in line with the results of another relatively brief program (eight sessions) for inpatients targeting " community reentry skills " (Kopelowicz, Wallace, & Zarate, 1998). "
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    ABSTRACT: Objective: Most research on the Illness Management and Recovery (IMR) program for people with severe mental illnesses has focused on individuals with stable symptoms living in the community, with less attention to persons being treated in an inpatient setting. We evaluated the feasibility and effects of an IMR program adapted for individuals with schizophrenia who were awaiting discharge into the community. Method: A randomized controlled trial was conducted at 2 hospitals in Taiwan to compare the adapted IMR program with treatment as usual (TAU). Ninety-seven individuals with schizophrenia were randomized to the adapted IMR program or TAU. Four outcome indicators including illness-management knowledge, attitudes toward medication, insight, and symptoms were assessed at baseline, posttreatment, and at a 1-month follow-up following discharge from the hospital. Results: Participants in the adapted IMR group showed significantly greater improvements at posttreatment and 1-month follow-up in illness-management knowledge, attitudes toward medication, insight, and negative symptoms on the Brief Psychiatric Rating Scale (BPRS) than individuals in the TAU group. There were no significant differences between the 2 groups on other subscales of the BPRS. Conclusions and implications for practice: This is the first controlled evaluation of a version of the IMR program in an East Asian culture, and the first to evaluate it in an acute care inpatient setting. Our findings support the feasibility and potential benefits of implementing an adapted IMR program, focused on the prevention of relapses and rehospitalizations, during the discharge period of an inpatient treatment stay to prepare individuals to reenter the community.
    Psychiatric Rehabilitation Journal 12/2013; 36(4):243-9. DOI:10.1037/prj0000013 · 0.75 Impact Factor
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    • "The current study uniquely examined the delivery impact of practitioners who were mental health professionals, peer providers, or paraprofessionals on consumer outcome and fidelity. The findings demonstrate the superiority of IMR over TAU, replicating prior research (e.g., Fujita et al., 2010; Hasson-Ohayon et al., 2007; Levitt et al., 2009; Salyers, Rollins, Clendenning, McGuire, & Kim, 2011). It is interesting that no significant differences were found in consumers' outcome regardless if the practitioner was a professional, paraprofessional, or a peer provider. "
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    ABSTRACT: Objective: Illness Management and Recovery (IMR) is a widely used evidence-based standardized psychosocial intervention. Little is known, however, about the impact of practitioner professional background on the consumer outcome. The current study aims to examine the delivery impact of practitioners who were mental health professionals, peer providers, or paraprofessionals on fidelity and consumer outcome in IMR. Method: Study participants were 252 persons with serious mental illness receiving psychiatric rehabilitation services in the community who received IMR (n = 210) or treatment as usual (TAU; n = 42). Study participants completed IMR groups that were delivered by either mental health professionals (n = 126), peer providers (n = 43), or paraprofessionals (n = 41). Study participants in the treatment group completed the Illness Management and Recovery scale before starting and after completing the IMR program; participants in the control group completed the same scale twice in similar time intervals. Fidelity ratings were made. Results: Regardless of practitioner background, consumers who received the IMR intervention demonstrated significant improvement compared to the control group. Post hoc analyses showed no statistically significant difference on consumer outcome regardless of whether the practitioner was a professional, paraprofessional, or a peer provider. All three IMR groups had good fidelity scores. Conclusions and implications for practice: The results demonstrate that IMR can be implemented with good fidelity and generate positive outcomes when delivered by practitioners who receive sufficient training and supervision regardless of their professional background.
    Psychiatric Rehabilitation Journal 11/2013; 36(4). DOI:10.1037/prj0000026 · 0.75 Impact Factor
    • "Studies show that this intervention helps people with serious mental illness to acquire knowledge of the illness and progress toward personal goals (Hasson-Ohayon, Roe, & Kravetz, 2007); improve self-management and become more hopeful (Salyers et al., 2009); enhance functional outcomes (Levitt et al., 2009); reduce hospital use over time (Salyers et al., 2010); and increase their psychosocial functioning, while reducing symptoms and suicidal ideation (Färdig, Lewander, Melin, Folke, & Fredriksson, 2011). In addition to these rigorous studies of the program, qualitative research has shown that participants report it improves cognitive abilities, social support, and coping (Roe, Hasson-Ohayon, Salyers, & Kravetz, 2009). "
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    ABSTRACT: Cognitive Behavioral Therapy (CBT) has been established as a beneficial treatment for people with schizophrenia. Accordingly, various psychosocial interventions based on a CBT model have been developed. An additional established finding is that persons with schizophrenia exhibit metacognitive deficits and limitations in their abilities to construct complex accounts of themselves and others and to use that knowledge to respond to psychological problems. Addressing these limitations, while providing CBT, seems to require the integration of an intersubjective approach with CBT-based protocols. This paper presents three examples of an integrative approach to psychotherapy for people with schizophrenia that integrates CBT-based psychosocial treatments with an intersubjective approach. The proposed model of integration needs to be examined in order to establish its possible contribution to the clinical work with persons with schizophrenia. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
    Journal of Psychotherapy Integration 12/2012; 22(4):356-374. DOI:10.1037/a0029576
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