Illness management and recovery in community practice.

Abstract

Objective To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. Methods IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR treatment integrity scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). Results Average IMR competence scores were in the “Needs Improvement” range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. Conclusions and Implications for Practice IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed.

Mobile Health (mHealth) Versus Clinic-Based Group Intervention for People With Serious Mental Illness: A Randomized Controlled Trial

“…However, the barriers associated with clinic-based care may limit the benefits of these interventions. When individuals experience symptom exacerbations (arguably, when they need illness management support the most), they may avoid going to a clinic or interacting with others, perhaps because of the clinic's distance from their residence or hours of operation (14,15), the stigma associated with seeking care (16), or dissatisfaction with services (17)(18)(19).…”

A systematic review of influences on implementation of supported self-management interventions for people with severe mental health problems in secondary mental health care settings

“…The majority of studies had samples including people with severe mental health problems of a mixture of types (including schizophrenia or schizoaffective disorder, depression and bipolar disorder) [ 27 , 28 , 30 – 32 , 38 , 39 , 45 , 48 ]. Three studies had a sample consisting of schizophrenia or schizoaffective disorder, depression and bipolar disorder, along with an “other” category [ 29 , 41 , 47 ].…”

“…Interventions were found to be fit for purpose, as they achieved the goals of teaching services users new skills and strategies [ 32 ]. Aspects which were rated at least ‘satisfactory’, and could be viewed as facilitators, include therapeutic relationship, recovery orientation, participation from all group members, and educational techniques [ 38 ].…”

WeChat-based mHealth intention and preferences among people living with schizophrenia

“…However, many people living with schizophrenia (PLS) do not receive adequate care or receive poor quality care ( Kazdin, 2017 ). Reasons for the treatment gap may include time and financial burden, poor availability of services (e.g., long distance from psychiatric hospital/clinic, transportation), stigma associated with seeking care, and dissatisfaction with services ( McGuire et al, 2016 ; Mojtabai et al, 2009 ). The huge disease burden and significant treatment gap of schizophrenia have driven the advancement of mobile health (mHealth) that use mobile phones in support of health care to complement for the traditional clinical-based care ( Farrell, Mahone & Guilbaud, 2004 ).…”