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Implementing illness management and recovery within assertive community treatment
A pilot trial of feasibility and effectiveness
Monroe-DeVita, M., Morse, G., Mueser, K. T., McHugo, G. J., Xie, H., Hallgren, K. A., Peterson, R., Miller, J., Akiba, C., York, M., Gingerich, S., & Stiles, B. (2018). Implementing illness management and recovery within assertive community treatment: A pilot trial of feasibility and effectiveness. Psychiatric Services, 69(5), 562-571. https://doi.org/10.1176/appi.ps.201700124
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.
