Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania.
Psychiatr Serv. 2018 May 1;69(5):562-571. doi: 10.1176/appi.ps.201700124. Epub 2018 Feb 15.
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.
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.
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.
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.
在一项试点可行性和有效性研究中，将基于课程的疾病管理和康复（IMR）计划纳入强化社区治疗（ACT）中，以帮助患有严重精神疾病的人实现个人康复目标，从而改善参与者的康复和功能。
采用小规模集群随机对照设计，在两个州测试 ACT 团队中 IMR 的实施情况。将 8 个高保真 ACT 团队分配到提供 IMR（ACT+IMR；4 个团队）或标准 ACT 服务（仅 ACT；4 个团队）。在基线、6 个月和 1 年评估了 101 名精神分裂症谱系或双相情感障碍患者的临床结果。
IMR（课程出席和模块完成）在 ACT+IMR 团队之间存在差异，其中一个团队的参与者接触量明显较少。意向性治疗分析结果显示，在后续临床医生评定的疾病自我管理方面，ACT+IMR 组的参与者表现出明显更好的结果，具有中等效应大小。在一项功能衡量指标中发现了一个非显著的中等效应大小，而在患者评定的疾病自我管理和社区融合方面则观察到了较小的效应大小。课程和模块完成情况预测了 12 个月随访中 12 项结果测量中的四项的更好结果。
研究结果支持在 ACT 团队中实施 IMR 的可行性。尽管存在一些不显著的发现，但本小规模研究中某些变量的效应大小以及 ACT+IMR 团队内的剂量反应关系表明，这种新方法可能有望改善严重精神疾病患者的康复。进一步利用混合有效性实施设计的大规模研究可能会为这一领域提供有希望的方向。
