Assertive community treatment (ACT) is an established approach for providing psychiatric services to consumers with severe mental illness who have a history of frequent hospitalizations, have been discharged from a long-term hospital or institutional setting, or experience homelessness. The ACT model is a treatment approach based on a multi-disciplinary team, that usually includes a psychiatrist (or other prescriber), nurse, several case managers, an employment specialist, and a co-occurring substance abuse specialist. The members of an ACT team work closely together to provide a wide range of community-based practical supports to consumers, including helping them address living needs (housing, food, bills), and obtain psychiatric and medical services.
Although ACT is effective at reducing hospitalizations and stabilizing housing in the community for consumers with the most severe impairments, it is less effective at teaching them how to manage their psychiatric symptoms more effectively to improve their independent community functioning. The Illness Management and Recovery (IMR) program, in comparison, is an evidence-based practice that helps consumers learn how to participate actively in treatment, manage symptoms, prevent relapses, and improve functioning in order to meet their personal recovery goals. If IMR can be successfully integrated into ACT, the combined intervention will have unique potential for improving illness management, promoting independent community living, and making recovery a real possibility for those consumers with the greatest needs. This study developed and evaluated a set of standardized guidelines for integrating IMR into ACT as a first step toward improving the effectiveness of the ACT model.
This research project accomplished three specific aims: (1) further developed, adapted, and standardized the intervention protocol (treatment manual, training materials, and fidelity scale) for integrating IMR into ACT, based on preliminary pilot study findings, input from a committee of technical experts, and feedback from a diverse committee of stakeholders; (2) assessed the feasibility and acceptability of the integrated IMR+ACT program with a small, open clinical trial involving three IMR+ACT test sites; and (3) conducted a pilot randomized controlled trial with 8 ACT teams in two states (Missouri and Washington) randomized to provide either the IMR+ACT program (4 teams) or ACT-only (4 teams) in order to assess the feasibility of randomizing IMR into ACT teams and conduct a preliminary evaluation of treatment effects.
This study standardized guidelines for integrating IMR and ACT, criteria for evaluating fidelity (i.e., adherence) to the principles of integration, and research demonstrating the feasibility and preliminary effects of the integrated program. These steps were necessary before conducting a large-scale randomized controlled trial to determine the effectiveness and cost-effectiveness of incorporating IMR into ACT. This research has the potential to improve the effectiveness of ACT by helping consumers with severe disability learn how to manage their illness and improve their functioning in order to achieve their recovery goals, thereby facilitating their transition to less intensive and less expensive levels of care.
Co-Investigator: Kim T. Meuser, Ph.D.
Co-Investigator: Susan Gingerich, M.S.W., Independent Consultant
Please see the following article:
Monroe-DeVita, M., Morse, G., Mueser, K. T., McHugo, G. J., Xie, H., Hallgren, K. A., … 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. doi:10.1176/appi.ps.201700124
Inquiries related to the project should be addressed to:
Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215