1/2-Integration of Illness Management and Recovery Within ACT

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The goals of our multi-site, linked R34 proposals are to develop and evaluate the feasibility of a novel psychosocial approach for improving the mental health of people with severe mental illness while obtaining preliminary pilot data needed to plan a subsequent R01 research application to further evaluate this intervention. Specifically, we plan to adapt and pilot an approach for integrating two evidence-based practices for adults with serious mental illness: Illness Management and Recovery (IMR) and Assertive Community Treatment (ACT). This R34 research project will accomplish three specific aims: (1) develop, adapt, and standardize the treatment protocol for integrating IMR into ACT teams; (2) assess the implementation feasibility and acceptability of the IMR+ACT intervention in a small, open clinical trial; and (3) conduct a preliminary outcome and process evaluation using a pilot randomized clinical trial (RCT) design, with randomization occurring at the ACT team level. We hypothesize that the protocol for combining IMR+ACT will be feasible to implement and acceptable to consumers and providers. The integrated IMR+ACT program has the potential to reduce persistent symptoms, enhance functioning, and facilitate the recovery of people with severe mental illness who are receiving ACT services. The research and development activities will be conducted in three stages. In Stage 1 we will expand our pre-application pilot activities to further develop, adapt, and refine the IMR+ACT treatment protocol. The new protocol will include a new treatment manual, training materials, and a fidelity scale, all of which will specify the adaptation and integration of IMR within ACT. During Stage 2, we will conduct a small open trial of IMR+ACT in order to collect data on the feasibility of implementing the program, its acceptability, and the fidelity of ACT staff to the model. In Stage 3, we will conduct an outcome and process evaluation of the IMR+ACT intervention using an RCT design. Specifically, we will randomize eight teams to implement either the IMR+ACT program or continue to provide ACT Only (four teams per condition) in two states, and assess outcomes across a battery of clinical, functional, and recovery variables in a total of 96 consumers (12 per ACT team). The findings will yield important information about the feasibility of randomizing ACT teams to provide IMR or not, estimates of within team variances, and preliminary data on the clinical impact of adding IMR to ACT services, which will inform the planning of a larger-scale R01 study of IMR+ACT effectiveness.