Optimizing Chronic Illness Self-Management for Individuals with Schizophrenia

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DESCRIPTION (provided by applicant): Abstract Recovery is cited within Transforming Mental Health Care in America, Federal Action Agenda: First Steps, as the "single most important goal" for the mental health service delivery system. Increasingly, physical wellness is being recognized as a key component of a more holistic approach to recovery. The elevated rates of medical co-morbidity among individuals with schizophrenia represent a significant public health challenge with profound service delivery, cost and quality implications. Innovative and portable interventions are sorely needed to more effectively address this problem. Despite the growing recognition that self-management strategies hold enormous promise for improving quality and outcomes of care for chronic medical illnesses, and the fact that self-management is gaining prominence as a recovery oriented treatment focus, relatively little is known about how to extend use of effective medical self-care programs to help persons with schizophrenia more actively participate in their health and medical care management. To address this gap, our R34 application meets the objectives of PAR-06-248 "From Intervention Development to Services: Exploratory Research Grants (R34)" and proposes to develop and pilot test an optimized version of an existing and effective chronic medical illness self-management program to better meet the needs adults with schizophrenia. Our specific aims are to: 1. Develop intervention materials and a manual for the proposed adapted chronic medical illness self management intervention. 2. Refine materials and implementation procedures based on a preliminary, short-term trial with 6-8 patients. 3. Implement a carefully monitored pilot trial for 50 participants and measure the effect at 6 months on the primary outcomes of: a) health related self-efficacy and recovery orientation; b) medical illness self-management skills; c) social/communication skills focusing on interactions with health care providers; d) physical and mental health status; and f) medical service use patterns. Secondary, exploratory analyses will examine the modifying effect of various covariates on the effectiveness of the intervention including medication use, neurocognition, substance abuse, psychiatric symptoms, number of and seriousness of related comorbidities, and quantitative and qualitative ratings of consumer participation in the intervention. This R34 application meets the objectives of PAR-06-248 "From Intervention Development to Services: Exploratory Research Grants (R34)" and proposes to develop and pilot test an optimized version of an existing and effective chronic medical illness self-management program to better meet the needs adults with schizophrenia.