Illness Management and Recovery Program: IMR-Web

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DESCRIPTION (provided by applicant): Serious mental illnesses (SMI) exact a high toll on society, both in terms of direct and indirect costs of health care and lost productivity, and in terms of the suffering of inflicted individuals and their families. Mental health provider organizations have been charged with transforming the services they provide to improve the outcomes of clients with SMI. An increasingly important component of these services are intensive, evidence-based rehabilitation interventions that improve illness self-management, functioning, and quality of life. However, dissemination of these interventions has been severely limited because community mental health agencies often lack sufficient clinician time and expertise. The Illness Management and Recovery(IMR) program is the first comprehensive, evidence-based, self-management training program selected by SAMHSA (Substance Abuse & Mental Health Services Administration) for national dissemination. IMR is a curriculum-based program that enables clients to set and achieve personal recovery goals, and acquire the knowledge and skills necessary to manage their illnesses independently. IMR was developed as part of the National Implementing Evidence-Based Practices Project and is comprised of five evidence-based practices: psychoeducation, cognitive-behavioral approaches to medication adherence, relapse prevention, social skills training, and coping skills training for persistent symptoms. The paper-based IMR program (e.g. workbooks and manuals) has been implemented in demonstration projects (within 5 states). However, it has proven relatively labor intensive and too costly for the vast majority of programs. In addition, the accessibility of the paper-based IMR program is limited by the number of trained clinicians who can efficiently provide the intervention. An insightful solution to this limitation is to computerize self-administration of IMR modules via the internet. There has been proven substantial success with internet-based, audio, computer-assisted, self-interviewing technology that meets the needs of individuals with SMI, including cognitive deficiencies, limited literacy, and little or no computer expertise. In this project, a dedicated touchscreen kiosk at clinics will provide a browser-based connection to "IMR-Web", an internet tool that supports clients as they engage in IMR. IMR materials will be translated into interactive, engaging, multimedia presentations with simplified navigation requirements. While IMR-Web does not replace clinicians, it will substantially reduce the demands for clinician time and intensive training in the full IMR curriculum. IMR-Web has the potential to efficiently support broad utilization of IMR, improve standardization of IMR delivery, and enhance consumer involvement, while reducing resource requirements for provider organizations. IMR-Web will track client progress and help clinicians better identify challenges to address during treatment visits. This project is a partnership between NeuroComp, IMR developers, and RAND. In Phase I, two exemplary IMR modules will be computerized and evaluated in clients with SMI. Primary determinants of feasibility will be usability-acceptability, ability to complete modules, and retention of critical information by clients. PUBLIC HEALTH RELEVANCE: Persistent, Serious Mental Illness (SMI) exacts a tremendous toll on society, afflicting approximately 15M US citizens. Costs can be defined and measured both in terms of indirect and direct impact on the health care system, lost productivity and most importantly, suffering of the individuals and their families. The proposed IMR-Web will provide a highly efficient, computerized, web-enabled, method of implementing the Illness Management and Recovery (IMR) program in a manner that will enable much broader adoption by States and health care management systems. IMR-Web will be the first web-enabled, evidence-based recovery program selected by the Substance Abuse and Mental Health Services Administration (SAMHSA) for national implementation. IMR-Web will lead to more rapid, cost-effective adoption of the powerful and comprehensive IMR program.