Illness Management and Recovery Program: IMR-Web

描述（由申请人提供）：严重精神疾病（SMI）对社会造成了很高的代价，无论是在直接和间接的医疗保健费用和生产力损失方面，还是在受害个人及其家庭的痛苦方面。心理健康提供者组织负责改变他们提供的服务，以改善患有重度精神障碍的客户的结果。这些服务的一个日益重要的组成部分是强化的、以证据为基础的康复干预措施，以改善疾病的自我管理、功能和生活质量。然而，这些干预措施的传播受到严重限制，因为社区精神卫生机构往往缺乏足够的临床医生的时间和专业知识。疾病管理和恢复（IMR）计划是SAMHSA（物质滥用和精神卫生服务管理局）选择的第一个全面的，以证据为基础的自我管理培训计划。IMR是一个以健康为基础的计划，使客户能够设定和实现个人康复目标，并获得独立管理疾病所需的知识和技能。IMR是作为国家实施循证实践项目的一部分而开发的，包括五种循证实践：心理教育，药物依从性的认知行为方法，复发预防，社交技能培训和持续症状的应对技能培训。在示范项目（5个州内）中实施了基于纸张的IMR方案（例如工作簿和手册）。然而，它已被证明是相对劳动密集型的，而且对于绝大多数程序来说成本太高。此外，纸质IMR程序的可访问性受到能够有效提供干预的训练有素的临床医生数量的限制。针对这一局限性的一个有见地的解决方案是通过互联网对IMR模块进行计算机自动管理。事实证明，基于互联网、音频、计算机辅助的自我访谈技术取得了巨大的成功，满足了重度精神障碍患者的需求，包括认知缺陷、识字能力有限以及很少或没有计算机专业知识。在该项目中，诊所的专用触摸屏亭将提供基于浏览器的“IMR-Web”连接，这是一种支持客户参与IMR的互联网工具。IMR材料将被翻译成交互式，引人入胜的多媒体演示文稿，简化了导航要求。虽然IMR-Web不会取代临床医生，但它将大大减少临床医生的时间和完整IMR课程中的强化培训需求。IMR-Web有可能有效地支持IMR的广泛使用，提高IMR交付的标准化，并提高消费者的参与度，同时减少提供商组织的资源需求。IMR-Web将跟踪客户的进展，并帮助临床医生更好地确定治疗访问期间要解决的挑战。该项目是NeuroComp、IMR开发人员和兰德公司之间的合作项目。在第一阶段，两个示范性IMR模块将被计算机化，并在患有SMI的客户中进行评估。可行性的主要决定因素是可用性-可接受性、完成模块的能力以及客户保留关键信息的能力。持续性严重精神疾病（SMI）对社会造成巨大损失，约有1500万美国公民受到影响。成本可以从对卫生保健系统的间接和直接影响、生产力损失以及最重要的个人及其家庭的痛苦来定义和衡量。拟议的IMR-Web将提供一种高效、计算机化、网络化的方法，以使各州和卫生保健管理系统能够更广泛地采用疾病管理和康复（IMR）方案。IMR-Web将是物质滥用和精神卫生服务管理局（SAMHSA）选择的第一个基于网络的循证康复计划。IMR-Web将导致更快速，更经济有效地采用功能强大和全面的IMR程序。

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.