Mental Illness Self-Management Through Wellness Recovery Action Planning

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DESCRIPTION (provided by applicant): The purpose of this R34 application is to conduct a feasibility study in preparation for an R01 application testing Wellness Recovery Action Planning (WRAP) versus an attention-control placebo called Choosing Wellness (CW). WRAP is a peer-led, mental illness self-management intervention developed by people in recovery from psychiatric disorders. While ample evidence supports the efficacy of structured self- management programs for chronic physical conditions such as diabetes and asthma, few rigorous studies have evaluated this approach for mental health disorders. The application has three aims. The first aim is to develop an intervention version of WRAP and an accompanying fidelity assessment suitable for use in a controlled study. The second aim is to adapt the CW intervention for use in this study, along with a fidelity assessment, so that CW can be used as an attention-control placebo intervention for a future large-scale randomized controlled trial. The third aim is to gather pilot data by conducting a small, randomized trial to assess the effectiveness of the WRAP intervention, as well as gather satisfaction and feasibility data from consumer and provider surveys, and use hermeneutic photography procedures to better understand how WRAP influences recovery. The proposed research will use a design in which 132 individuals with severe mental illness will be recruited from three community mental health agencies and randomly assigned to the WRAP (n=66) or attention-control placebo condition (n=66). Subjects will be assessed at study baseline, 6 weeks post-intervention, and at 6-month follow-up. Survey and interview procedures will gather data from each agency's staff and clients to assess intervention acceptability and identify logistical problems. Hermeneutic photography will be used to examine participants' perspectives on how WRAP impacts their lives. The study protocol includes measures of recovery, hope, self-confidence, self-advocacy, peer support, and psychiatric symptoms. A study advisory committee composed of clients and staff from each agency, the creator of WRAP, other WRAP experts, state mental health authority administrators, and family members, will provide input into the study design and assist in interpreting the results in preparation for an R01 application. This project responds to the "Functioning PA" (PA-08-255) released 09/26/08 given its aim "to develop innovative behavioral and ecological interventions that will reduce complications in daily living (e.g., innovative employment strategies, new methods of rehabilitation, or new models of independent living)." PUBLIC HEALTH RELEVANCE: The overall goal of the proposed study is to advance our understanding of how individuals with mental illness can learn to self-manage their symptoms and rebuild productive lives. Established as an effective approach for patients with chronic medical conditions, illness self-management interventions have the potential to be an important adjunct to traditional mental health treatment, and serve a tertiary preventive function by preventing relapse once treatment has ended. We hope that this type of program can further our nation's public health goal of recovery for significant proportions of citizens diagnosed with serious mental illness.