Mental Illness Self-Management Through Wellness Recovery Action Planning

描述(由申请人提供)：此R34应用程序的目的是进行可行性研究，以准备R01应用程序，测试健康恢复行动计划(WRAP)与名为选择健康(CW)的注意力控制安慰剂。WRAP是一种由同行主导的精神疾病自我管理干预措施，由精神障碍康复者开发。虽然充足的证据支持结构化自我管理计划对糖尿病和哮喘等慢性身体疾病的有效性，但很少有严格的研究评估这种方法对精神健康障碍的疗效。该应用程序有三个目标。第一个目标是开发适合于对照研究的干预版本的WRAP和伴随的保真度评估。第二个目标是将CW干预与保真度评估一起应用于本研究，以便CW可用作未来大规模随机对照试验的注意控制安慰剂干预。第三个目标是通过进行小规模随机试验来收集试点数据，以评估包裹干预的有效性，并从消费者和提供者调查中收集满意度和可行性数据，并使用解释学摄影程序更好地了解包裹如何影响康复。这项拟议的研究将采用一种设计，从三家社区精神卫生机构招募132名严重精神疾病患者，并随机分配到WRAP(n=66)或注意力控制安慰剂(n=66)。受试者将在研究基线、干预后6周和6个月随访时进行评估。调查和访谈程序将从每个机构的工作人员和客户那里收集数据，以评估干预的可接受性并确定后勤问题。解释学摄影将被用来检查参与者对WRAP如何影响他们的生活的观点。研究方案包括康复、希望、自信、自我倡导、同伴支持和精神症状的测量。由每个机构的客户和工作人员、WRAP的创建者、其他WRAP专家、州精神卫生当局管理人员和家庭成员组成的研究咨询委员会将为研究设计提供意见，并协助解释结果，为R01申请做准备。该项目响应了2008年9月26日发布的《功能性PA》(PA-08-255)，其目标是“开发创新的行为和生态干预措施，以减少日常生活中的并发症(例如，创新的就业战略、新的康复方法或新的独立生活模式)。” 公共卫生相关性：这项拟议研究的总体目标是促进我们对精神疾病患者如何学习自我管理其症状和重建生产性生活的理解。疾病自我管理干预被确立为慢性病患者的有效方法，有可能成为传统精神健康治疗的重要辅助手段，并通过在治疗结束后防止复发发挥三级预防功能。我们希望这种类型的计划能够促进我国公共卫生目标的实现，即为相当大比例的被诊断为严重精神疾病的公民恢复健康。

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.