Mental Illness Self-Management Through Wellness Recovery Action Planning

描述（由申请人提供）：本R34申请的目的是为R01申请进行可行性研究，测试健康恢复行动计划（WRAP）与注意力控制安慰剂选择健康（CW）。WRAP是一项由同伴主导的精神疾病自我管理干预，由精神疾病康复者开发。虽然有充分的证据支持结构化自我管理程序对慢性身体状况（如糖尿病和哮喘）的有效性，但很少有严谨的研究评估这种方法对精神健康障碍的影响。该应用程序有三个目的。第一个目标是开发一个干预版本的WRAP和相应的保真度评估，适合在对照研究中使用。第二个目标是将连续波干预与保真度评估一起用于本研究，以便连续波可以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一项小型随机试验来收集试点数据，以评估WRAP干预措施的有效性，并从消费者和提供者调查中收集满意度和可行性数据，并使用解释性摄影程序来更好地了解WRAP如何影响康复。拟议的研究将采用一种设计，从三个社区精神卫生机构招募132名患有严重精神疾病的个体，并随机分配到WRAP （n=66）或注意力控制安慰剂（n=66）组。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，以评估干预措施的可接受性并确定后勤问题。解释性摄影将用于检查参与者对WRAP如何影响他们生活的看法。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措施。研究咨询委员会由来自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，将为研究设计提供投入，并协助解释R01申请的准备结果。该项目回应了2008年9月26日发布的“功能性PA”（PA-08-255），其目的是“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，创新的就业策略，新的康复方法或独立生活的新模式）。”

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.