Integration of Illness Management and Recovery within Assertive Community Treatment (ACT+IMR)

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Principal Investigator: 
Maria Monroe-DeVita, Ph.D. (University of Washington) & Gary Morse, Ph.D. (Places for People, St. Louis, MO)
Funding Source: 
The National Institute of Mental Health
Project Period: 
June 7, 2011 – September 30, 2014
PBHJP Project Faculty and Staff: 
Project Contact: 
Kim Mueser, Ph.D. (Co-Investigator) - Boston University
Gregory McHugo, Ph.D. (Co-Investigator) and Haiyi Xie, Ph.D. (Co-Investigator) - Dartmouth Psychiatric Research Center
Susan Gingerich, MSW (Co-Investigator) - Gingerich Training and Consultation
Joris Miller, MSW and Mary York, MSW - Places for People, St. Louis, MO
Project Summary: 

The goals of this multi-site, linked R34 research and development grant are to develop and evaluate the feasibility of a novel psychosocial approach for improving the mental health of people with severe mental illness while obtaining preliminary pilot data needed to plan a subsequent R01 research application to further evaluate this intervention.  Specifically, we plan to adapt and pilot an approach for integrating two evidence-based practices for adults with serious mental illness: Illness Management and Recovery (IMR) and Assertive Community Treatment (ACT).  This project has three specific aims:  (1) develop, adapt, and standardize the treatment protocol for integrating IMR into ACT teams; (2) assess the implementation feasibility and acceptability of the ACT+IMR intervention in a small, open clinical trial; and (3) conduct a preliminary outcome and process evaluation using a pilot randomized clinical trial (RCT) design, with randomization occurring at the ACT team level.   We hypothesize that the protocol for combining ACT+IMR will be feasible to implement and acceptable to consumers and providers.  The integrated ACT+IMR program has the potential to reduce persistent symptoms, enhance functioning, and facilitate the recovery of people with severe mental illness who are receiving ACT services.  The research and development activities are conducted in three stages. In Stage 1 we expanded our pre-application pilot activities to further develop, adapt, and refine the ACT+IMR treatment protocol.  The new protocol includes a new treatment manual, training materials, and a fidelity scale, all of which specify the adaptation and integration of IMR within ACT.  During Stage 2, we conducted a small open trial of ACT+IMR in order to collect data on the feasibility of implementing the program, its acceptability, and the fidelity of ACT staff to the model.  In Stage 3, we are now conducting an outcome and process evaluation of the ACT+IMR intervention using an RCT design.  Specifically, we have randomized eight teams to implement either the ACT+IMR program or continue to provide ACT-only (four teams per condition) in two states, and are assessing outcomes across a battery of clinical, functional, and recovery variables for a total of 96 consumers (12 per ACT team).  The findings will yield important information about the feasibility of randomizing ACT teams to provide IMR or not, estimates of within team variances, and preliminary data on the clinical impact of adding IMR to ACT services, which will inform the planning of a larger-scale R01 study of ACT+IMR effectiveness.

Public Health Relevance: 

To promote quality improvement of community mental health services in order to more effectively serve individuals with severe and persistent mental illness.

Evidence Based Practices for Adults
Additional Reports: 

For information on the newly developed ACT+IMR Manual, please contact Maria Monroe-DeVita at