Marie M. Hamilton

Initial Outcomes of a Mental Illness Self-Management Program Based on Wellness Recovery Action Planning

OBJECTIVE This study examined changes in psychosocial outcomes among participants in an eight-week, peer-led, mental illness self-management intervention called Wellness Recovery Action Planning (WRAP). METHODS Eighty individuals with serious mental illness at five Ohio sites completed telephone interviews at baseline and one month after the intervention. RESULTS Paired t tests of pre- and postintervention scores revealed significant improvement in self-reported symptoms, recovery, hopefulness, self-advocacy, and physical health; empowerment decreased significantly and no significant changes were observed in social support. Those attending six or more sessions showed greater improvement than those attending fewer sessions. CONCLUSIONS These promising early results suggest that further research on this intervention is warranted. Confirmation of the efficacy and effectiveness of peer-led self-management has the potential to enhance self-determination and promote recovery for people with psychiatric disabilities.

Improving Propensity for Patient Self-Advocacy Through Wellness Recovery Action Planning: Results of a Randomized Controlled Trial

A fundamental aspect of successful illness self-management for people with serious mental illnesses is the ability to advocate for themselves in health and rehabilitation settings. This study reports findings from a randomized controlled trial comparing propensity for patient self-advocacy among those who received a peer-led mental illness self-management intervention called Wellness Recovery Action Planning (WRAP) and those who received usual care. Outcomes were self-reported engagement in self-advocacy with service providers, and the relationship between patient self-advocacy and other key recovery outcomes. In a multivariable analysis, at immediate post-intervention and 6-month follow-up, WRAP participants were significantly more likely than controls to report engaging in self-advocacy with their service providers. Higher self-advocacy also was associated with greater hopefulness, better environmental quality of life, and fewer psychiatric symptoms among the intervention group. These findings provide additional support for the positive impact of peer-led illness self-management on mental health recovery.

Predictors of mental health services use among lesbian and heterosexual women.

Studies examining mental health services have identified a series of indicators with demonstrated effects on services access, barriers, and utilization, including gender, race/ethnicity, and socioeconomic status, as well as indicators such as type of insurance, client attitudes toward mental health, and diagnosis. This study identifies predictors of mental health services utilization in a diverse community sample of lesbians and heterosexual women (N=120). Outcomes for study participants are compared to those found in the services utilization literature, and similarities and differences among lesbians and heterosexual women are examined. Suggestions are offered for identifying new factors in mental health service utilization among groups with diverse sexual orientations.

Impact of Wellness Recovery Action Planning on Service Utilization and Need in a Randomized Controlled Trial

OBJECTIVE The purpose of this study was to assess the impact of a mental illness self-management intervention, called Wellness Recovery Action Planning (WRAP), on the use of and need for mental health services over time compared with nutrition and wellness education. METHOD Participants were recruited from outpatient community mental health settings in Chicago, Illinois. Using a single-blind, randomized controlled trial design, 143 individuals were assigned to WRAP or to a nutrition education course and assessed at baseline and at 2-month and 8-month follow-up. The WRAP intervention was delivered by peers in recovery from serious mental illness who were certified WRAP educators over nine weekly sessions lasting 2.5 hrs. The nutrition education curriculum was taught by trained non-peer educators using the same schedule. Mixed-effects random regression analysis tested for differences between the two interventions in (a) self-reported use of 19 clinical, rehabilitation, peer, emergent, and ancillary services; and (b) self-reported need for these services. RESULTS Results of mixed-effects random regression analysis indicated that, compared with controls, WRAP participants reported significantly greater reduction over time in service utilization (total, individual, and group), and service need (total and group services). Participants in both interventions improved significantly over time in symptoms and recovery outcomes. DISCUSSION Training in mental illness self-management reduced the self-reported need for and use of formal mental health services over time. This confirms the importance of WRAP in an era of dwindling behavioral health service availability and access.

The Relationship Between Type and Quality of Social Support and HIV Medication Adherence

Abstract In the last 10 years HIV has become a disease that can be effectively managed using antiretroviral medications. However, many factors affect adherence, including demographics, income, housing, mental health issues, and access to health care, as well as types and quality of social support. This paper summarizes results regarding specific sources of social support that are part of a larger, randomized study of medication adherence among people with HIV/AIDS. Results summarize findings from 98 program participants and include information regarding support from partners, family and health care providers, as well as the impact of support from these sources on medication adherence. Among participants in this study, those with higher levels of social support from partners demonstrated higher rates of medication adherence. Those who received more social support from their families, however, reported significantly lower adherence rates. These results suggest that efforts to improve medication adherence need to address the diverse types of social support networks of people diagnosed with HIV/AIDS.

The recovery education in the academy program: transforming academic curricula with the principles of recovery and self-determination.

TOPIC This article describes a curricular transformation initiative, the Recovery Education in the Academy Program (REAP), spearheaded by the University of Illinois at Chicagos National Research and Training Center on Psychiatric Disability. PURPOSE REAP is designed to integrate principles of recovery, self-determination, and other evidence-based practices for people with psychiatric disabilities into medical, social, and behavioral sciences curricula. The principles on which the curricula transformation efforts are based, the instructional activities employed, early outcomes of the endeavor, and future plans for replication are delineated. SOURCES USED As described in this paper, REAP builds on a theoretical framework derived from the evidence-based literature, multiple technical reports, and curricular initiatives, including the Institute of Medicine, the Annapolis Coalition for Behavioral Workforce Development, and the Final Report of Presidents New Freedom Commission on Mental Health. CONCLUSIONS REAP has delivered state-of-the-science education to over 1,000 trainees, including medical students, psychiatry residents, psychology and social work interns, and rehabilitation counselors, pre/post-doctoral students and professionals within a variety of academic settings. REAP serves as a replicable structure to successfully integrate recovery education into existing, accredited academic programs and curricula using the parameters outlined by multiple experts and stakeholders. Barriers to curricular transformation and strategies to overcome these barriers are highlighted.

Cultural competency in peer-run programs: results of a web survey and implications for future practice.

OBJECTIVE The study explored perceptions of adults with psychiatric disabilities regarding cultural competency of peer-run mental health support groups and programs. METHODS Web survey respondents were recruited via mental health list-servs, web sites, newsletters, emails, and word of mouth. A total of 527 peers were surveyed about cultural competency barriers facing peer-run programs; common reasons for not using peer services; and strategies to engage diverse communities. RESULTS Both multicultural and Caucasian respondents agreed that lack of funding and staff education about diversity were barriers to cultural competency in peer programs. Multicultural respondents were more likely than whites to feel that both the recognition of the need for and interest in attending cultural competency training is lacking in peer programs, as well as information about the diverse composition of peer program memberships. Among those who had never participated in peer support, people of color were more likely than whites to endorse feeling they would not belong and believing their languages would not be spoken in peer programs. Whites, on the other hand, were more likely to cite a preference for professional over peer support, while nearly half of both groups indicated that the main reason for non-attendance is a lack of knowledge about peer programs. Qualitative results highlighted successful outreach and engagement strategies. CONCLUSIONS Study findings informed development of a cultural competency tool that was pilot-tested among peer-run programs. Given the importance of peer support in recovery, these findings suggest the need for additional research on cultural competency in peer programs.

Employment outcomes for individuals with HIV/AIDS and co-occurring mental health factors

With the advent of more advanced treatments and therapies, people with HIV/AIDS are experiencing significant improvement in their health, making many of their ongoing employment and career goals more realistic. However, these individuals continue to report experiencing employment barriers, including factors related to symptoms and illness progression, medication adherence and HIV treatment, and beliefs about health and wellness. The present evaluation focuses on factors predicting employment status among individuals with HIV/AIDS, as well as the effects of other indicators on work, including chronic mental health comorbidities such as depression, medication adherence to antiretroviral regimens, and perceived adjustment to chronic illness. Results of multivariate logistic regression identify significant predictors of work participation among this population, including gender and education. Study strengths, weaknesses, and recommendations for innovative services are discussed.