Pamela J. Steigman

Consumer Empowerment and Self-Advocacy Outcomes in a Randomized Study of Peer-Led Education

This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering mental health consumers to become better advocates for their own care. A total of 428 adults with mental illness were randomly assigned to BRIDGES (intervention condition) or a services as usual wait list (control condition). Interviews were conducted at enrollment, at the end of the intervention, and 6-months post-intervention. Random regression results indicate that, compared to controls, BRIDGES participants experienced significant increases in overall empowerment, empowerment-self-esteem, and self-advocacy-assertiveness, and maintained these improved outcomes over time. Peer-led education interventions may provide participants with the information, skills and support they need to become more actively involved in the treatment decision-making process.

Changes in caregiving satisfaction and information needs among relatives of adults with mental illness: Results of a randomized evaluation of a family-led education intervention

The authors examined changes in caregiving satisfaction and information needs among 462 relatives of individuals with mental illness who participated in a study of a family-led education course, the Journey of Hope (JOH). Participants were randomly assigned to receive JOH or to a control group waiting list and followed for 9 months. General linear model repeated measures analysis of variance found that, compared with the control group, the intervention group showed significant improvement in caregiving satisfaction and information needs following course completion and maintained these gains for another 6 months. Education and support from other family members in the form of a structured course is effective in meeting the caregiving needs of relatives of persons with mental illness.

Early outcomes and lessons learned from a study of the Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) program in Tennessee.

OBJECTIVE Peer-led education interventions have the potential to provide mental health consumers with the knowledge, skills and support they need to live successful and rewarding self-determined lives. However, few studies have explored whether and how these interventions enhance recovery. This study addresses this knowledge gap by examining changes among 160 participants in the Building Recovery of Individual Dreams and Goals (BRIDGES) education program. BRIDGES is a peer-led 8-week course taught by trained instructors who publicly disclose the fact that they are in recovery from mental illness. METHOD Structured interviews assessing recovery outcomes were conducted with participants in the month prior to their receipt of BRIDGES, and immediately after receipt of the intervention. Paired t-tests were conducted to examine changes in psychiatric symptoms, hopefulness, social support, self-advocacy, empowerment, adaptive coping, and recovery pre-receipt and post-receipt of BRIDGES. RESULTS Post-receipt of BRIDGES, participants reported significantly fewer psychiatric symptoms, decreased use of maladaptive coping behaviors, and increased feelings of hopefulness, self-advocacy, empowerment, and recovery. CONCLUSIONS These promising early results from our ongoing study of BRIDGES suggest that peer-led education interventions are a valuable resource. Additional research is needed to better understand the effectiveness of these interventions, including potential long-term post-program participation benefits.

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.

Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses.

Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were self-reported health competencies, medical conditions, and health service utilization. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). A lower proportion screened positive for hyperlipidemia (7%). Multivariable random regression analysis found significant pre- to post-screening increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control. Screening identified 82 instances of undiagnosed diabetes, hypertension or hyperlipidemia, and 76 instances where these disorders were treated but uncontrolled. These results are discussed in the context of how this global public health approach holds promise for furthering the goal of integrating health and mental health care.

Psychiatric symptoms moderate the effects of mental illness self-management in a randomized controlled trial.

Abstract Depression has been shown to moderate the effects of physical illness self-management (ISM) programs. We attempted to replicate these findings for a mental ISM intervention. Outpatients with serious mental illness (N = 428) from eight Tennessee communities were randomly assigned to receive a peer-led self-management intervention called Building Recovery of Individual Dreams and Goals Through Education and Support or services as usual. Psychiatric symptoms were assessed with the Brief Symptom Inventory; the outcome of personal empowerment was measured by the Empowerment Scale. Intent-to-treat analysis using mixed-effects random regression found significant interaction effects between study condition and three moderating symptom profiles. Empowerment was greater for the intervention participants with high levels of depressive symptoms, anxiety symptoms, and general symptom distress than for the experimental participants with low symptom levels and the control subjects with high or low levels of symptoms. These results shed light on how mental ISM programs operate and ways these can be improved.

The foot pad in rheumatoid arthritis measurement and possible effects on foot disability.

The human foot pad is essential in buffering stress and strain during ambulation. Foot pad atrophy has been associated with foot pain, limping gait, callous formation, and foot ulcers. We report a method to measure foot pad thickness and have investigated its measurement reliability. Two podiatrists independently and bilaterally measured fore and rear foot pads on lateral view radiographs of weight bearing for 78 patients with rheumatoid arthritis. The intrarater coefficient on the fore and rear foot pads was 0.90 or higher, whereas the interrater reliability ranged from 0.73 to 0.92. These results suggest foot pad measurement is simple, practical, and reproducible for measuring foot pad atrophy. This measurement will help identify patients at risk for foot pain and/or ulceration so that appropriate orthotics and soft tissue supplements may be recommended.