Implementing Illness Management & Recovery in Rural Kentucky

1. Implementing Illness Management & Recovery in Rural Kentucky Jeff Drury, Ph.D.

2. What Is Illness Management & Recovery (IMR) • Illness Management and Recovery is a structured approach to helping adults with severe mental illness manage their lives more independently. IMR provides a set of specific techniques to educate consumers about their illness and related issues, such as medications and side effects, and to train them to use successful skills and strategies to cope and prevent relapse.

3. Key IMR Components • Consumers define recovery. • Education about mental illnesses is the foundation of informed decision-making. • The Stress-Vulnerability Model provides a blueprint for illness management. • Collaborating with professionals and significant others helps consumers achieve their recovery goals. • Relapse prevention planning reduces relapses and rehospitalizations. • Consumers can learn new strategies for managing their symptoms, coping with stress, and improving their quality of life.

4. How IMR is Provided • Trained IMR practitioners meet weekly with consumers either individually or as a group for 3 to 10 months. • Critical components of IMR are summarized in educational handouts that practitioners distribute and review with consumers during the sessions. • Techniques of psychoeducation, motivational interviewing, and cognitive behavioral therapy are used to facilitate the process.

5. Topic Areas of IMR Handouts • Recovery strategies • Practical facts on mental illness • Stress-Vulnerability Model and treatment strategies • Building social support • Using medication effectively • Drug and alcohol use • Reducing relapse • Coping with stress • Coping with problems and persistent symptoms • Getting your needs met in the mental health system

6. Why Illness Management & Recovery? • Allow our consumers to better collaborate with professionals in the management of their illness • Reduce the effects of their illness • Reduce susceptibility to relapse • Learn effective coping skills • Better advocate for their needs within the mental health system • Regain mastery over their own lives • Discover (or rediscover) strengths • Learn how to direct one’s own treatment • Spend less time on their illness and more time pursuing personal goals • Affect a shift in thinking for both consumers and professionals in our area towards recovery

7. Planning Grant • In the spring of 2008, Comprehend was awarded a $20,100 planning grant by the Health Foundation of Greater Cincinnati to study the feasibility of implementing Illness Management & Recovery in Rural Kentucky.

8. Goals for Planning Grant • Assessment of Agency’s Readiness for Change • Increasing Knowledge Base of IMR • Site Visits to Existing IMR Sites • Receipt of Expert Consultation • Development of Business Plan to Implement IMR Model

9. Readiness for Change • Used Texas Christian University Survey of Organizational Functioning (TCUSOF) • Agency Needs, Institutional Resources, Staff Attributes, & Organizational Climate • Two planning group members also participated in Prosci Change Management Workshop on ADKAR Change Model • Awareness, Desire, Knowledge, Ability, Reinforcement

10. Increasing Knowledge Base • Literature review by planning team members • Review of IMR Toolkit • Series of informational sessions on IMR for agency staff

11. Site Visits to IMR Sites • Eastern State Hospital Recovery Mall • Shawnee Mental Health Center (Portsmouth) • Centerpoint Health Site Visit (Cincinnati) • HFGC Grantees Group

12. Receipt of Expert Consultation • SAMHSA’s IMR Toolkit • TreatmentTeam.com Understanding Mental Illness Series • SAMHSA’s Knowledge Application Program Series • Staff members from Site Visit locations (Dr. David Susman, Meghan Sweeney, Melanie Ellerbrock) • ACT Center of Indiana (Tim Gearhart)

13. Implementation Grant • In the spring of 2009, Comprehend was awarded a $25,000 implementation grant by the Health Foundation of Greater Cincinnati for the implementation of Illness Management & Recovery in Rural Kentucky.

14. Our Logic Model

15. Goals for Implementation Grant • Develop necessary infrastructure to establish IMR program (i.e. training, consultation, fidelity assessments). • To provide high fidelity IMR services to 75 individuals with severe mental illness. • To reinforce and sustain implementation of IMR programming beyond implementation grant period (i.e. sustainability).

16. Baseline Fidelity Assessment • August 26, 2009 Tim Gearhart and Alan McGuire of ACT Center of Indiana conduct pre-implementation fidelity review • IMR Fidelity Scale • General Organizational Index (GOI) • Baseline Fidelity Report

17. Training/Consultation • August 27-28, 2009 Tim Gearhart and Alan McGuire of ACT Center of Indiana conduct a two-day training for Comprehend staff on providing IMR services. • Approximately twenty Comprehend staff members are trained in IMR model. • ACT Center of Indiana remains available for consultation/supervision via weekly phone calls.

18. Roll Out of IMR Programming • IMR programming has been provided in both individual and group based formats. • Primary provision of IMR programming has been done in group setting within our day programs for adults with severe mental illness. • To date, 31 unique individuals have received IMR services.

19. Outcomes • Using Consumer Outcome Monitoring Package (COMP) • Computer application • Choose from a pre-established list of outcomes developed for each evidence-based practice • Reports can be generated quarterly or monthly • Allows viewing of outcome data using tables and graphs • We are considering adding Quality of Life measure

20. Sustainability of IMR • Additional on-site training from ACT Center of Indiana. • Expansion into remaining day programs. • Post-implementation fidelity review upcoming. • Ongoing publicity of IMR programming. • Ongoing efforts to maximize reimbursement. • Modeling of IMR notes into EMR system.

21. Facilitators to Success • Health Foundation of Greater Cincinnati • HFGC Grantees Group • Existence of extensive theoretical and research literature on IMR • Technical Assistance from SAMHSA, NAMI, ACT Center of Indiana, HFGC • General support of DBHIDD for evidence based practices

22. Barriers to Success • Absence of any formal, specific state level support, guidance, or guidelines for IMR • Absence of any reimbursement system for evidence based practices in Kentucky • Absence of any high fidelity programs in Kentucky upon which to model new IMR programming