Six at a Glance
By Steve Herndon
Components of the six Evidence-Based Practices toolkits are similar, but the practices themselves are diverse, and they may be unfamiliar to some practitioners and supervisors in the field today. The following descriptions provide a glimpse into the practices that are currently the focus of SAMHSA's national project.
Illness Management and Recovery
Empowerment is key in the Illness Management and Recovery model. Consumers of mental health services who experience symptoms of schizophrenia, bipolar disorder, and major depression learn methods for controlling their illness and finding their own paths to recovery.
The program is based on strong collaboration between mental health providers and consumers. It generally consists of weekly sessions in individual or group formats over a 3- to 6-month period. In these sessions, practitioners educate consumers on nine topic areas, ranging from recovery strategies and illness information to coping with stress and finding help in the mental health system.
The toolkit teaches practitioners how to conduct sessions and respond to any problems that may arise. They also learn how to deploy motivational, cognitive-behavioral, and educational strategies to help consumers.
When using the Illness Management and Recovery model, practitioners often report a high rate of job satisfaction as consumers learn to reduce relapses, avoid hospitalization, and make steady progress toward personalized recovery goals.
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Medication Management Approaches in Psychiatry (MedMAP)
Medications play a pivotal role in recovery for most people diagnosed with serious mental illnesses. But many consumers diagnosed with schizophrenia are not prescribed medicines based on clinical guidelines. These consumers are often over- or under-medicated and cannot achieve maximum recovery.
MedMAP responds to these problems by providing research-based algorithmsscientific formulas or proceduresthat practitioners can use as a guide for prescribing medications and dosages.
The MedMAP toolkit contains practical considerations for carrying out this model as well as an emphasis on the key ingredients: clear, thorough documentation, objective measures of desired outcomes, and shared decision-making between consumers and practitioners.
In addition to helping consumers meet their recovery objectives, MedMAP has the potential to reduce costs and return more value per health care dollar. Research also indicates that consumers whose medications are regulated by algorithms are more satisfied with their treatment and outcomes than consumers who are prescribed medication without algorithms. Although MedMAP currently is designed for use only in treating schizophrenia, researchers hope to expand the approach for treatment of other mental illnesses in the near future.
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Assertive Community Treatment (ACT)
The Assertive Community Treatment model delivers comprehensive services to individuals with serious mental illness whose needs have not been met through traditional service delivery. The core of the program is an interdisciplinary team of 10 to 12 practitioners who provide integrated services directly to approximately 100 people in the communities where problems occurnot in offices or clinics.
ACT team members collaborate on assessments, treatment plans, and day-to-day interventions, and they share responsibility for ensuring that consumers receive services that support recovery. The team reviews each consumer's status daily so that the nature and intensity of services can be adjusted quickly as needs change.
It's important to follow the ACT model precisely. Variations can limit or even nullify consumer benefits. Researchers have found that ACT, when done properly, surpasses alternative approaches such as brokered care or clinical case management programs in regard to consumers' independence, satisfaction, and quality of life.
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Through Family Psychoeducation, practitioners work in partnership with families and consumers to support recovery. Specifically, practitioners educate families about the illness and help them develop coping skills for related problems. The term "family" in this case refers to anyone committed to the care and support of someone with mental illness.
Family Psychoeducation is designed for a single- or multi-family group format. As the toolkit explains, most licensed mental health practitionersincluding social workers, psychiatric nurses, psychiatrists, psychologists, occupational therapists, and case managerscan learn to work within this model effectively.
Consumers, family members, and clinicians develop bonds and build their knowledge base through introductory sessions, educational workshops, and problem-solving sessions all devoted to recovery goals and sharing information. Clinicians stand to gain an enhanced understanding of how illness affects family dynamics and how to shift perspectives from being a practitioner to a partner in recovery.
The American Psychiatric Association cites Family Psychoeducation, when used in conjunction with medication, as one of the most effective ways to further the recovery process for schizophrenia. Recent studies also show promising results for people with bipolar disorder, major depression, and other serious mental illnesses.
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People with mental illness have strengths, talents, and abilities that are often overlookedincluding the motivation to work. Research and opinion surveys have shown that the majority of adults with a serious mental illness want to work. And, they can do so effectively with the Supported Employment model.
How can Supported Employment generate better outcomes than traditional vocational programs? Primarily, this
model focuses on helping consumers
find competitive jobs they want in their communityjobs that are open to anyone and provide equal compensation.
The toolkit materials stress the importance of letting consumers choose their work and support options based on their preferences, strengths, and experiences. In the Supported Employment model, vocational services are integrated with treatment. This means that the employment specialists work with the case manager, therapist, psychiatrist, and others on the treatment team. What's more, nobody is excluded from a successful Supported Employment program, and there are no pre-vocational training requirements for participants.
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Co-occurring Disorders: Integrated Dual Disorders Treatment
More than half the adults with serious mental illness in public mental health systems are further impaired by substance abuse or a dependence on alcohol or drugs. These people are at high risk for negative outcomes, including hospitalization, overdose, violence, legal problems, homelessness, victimization, HIV infection, and hepatitis.
Research has shown that treating the substance use disorder and mental illness togetheras described in the Co-occurring Disorders modelhelps to aid recovery. In this model, clinicians learn about the interactions of alcohol and drugs with mental illness. One core team provides integrated services to consumers at different stages of treatment.
At the outset of the program, consumers work with clinicians to form an individualized treatment plan for both disorders. There is also a motivational component in which clinicians use specific listening and counseling skills to help consumers develop awareness, hopefulness, and motivation for recovery.
For more information, contact SAMHSA's National Clearinghouse for
Mental Health Information, P.O. Box 42490, Washington, DC 20015.
Telephone: 1 (800) 789-2647 or 1 (800) 889-2647 (TTY). Or visit
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