Mental Disorders
Conditions
Keywords
Recovery, Hope, Empowerment, Randomized Control Trial
Brief summary
The present study will determine if Spaniol and colleague's (1994) Recovery Workbook group intervention is an effective clinical tool to move a person with SMI along in their journey of recovery. The primary outcome measurements of this study will be the participants' perceived level of empowerment, hope and optimism, knowledge of recovery, and life satisfaction. This kind of information would add to the current body of knowledge about how principles of recovery can be used in psychoeducational programs used by outpatient community mental health services.
Detailed description
ABSTRACT: Objective: Adopting the principles of recovery into the mental health field has been a growing area for discussion at many different levels of care. The present study will determine if Spaniol and colleague's (1994) Recovery Workbook group intervention can be used as an effective clinical tool to move a person with a severe mental illness along in their journey of recovery. The primary outcome measurements of this study will be the participants' perceived level of empowerment, hope and optimism, knowledge of recovery, and life satisfaction. Method: The study will be a multicenter, prospective, single-blinded, randomized control trial. Sixty participants will be recruited from three Assertive Community Treatment Teams (ACTT) in Kingston, Ontario and individuals will be randomized to either the control or intervention arm of the study. The control arm of the study will receive their regular services from ACTT. The intervention arm will participate in a 10-week psychoeducational group program in addition to receiving their regular services from ACTT. Results: Analysis will be performed by intention to treat, based on total scores of four assessments which will be performed at the trial commencement and termination.
Interventions
BEHAVIORALRecovery Workbook Training (psychoeducational training)
The Recovery Workbook uses an educational process to increase awareness of recovery, increase knowledge and control of the illness, increase awareness of the importance and nature of stress, enhance personal meaning, build personal support, and develop goals and plans of action. The intervention period of 30 weekly sessions recommended by Spaniol and colleagues was shortened to 12 weekly sessions to accommodate for clinical and participant commitment. No workbook content was excluded, and all practice exercises were covered.
BEHAVIORALACT as usual
Assertive Community Treatment services provided as per established and evidence-based fidelity standards.
Sponsors
Queen's University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Receive support from an Assertive Community Treatment Team. 2. Meet the DSM-IV diagnostic classification for schizophrenia, schizoaffective, schizophreniform, delusional disorder, or bipolar disorder. 3. Aged 18-55 years-old. 4. Individuals agree to participate in the study after they have been informed of all the expected benefits and risks. 5. Neither substance misuse nor organic disorder judged to be the major cause of psychotic symptoms.
Exclusion criteria
1. Inability to give informed consent 2. Diagnosis of dementia 3. Significant head injury or other brain injury leading to cognitive impairment 4. Mental retardation (premorbid IQ \< 65) 5. Require an interpreter
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hope Herth Index | Within 3 days of completion of intervention | The Herth Hope Index was used to gather information about participants' level of hopefulness. The 12-item scale is easily administered and has been used with persons with serious mental illness . It is a self-report tool, and respondents answer on a 4-point agreement scale that ranges from strongly disagree to strongly agree. The scoring range is from 12-48 with a higher score indicating higher levels of hope. The scale has been shown to have an alpha coefficient of .97 and a test-retest reliability of .91 within two weeks. Criterion-related validity has also been supported by high correlations (.81-.92) with instruments measuring the same construct. |
| Empowerment Scale | Within 3 days of completion of interventions | The construct measured is empowerment. The Empowerment Scale is a self-reported measure that contains 28 statements about empowerment to which participants respond on a 4-point agreement scale. Scoring range is 28-112, with a lower score indicating higher empowerment. Studies have demonstrated the scale's high internal consistency ({alpha}=.85-.90) and good reliability ({alpha}\>.60) and validity (28,31,32). |
| Recovery Assessment Scale | Within 3 days of completion of intervention | The construct is Personal Recovery, defined as a person's ability to live a full and meaningful life. The Recovery Assessment Scale (RAS) has 41-items and uses a 5-point agreement scale, and a total score is used, with scores ranging from 41-205, with a higher score indicating a higher sense of personal recovery. The RAS also has 5 subscales (see below). Subscales are added to produce a total score. Domain 1 is Confidence and Hope. he scoring range here is 9-45, where a higher score indicating higher recovery. Domain 2 is Willingness to Ask for Help. Scoring range is 3-15. Domain 3: Ability rely on others: Scoring range 5-25. Domain 4 Symptoms: Scoring range 4-20. Domain 5: Goal and Success Orientation: Scoring range 3-15. For each domain, higher values represent a better outcome. |
| Quality of Life Index, General Version | Within 3 days of completion of intervention | The Quality of Life Index, General Version (37), is a 33-item self-report scale measuring satisfaction with and importance of aspects of life. It includes four subscales: health and functioning, socioeconomic status, psychological status, and significant others. Satisfaction and importance are measured on a 6-point agreement scale. A high score indicates higher quality of life. Full scoring instructions and computer algorithm is available at http://qli.org.uic.edu/questionaires/pdf/genericversionIII/genericscoring.pdf. Importance ratings are used to weight satisfaction responses so that scores reflect satisfaction with aspects of life that are valued by the individual (37). For internal consistency and reliability, Cronbach's alpha is .92 for the entire tool and .88, .75, .80, and .68, respectively, for the subscales (37). Possible range for the final scores = 0 to 30, where a higher value represents a better outcome.. |
Countries
Canada
Participant flow
Recruitment details
Managers of 2 ACT teams reviewed all clients to identify those eligible for study between August and October 2006. Eighty-one identified and informed about the study, with 34 people providing informed consent. Clients were grouped by team and then randomized to one of the two arms. One person dropped out at time of randomization
Pre-assignment details
Participants were grouped according to team prior to randomization because the group intervention was administered by team
Participants by arm
| Arm | Count |
|---|---|
| ACT With Recovery Workbook Recovery Workbook (Psychoeducation training) Clients of Assertive Community Treatment randomized to condition receiving the Recovery Workbook intervention in a group format over 12 weeks. The sessions focus on the following areas: Introduction; Recovery; Knowledge and Control; Managing life stress; Enhancing personal meaning; Building personal support and; Setting personal goals
Recovery Workbook Training (psychoeducational training): The Recovery Workbook uses an educational process to increase awareness of recovery, increase knowledge and control of the illness, increase awareness of the importance and nature of stress, enhance personal meaning, build personal support, and develop goals and plans of action. The intervention period of 30 weekly sessions recommended by Spaniol and colleagues was shortened to 12 weekly sessions to accommodate for clinical and participant commitment. No workbook content was excluded, and all practice exercises were covered. | 16 |
| ACT as Usual Assertive community Treatment The participants were clients of Assertive Community Treatment receiving standard treatment as usual. Assertive Community Treatments are structured to meet set fidelity standards that are evidence-based.
ACT as usual: Assertive Community Treatment services provided as per established and evidence-based fidelity standards. | 17 |
| Total | 33 |
Baseline characteristics
| Characteristic | ACT With Recovery Workbook | ACT as Usual | Total |
|---|---|---|---|
| Age, Continuous Age | 44.69 years STANDARD_DEVIATION 9.62 | 44.58 years STANDARD_DEVIATION 8.05 | 44.62 years STANDARD_DEVIATION 8.5 |
| Hope, Empowerment, Recovery, QOL Empowermeent | 61.96 units on a scale STANDARD_DEVIATION 6.91 | 63.88 units on a scale STANDARD_DEVIATION 6.91 | 62.95 units on a scale STANDARD_DEVIATION 6.87 |
| Hope, Empowerment, Recovery, QOL Hope | 37.13 units on a scale STANDARD_DEVIATION 6.53 | 36.00 units on a scale STANDARD_DEVIATION 5.36 | 36.54 units on a scale STANDARD_DEVIATION 5.38 |
| Hope, Empowerment, Recovery, QOL Quality of Life | 20.34 units on a scale STANDARD_DEVIATION 5.01 | 20.70 units on a scale STANDARD_DEVIATION 4.13 | 20.53 units on a scale STANDARD_DEVIATION 4.51 |
| Hope, Empowerment, Recovery, QOL Recovery | 163.75 units on a scale STANDARD_DEVIATION 22.6 | 156.41 units on a scale STANDARD_DEVIATION 14.22 | 159.97 units on a scale STANDARD_DEVIATION 18.87 |
| Sex: Female, Male Female | 5 Participants | 6 Participants | 11 Participants |
| Sex: Female, Male Male | 11 Participants | 11 Participants | 22 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 16 | 0 / 17 |
| serious Total, serious adverse events | 0 / 16 | 0 / 17 |
Outcome results
Primary
Empowerment Scale
The construct measured is empowerment. The Empowerment Scale is a self-reported measure that contains 28 statements about empowerment to which participants respond on a 4-point agreement scale. Scoring range is 28-112, with a lower score indicating higher empowerment. Studies have demonstrated the scale's high internal consistency ({alpha}=.85-.90) and good reliability ({alpha}\>.60) and validity (28,31,32).
Time frame: Within 3 days of completion of interventions
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACT With Recovery Workbook | Empowerment Scale | 55.93 units on a scale | Standard Deviation 6.91 |
| ACT as Usual | Empowerment Scale | 61.96 units on a scale | Standard Deviation 7.33 |
Primary
Hope Herth Index
The Herth Hope Index was used to gather information about participants' level of hopefulness. The 12-item scale is easily administered and has been used with persons with serious mental illness . It is a self-report tool, and respondents answer on a 4-point agreement scale that ranges from strongly disagree to strongly agree. The scoring range is from 12-48 with a higher score indicating higher levels of hope. The scale has been shown to have an alpha coefficient of .97 and a test-retest reliability of .91 within two weeks. Criterion-related validity has also been supported by high correlations (.81-.92) with instruments measuring the same construct.
Time frame: Within 3 days of completion of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACT With Recovery Workbook | Hope Herth Index | 38.93 units on a scale | Standard Deviation 5.34 |
| ACT as Usual | Hope Herth Index | 35.06 units on a scale | Standard Deviation 5.36 |
Primary
Quality of Life Index, General Version
The Quality of Life Index, General Version (37), is a 33-item self-report scale measuring satisfaction with and importance of aspects of life. It includes four subscales: health and functioning, socioeconomic status, psychological status, and significant others. Satisfaction and importance are measured on a 6-point agreement scale. A high score indicates higher quality of life. Full scoring instructions and computer algorithm is available at http://qli.org.uic.edu/questionaires/pdf/genericversionIII/genericscoring.pdf. Importance ratings are used to weight satisfaction responses so that scores reflect satisfaction with aspects of life that are valued by the individual (37). For internal consistency and reliability, Cronbach's alpha is .92 for the entire tool and .88, .75, .80, and .68, respectively, for the subscales (37). Possible range for the final scores = 0 to 30, where a higher value represents a better outcome..
Time frame: Within 3 days of completion of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ACT With Recovery Workbook | Quality of Life Index, General Version | 20.34 units on a scale | Standard Deviation 5.01 |
| ACT as Usual | Quality of Life Index, General Version | 20.70 units on a scale | Standard Deviation 4.13 |
Primary
Recovery Assessment Scale
The construct is Personal Recovery, defined as a person's ability to live a full and meaningful life. The Recovery Assessment Scale (RAS) has 41-items and uses a 5-point agreement scale, and a total score is used, with scores ranging from 41-205, with a higher score indicating a higher sense of personal recovery. The RAS also has 5 subscales (see below). Subscales are added to produce a total score. Domain 1 is Confidence and Hope. he scoring range here is 9-45, where a higher score indicating higher recovery. Domain 2 is Willingness to Ask for Help. Scoring range is 3-15. Domain 3: Ability rely on others: Scoring range 5-25. Domain 4 Symptoms: Scoring range 4-20. Domain 5: Goal and Success Orientation: Scoring range 3-15. For each domain, higher values represent a better outcome.
Time frame: Within 3 days of completion of intervention
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ACT With Recovery Workbook | Recovery Assessment Scale | Recovery total | 168.81 units on a scale | Standard Deviation 20.11 |
| ACT With Recovery Workbook | Recovery Assessment Scale | Confidence and Hope | 37.13 units on a scale | Standard Deviation 5.51 |
| ACT With Recovery Workbook | Recovery Assessment Scale | Willingness to Ask for Help | 12.00 units on a scale | Standard Deviation 2.33 |
| ACT With Recovery Workbook | Recovery Assessment Scale | Ability rely on others | 21.31 units on a scale | Standard Deviation 2.91 |
| ACT With Recovery Workbook | Recovery Assessment Scale | Symptoms | 17.18 units on a scale | Standard Deviation 1.79 |
| ACT With Recovery Workbook | Recovery Assessment Scale | Goal and Success Orientation | 11.75 units on a scale | Standard Deviation 2.11 |
| ACT as Usual | Recovery Assessment Scale | Symptoms | 14.76 units on a scale | Standard Deviation 2.61 |
| ACT as Usual | Recovery Assessment Scale | Recovery total | 149.11 units on a scale | Standard Deviation 22.09 |
| ACT as Usual | Recovery Assessment Scale | Ability rely on others | 18.35 units on a scale | Standard Deviation 4.74 |
| ACT as Usual | Recovery Assessment Scale | Confidence and Hope | 31.82 units on a scale | Standard Deviation 7.92 |
| ACT as Usual | Recovery Assessment Scale | Goal and Success Orientation | 9.65 units on a scale | Standard Deviation 2.62 |
| ACT as Usual | Recovery Assessment Scale | Willingness to Ask for Help | 11.11 units on a scale | Standard Deviation 1.73 |