Despite recent advances, treatment non-adherence continues to be a major barrier to recovery for persons with severe mental illnesses (SMI), resulting in devastating personal and societal costs. Research suggests that incorporating elements of person-centered medicine and collaborative care planning into clinical practice may enhance rates of engagement in and adherence to treatment. Such principles are considered to be the cornerstones of the emerging paradigm of recovery-oriented care, in which the goals of treatment reach beyond symptom reduction and management to include a meaningful life in the community, irrespective of illness. As behavioral health organizations begin to respond to local and federal mandates to adopt a recovery-oriented framework of care, there is a paucity of guiding data on the specific recovery-oriented practices (ROPs) that are most likely to be accessed by, adhered to, and associated with more positive outcomes for consumers, and the contextual factors that may facilitate or impede the uptake of such practices into routine care. The proposed project, conducted in partnership with the National Council for Community Behavioral Healthcare, the umbrella organization representing community mental health centers (CMHCs) nationally, and the NASMPD National Research Institute (NRI), the research/evaluation agency for State Mental Health Agencies across the country, will be the first nationally representative study of the organizational and individual factors associated with agency diffusion of ROPs.
The specific aims are: 1) To describe the extent to which ROPs are being adopted by CMHCs and to understand the system, organizational, and provider factors associated with agency uptake of these practices;2) To identify structural, functional, and contextual characteristics of an organization that are associated with enhanced consumer outcomes and engagement in/adherence to care;3) To identify specific ROPs that are associated with adherence to and involvement in care and positive consumer outcomes, and specific organizational and provider characteristics that may impact the magnitude or path of the relationship between ROPs and outcomes;and 4) To gain an in-depth understanding, using qualitative research methods, of the mechanisms by which an organization adopts a recovery-oriented framework for care delivery.
These aims will be achieved through three phases of research: 1) a national survey of the organizational socio-technical factors associated with degree of adoption of ROPs in a random sample of 360 CMHCs;2) an examination of the relationship between agency implementation of ROPs and patient-level outcomes as captured in large, existing national datasets;and 3) an in-depth exploration of the facilitators and barries associated with agency uptake of ROPs via collective case study analysis. Through a greater understanding of the infrastructure, tools, supports, and outcomes associated with agency diffusion of ROPs, this research will help to fill the existing gaps in knowledge and provide actionable recommendations to guide organizations as they strive to improve the quality and effectiveness of care for persons with SMI.

Public Health Relevance

In recent years, behavioral healthcare organizations are increasingly being asked to demonstrate adoption of a recovery-oriented framework of care that is consumer-driven, person-centered, and responsive to the individual needs of persons with serious mental illness. However, there are limited data from which to guide agencies in the process of transforming existing policies, practices, and structures, into ones that are more consistent with a recovery-oriented model of care. The proposed research will help to bridge this critical gap in knowledge by conducting the first study of the organizational and individual factor associated with the uptake and diffusion of effective recovery-oriented practices that are both accessed and adhered to by consumers receiving services at community mental health centers nationwide.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1)
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Juliano-Bult, Denise M
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Yale University
Schools of Medicine
New Haven
United States
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