Lack of adherence to medication and outpatient treatment along with substance abuse are two of the most troubling factors to emerge as persons with psychotic disorders have returned to the community. These factors have combined to produce a new cohort of patients who experience poor clinical and functional outcomes and a """"""""revolving door,"""""""" cycle of recurrent inpatient and detox admissions followed by continued drug use. Primarily young and in urban settings, these patients are more likely to be from ethnic minority communities and to be disaffiliated from traditional mental health services. This study evaluates the effectiveness of an innovative approach to increasing medication and outpatient treatment adherence among this population that combines a peer-run engagement program with intensive community-based clinical care. Based on input from dually diagnosed patients, including those of African-American and Latino origin, this approach is informed by a theoretical model in which adherence is hypothesized to be mediated by social support, self-efficacy, and degree of collaboration and cultural sensitivity present in treatment relationships between patients and their mental health providers.
Aims i nclude evaluations of this theoretical model and of the effectiveness of the social engagement intervention as compared to standard care with and without a medication compliance skills training module in increasing medication and outpatient treatment adherence and level of functioning and decreasing psychiatric symptoms, substance abuse, and the rate and duration of readmissions in the first 3 and 9 months following hospitalization. To achieve these aims, a controlled clinical trial will be conducted involving 360 adults with co-occurring psychotic and substance use disorders recruited during hospitalization over a 36-month period. Process measures will be employed to ensure fidelity of the interventions in each of the three conditions. The theoretical model informing the intervention and its effectiveness will be assessed through interviews at baseline, 12 weeks, and 9 months follow-up post-discharge from index hospitalization on measures of social support, self-efficacy, degree of collaboration and cultural sensitivity present in treatment relationships, treatment adherence, clinical and functional status, substance abuse, and inpatient and detox service utilization.
