The Effectiveness of FMPO in Improving the Quality of Care for Persons With Severe Mental Illness.

The Effectiveness of FMPO in Improving the Quality of Care for Persons With Severe Mental Illness

The purpose of this study is to learn how to help veterans play a stronger role in shaping their mental health care. Specifically we want to see if we can help veterans improve their mental health treatment by helping them decide if they want to involve family in their mental health treatment, and if so, how. The study will compare a "family member provider" program to an "enhanced treatment as usual approach" in achieving these goals.

Study Overview

• Status: Completed
• Conditions: Schizophrenia; Schizoaffective Disorder; Major Depression
• Intervention / Treatment: Behavioral: Family Member Provider Outreach; Behavioral: Enhanced treatment as usual (e-TAU)

Detailed Description

Previous research demonstrates that when families are active participants in the clinical care of persons with SMI, veterans experience improved outcomes, including treatment retention, vocational services participation, and empowerment. Numerous controlled trials show that when family involvement achieves the level of intensity and family psychoeducation (FPE), relapse rates are cut in half, and treatment adherence, clinical symptoms, and patient functioning are improved. However, despite these demonstrated benefits, rates of family involvement in the VA are unacceptably low. Even minimal family-clinician contact occurs for only one third of VA SMI patients, a lower rate than in non-VA systems of care. Therefore, it is not surprising that FPE, an intensive form of family-clinician contact, is almost never offered in the VA. In fact, a national VA survey conducted within the last three years indicated that 0% of VAs offer FPE programs conforming to EBP guidelines. Our previous experience further suggests that these deficits in care are due to combinations of provider, patient, and family factors, and that the VA presents specific challenges to implementing existing model programs, including FPE. We therefore believe it is necessary to approach the challenge of increasing family involvement in a step-wise fashion, first by engaging families in the processes of care, before trying to enlist them in more intensive programs such as FPE. Further, family engagement would likely be most effective if it builds on a foundation that empowers consumers to make informed choices regarding the involvement of relatives in care. Our group has developed and piloted a new, family-engagement approach that is gradual, patient-centered, recovery-based, and can address various barriers to improving care. It is manualized and thus replicable. The proposed study will implement and further evaluate this intervention, the brief Family Member Provider Outreach (FMPO).

• Study Type: Interventional
• Enrollment (Actual): 238
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • West Los Angeles, California, United States, 90073
      • VA Greater Los Angeles Healthcare System, West Los Angeles, CA
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age 18-70 years
• Diagnosis of a psychotic disorder in keeping with criteria established by the Serious Mental Illness Treatment Research and Evaluation Center (SMITREC){{646}} (schizophrenic disorders (295.0-295.9), affective psychoses (296.1, 296.4-296.8) and other psychotic diagnoses (297.0-298.9)) or diagnosis of Major Depression with psychotic features (296.xx)
• Decisional capacity to provide informed consent
• At least two outpatient visits within last six months
• At least monthly face-to-face contact for one hour or more with a patient-identified family member or caregiver
• Assessment by the treating therapist or psychiatrist that the patient is clinically stable enough to participate in the program.

Family Member/Caregiver Inclusion Criteria

• Age 18-80 years
• Decisional capacity to provide informed consent
• Permission from veteran to be contacted

Exclusion Criteria:

• Patients whose families have attended the FPE group within the last six months
• Patients whose families have had at least monthly clinician contact in the last six months
• Patients who are currently homeless
• Patients who participated in the FMPO pilot.

Family Member/Caregiver Exclusion Criteria:

• Individuals who do not meet the inclusion criteria
• Individuals who participated in the FMPO pilot.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: FMPO Condition; Family Member Provider Outreach is a brief recovery oriented model. THe FMPO meets with the consumer for 2-3 sessions and with the family for 2-3 sessions with the consumer's permission.	Behavioral: Family Member Provider Outreach; Family Member Provider Outreach is a brief recovery oriented model. THe FMPO meets with the consumer for 2-3 sessions and with the family for 2-3 sessions with the consumer's permission.
Active Comparator: Enhanced treatment as usual (e-TAU); Enhanced treatment as usual. In this condition, the consumer is given a list of family services available including the family intervention team.	Behavioral: Enhanced treatment as usual (e-TAU); Enhanced treatment as usual. In this condition, the consumer is given a list of family services available including the family intervention team.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Family-Clinician Contact (Including Contact With FMPO Clinician)	Chart review looking at the any clinician contact with veteran's family members	Within 6 months of intervention
Family-Clinician Contact (Not Including Notes From FMPO Clinicians)	Chart review looking at the any clinician contact with veteran's family members	Within 6 months of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Consumer's Recovery Rating - MHRM Total Score	We measured recovery attitudes and beliefs with the Mental Health Recovery Measure (MHRM), a 30-item self-report measure that has a total score and eight subscales.The MHRM scales range from 0-120, with a higher score indicating better recovery.	Within 6 months of intervention
Consumer's Recovery Rating - MHRM - Overcoming Stuckness Sub Score	We measured recovery attitudes and beliefs with the Mental Health Recovery Measure (MHRM), a 30-item self-report measure that has a total score and eight subscales. This sub score is Overcoming Stuckness.The MHRM sub scales range from 0-16, with a higher score indicating better recovery.	Within 6 month of the intervention

Collaborators and Investigators

• Sponsor: US Department of Veterans Affairs
• Collaborators: University of Maryland, Baltimore County
• Investigators: Principal Investigator: Lisa B Dixon, MD MPH, Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD

Publications and helpful links

General Publications

• Glynn SM, Dixon LB, Cohen A, Murray-Swank A. The Family Member Provider Outreach program. Psychiatr Serv. 2008 Aug;59(8):934. doi: 10.1176/ps.2008.59.8.934. No abstract available.
• Cohen AN, Drapalski AL, Glynn SM, Medoff D, Fang LJ, Dixon LB. Preferences for family involvement in care among consumers with serious mental illness. Psychiatr Serv. 2013 Mar 1;64(3):257-63. doi: 10.1176/appi.ps.201200176.
• Dixon LB, Glynn SM, Cohen AN, Drapalski AL, Medoff D, Fang LJ, Potts W, Gioia D. Outcomes of a brief program, REORDER, to promote consumer recovery and family involvement in care. Psychiatr Serv. 2014 Jan 1;65(1):116-20. doi: 10.1176/appi.ps.201300074.

Study record dates

Study Major Dates

• Study Start: September 1, 2007
• Primary Completion (Actual): May 1, 2011
• Study Completion (Actual): June 1, 2011

Study Registration Dates

• First Submitted: April 24, 2007
• First Submitted That Met QC Criteria: April 25, 2007
• First Posted (Estimate): April 27, 2007

Study Record Updates

• Last Update Posted (Estimate): April 24, 2015
• Last Update Submitted That Met QC Criteria: April 6, 2015
• Last Verified: August 1, 2014

More Information

Terms related to this study

• Keywords: Schizophrenia; Education; Mental Illness; Family member treatment; Active psychoses
• Additional Relevant MeSH Terms: Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia; Psychotic Disorders; Mental Disorders
• Other Study ID Numbers: IIR 04-255; H-28791 (Other Identifier: UMB IRB)