Culturally Responsive Person-Centered Care for Psychosis

Sponsor

Yale University (Other)

Overall Status

Completed

CT.gov ID

NCT00231933

Collaborator

National Institute of Mental Health (NIMH) (NIH)

290

Enrollment

Location

Arms

Duration (Months)

6.7

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study will compare standard individualized care to person-centered care and community-integrating care for treating psychosis in adults of Hispanic or African descent.

Condition or Disease	Intervention/Treatment	Phase
Psychotic Disorders	Behavioral: Person-centered planning (PCP) Behavioral: Community integration (CI) Behavioral: Illness management recovery (IMR)	Phase 1

Detailed Description

Patient-centered care is a type of customized mental health care that is based on each individual's needs, values, and preferences. This type of care has become increasingly important, especially for members of ethnic minorities. However, although this type of care is, in theory, more effective than standard, less personalized care in treating psychotic disorders, there is a significant gap between theory and practice. Research has shown that this gap is particularly evident in the treatment of psychotic disorders in individuals of ethnic backgrounds. This study will address these disparities by comparing the effectiveness of standard individualized care versus person-centered care and community-integrating care in treating psychosis in adults of Hispanic and African descents.

This open-label study will consist of two phases. In Phase I, interview data on self-management of mental illness and treatment seeking behaviors will be collected and analyzed. In Phase II, participants from two urban mental health centers will be randomly assigned to receive one of three treatment combinations: standard care incorporating illness management recovery (IMR); IMR plus person-centered planning (PCP); or IMR plus PCP and community integration (CI). IMR will focus on nine topic areas: recovery strategies; facts about psychosis; a stress-vulnerability model; building social support; reducing relapses; effective use of medications; coping with stress; coping with problems or symptoms; and meeting health care needs. PCP will aid participants in discovering a vision of a desirable future and developing a plan for achieving that goal. Techniques will include providing direction in the planning process, involving significant others, generating focus on assets and capacities, identifying and providing access to integrated community settings, and promoting acceptance of setbacks as part of the path to success. CI will include recovery group sessions and community integration activities. Recovery groups will consist of 10 to 12 people per group, and will aid participants in asserting the skills they learned in IMR and PCP. Community integration activities will entail a variety of excursions and social and recreational activities in the community to promote community involvement and acquisition of social roles. All treatments will last a total of 6 months. Assessments of psychiatric symptoms, social functioning, quality of life, and community integration will occur at Month 6 and at a follow-up visit at Month 18.

Study Design

Study Type:

Interventional

Actual Enrollment :

290 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Culturally-responsive, Person-centered Care for Psychosis

Study Start Date :

Oct 1, 2005

Actual Primary Completion Date :

May 1, 2009

Actual Study Completion Date :

May 1, 2009

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: 1 Participants will receive standard care incorporating illness management recovery	Behavioral: Illness management recovery (IMR) IMR focuses on nine topic areas: recovery strategies; facts about psychosis; a stress-vulnerability model; building social support; reducing relapses; effective use of medications; coping with stress; coping with problems or symptoms; and meeting health care needs.
Experimental: 2 Participants will receive illness management recovery plus person-centered planning	Behavioral: Person-centered planning (PCP) PCP aids participants in discovering a vision of a desirable future and developing a plan for achieving that goal. Techniques include providing direction in the planning process, involving significant others, generating focus on assets and capacities, identifying and providing access to integrated community settings, and promoting acceptance of set backs as part of the path to success. Behavioral: Illness management recovery (IMR) IMR focuses on nine topic areas: recovery strategies; facts about psychosis; a stress-vulnerability model; building social support; reducing relapses; effective use of medications; coping with stress; coping with problems or symptoms; and meeting health care needs.
Experimental: 3 Participants will receive illness management recovery plus person-centered planning and community integration	Behavioral: Person-centered planning (PCP) PCP aids participants in discovering a vision of a desirable future and developing a plan for achieving that goal. Techniques include providing direction in the planning process, involving significant others, generating focus on assets and capacities, identifying and providing access to integrated community settings, and promoting acceptance of set backs as part of the path to success. Behavioral: Community integration (CI) CI includes recovery group sessions and community integration activities. Behavioral: Illness management recovery (IMR) IMR focuses on nine topic areas: recovery strategies; facts about psychosis; a stress-vulnerability model; building social support; reducing relapses; effective use of medications; coping with stress; coping with problems or symptoms; and meeting health care needs.

Arm

Intervention/Treatment

Active Comparator: 1

Participants will receive standard care incorporating illness management recovery

Behavioral: Illness management recovery (IMR)

IMR focuses on nine topic areas: recovery strategies; facts about psychosis; a stress-vulnerability model; building social support; reducing relapses; effective use of medications; coping with stress; coping with problems or symptoms; and meeting health care needs.

Experimental: 2

Participants will receive illness management recovery plus person-centered planning

Behavioral: Person-centered planning (PCP)

PCP aids participants in discovering a vision of a desirable future and developing a plan for achieving that goal. Techniques include providing direction in the planning process, involving significant others, generating focus on assets and capacities, identifying and providing access to integrated community settings, and promoting acceptance of set backs as part of the path to success.

Behavioral: Illness management recovery (IMR)

Experimental: 3

Participants will receive illness management recovery plus person-centered planning and community integration

Behavioral: Person-centered planning (PCP)

Behavioral: Community integration (CI)

CI includes recovery group sessions and community integration activities.

Behavioral: Illness management recovery (IMR)

Outcome Measures

Primary Outcome Measures

Psychiatric symptoms [Measured at Months 6 and 18]
Social functioning [Measured at Months 6 and 18]
Quality of life [Measured at Months 6 and 18]
Community integration [Measured at Months 6 and 18]

Secondary Outcome Measures

Collaborative nature of care [Measured at Months 6 and 18]
Culturally responsive nature of care [Measured at Months 6 and 18]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Of Hispanic and/or African origin
DSM-IV diagnosis of an axis I psychotic disorder (e.g., schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features)