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BACKGROUND/RATIONALE:
Background/Rationale: The VHA is engaged in a major initiative to implement recommendations from the President's New
Freedom Commission for the care of persons with mental illness and substance use disorders. The Secretary's Mental
Health Strategic Plan lays out goals to create a system of care that is recovery-oriented, high quality, and delivers
evidenced-based practices (EBP). The minimal participation of caregivers in VA clinical care of persons with Severe
Mental Illness (SMI) constitutes a large gap between what we know works ("evidence") and what we do ("practice"). This
study will test an intervention to help close this gap. Previous research consistently demonstrates that individuals with SMI
have improved outcomes when families are active participants in their care, including treatment retention, participation in
vocational services, and empowerment. Controlled trials show that when families participate in family psychoeducation
(FPE), relapse rates are cut in half and clinical symptoms improve. A national VA survey indicated that 0% offer FPE
programs conforming to EBP guidelines. This proposal will thus test a veteran-centered program designed to enhance
family/caregiver involvement in the veteran's mental health care with a strategy that promotes the veteran's recovery.
OBJECTIVE(S):
Objectives/Primary Aims: We will test the effectiveness of an innovative, structured, brief and manualized family
engagement intervention for veterans with SMI, Family Member Provider Outreach (FMPO). FMPO aims to empower and
educate veterans to increase the likelihood that the veteran's family/caregiver will become constructive partners in their
mental health care. In the FMPO model's first "patient phase," a trained outreach person (a Family Member Provider
(FMP), who has a relative with a serious psychiatric illness, works with the veteran to help resolve veteran-based barriers to
family involvement, to empower veteran-consumers to encourage and facilitate family involvement and to encourage their
mental health providers to involve their families. The second "family phase" of FMPO will occur with the veteran's and
family's permission. Here, the FMP engages in education and support with relatives to strengthen their ability to support the
veteran and to interact effectively with the veteran's regular treatment team. We will test the following primary aims based
on Donabedian's Framework: Processes of Care: (1) to evaluate the effect (relative to enhanced Treatment as usual (e-
TAU) of FMPO on family involvement in care; Outcomes of Care: (2) to evaluate the effect (relative to e-TAU) of FMPO
on veteran outcomes. Secondary aims will (3) estimate the direct cost per patient of providing FMPO, relative to e-TAU;
(4) evaluate the effect (relative to e-TAU) of FMPO on family member outcomes. We will also investigate how the FMPO
program works with these aims: (6) to evaluate the utility of the family component of FMPO; and (7) to assess the
acceptability of FMPO and barriers and facilitators of its implementation.
METHODS:
Methods: Randomized controlled trial of 240 VA outpatients with SMI. Patients will be randomized to receive the FMPO
intervention or usual services. Baseline and six-month assessments will be completed with all participants.
Major variables and sources of data: Processes of Care (rates and frequency of clinician-family contact, participation in
family services, cost per patient) will be assessed via chart review and clinician report. Outcomes of Care (veteran
recovery, satisfaction with family and functioning) will be assessed via validated instruments collected in patient and
family interviews. Qualitative data regarding implementation will be collected from a subsample of patients, families, FMP
workers and clinicans to assess implementation process.
Main types of analyses: A Generalized Linear Mixed Model will be used to assess the primary aims within an intent to
treat framework. Cost-effectiveness and qualitative analyses will also be completed.
FINDINGS/RESULTS:
The study is ongoing.
IMPACT:
Increased participation of veterans with SMI in family psychoeducation and family involvement in mental health care promises to reduce symptoms, increase adherence, and improve veterans' outcomes. The FMPO model also promises to increase the veterans' empowerment and recovery.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Mental Illness, Special (Underserved, High Risk) Populations
DRE:
Quality of Care
Keywords:
Caregivers – not professionals, Education (patient), Schizophrenia
MeSH Terms:
none
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