Quality of Research
Review Date: September 2010
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Cook, J. A., Copeland, M. E., Jonikas, J. A., Hamilton, M. M., Razzano, L. A., Grey, D. D., et al. (2010). Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Manuscript submitted for publication. Study 2Cook, J. A., Copeland, M. E., Hamilton, M. M., Jonikas, J. A., Razzano, L. A., Floyd, C. B., et al. (2009). Initial outcomes of a mental illness self-management program based on Wellness Recovery Action Planning. Psychiatric Services, 60(2), 246-249. ![Pub Med icon](https://webarchive.library.unt.edu/web/20130217021525im_/http://nrepp.samhsa.gov/images/icon-pubmed.gif)
Supplementary Materials University of Illinois at Chicago (UIC) National Research and Training Center (NRTC) Ohio (OH) WRAP Study: Fidelity Scale
Outcomes
Outcome 1: Symptoms of mental illness |
Description of Measures
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Symptoms of mental illness were assessed using the Brief Symptom Inventory (BSI), a 53-item self-report instrument. The BSI yields scores on the Global Severity Index (an overall measure of psychological distress), the Positive Symptom Total (a measure of the number of symptoms), and nine symptom subscales: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Using a 5-point scale ranging from "not at all" to "extremely," participants rate each item for how much the symptom bothered them in the past week.
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Key Findings
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Participants were randomly assigned to an intervention group that received WRAP or to a wait-list control group that received services as usual. The BSI was administered to participants 6 weeks before (baseline) and 6 weeks after (posttest) they received the intervention and at a 6-month follow-up. WRAP participants had a significantly greater reduction in the severity and number of symptoms across time (from baseline to posttest to 6-month follow-up) relative to control group participants, as indicated by scores on the BSI Global Severity Index (p = .023); Positive Symptom Total (p = .027); and subscales measuring interpersonal sensitivity (p = .023), depression (p = .022), anxiety (p = .022), phobic anxiety (p = .034), and paranoid ideation (p = .009). No statistically significant differences were found between the two groups across time on somatization, obsessive-compulsive, hostility, and psychoticism subscales.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.9
(0.0-4.0 scale)
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Outcome 2: Hopefulness |
Description of Measures
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Hopefulness was assessed using the Hope Scale (HS), a 12-item self-report instrument with two subscales: one that measures belief in one's capacity to initiate and sustain actions and another that measures ability to generate routes by which goals may be reached. Participants rate each item on a 4-point scale ranging from "definitely false" to "definitely true," and scores for each item are summed to produce a total score.
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Key Findings
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In one study, participants were randomly assigned to an intervention group that received WRAP or to a wait-list control group that received services as usual. The HS was administered to participants 6 weeks before (baseline) and 6 weeks after (posttest) they received the intervention and at a 6-month follow-up. WRAP participants had a significantly greater improvement in hopefulness across time (from baseline to posttest to 6-month follow-up) relative to control group participants, as indicated by total HS scores (p = .018) and the subscale for belief in one's capacity to initiate and sustain actions (p = .020). No statistically significant difference was found between the two groups across time on the subscale for ability to generate routes by which goals may be reached.
In another study, the HS was administered to participants before (pretest) and 1 month after (posttest) they received the intervention. From pre- to posttest, participants who received WRAP had a significant increase in feelings of hopefulness, as indicated by scores on the two HS subscales (p < .01 for each subscale).
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental, Preexperimental
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Quality of Research Rating
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3.7
(0.0-4.0 scale)
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Outcome 3: Recovery from mental illness |
Description of Measures
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Recovery from mental illness was assessed using the Recovery Assessment Scale (RAS), a 41-item self-report instrument with five subscales: personal confidence, willingness to ask for help, goal orientation, reliance on others, and freedom from symptom domination. Participants rate each item on a 5-point scale ranging from "strongly agree" to "strongly disagree," and scores for each item are summed to produce a score for overall recovery.
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Key Findings
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The RAS was administered to participants before (pretest) and 1 month after (posttest) they received the intervention. From pre- to posttest, WRAP participants had a significant improvement in RAS scores for overall recovery (p < .001) and in the five subscales: personal confidence (p < .001), willingness to ask for help (p < .05), goal orientation (p < .05), reliance on others (p < .05), and freedom from symptom domination (p < .05).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Preexperimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Outcome 4: Self-advocacy |
Description of Measures
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Self-advocacy was assessed using the Patient Self-Advocacy Scale (PSAS), a 12-item self-report instrument that measures three dimensions: patient knowledge, assertiveness, and potential for nonadherence to treatment. Participants rate each item on a 5-point scale ranging from "strongly agree" to "strongly disagree."
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Key Findings
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The PSAS was administered to participants before (pretest) and 1 month after (posttest) they received the intervention. From pre- to posttest, WRAP participants had a significant improvement in self-advocacy, as indicated by scores in all three dimensions (p < .01 for each dimension).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Preexperimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Outcome 5: Physical and mental health |
Description of Measures
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Physical and mental health was assessed using the Medical Outcomes Study 12-Item Short Form Survey (SF-12), a self-report instrument that evaluates health indicators, allowing for examination of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, changes in health, and recovery from depression.
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Key Findings
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The SF-12 was administered to participants before (pretest) and 1 month after (posttest) they received the intervention. From pre- to posttest, WRAP participants had a significant improvement in physical and mental health (p < .01).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Preexperimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
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66% Female 34% Male
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63% White 28% Black or African American 5% Hispanic or Latino 3% American Indian or Alaska Native 1% Asian
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Study 2
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26-55 (Adult)
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64% Female 36% Male
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66% White 25% Black or African American 5% Race/ethnicity unspecified 4% Hispanic or Latino
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Symptoms of mental illness
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4.0
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4.0
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4.0
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4.0
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3.5
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4.0
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3.9
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2: Hopefulness
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4.0
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4.0
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3.6
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3.4
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3.0
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4.0
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3.7
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3: Recovery from mental illness
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4.0
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4.0
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2.8
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2.8
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2.0
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4.0
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3.3
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4: Self-advocacy
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4.0
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4.0
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2.8
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2.8
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2.0
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4.0
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3.3
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5: Physical and mental health
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4.0
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4.0
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2.8
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2.8
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2.0
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4.0
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3.3
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Study Strengths All outcome measures used in both studies have strong, well-established psychometric properties. Both studies assessed fidelity though multiple methods, including a checklist that documented adherence to prescribed topics, timeframes, and instructional modalities; weekly teleconference calls by the research team and the study's local WRAP coordinators to discuss each site's attendance and fidelity scores; and the use of trained, experienced facilitators. One study used random assignment and found no significant baseline differences between the intervention and control groups in regard to demographics, clinical status, and employment status. Attrition in both groups for this study was relatively low and was addressed appropriately in the analyses. The same study used a strong experimental design to minimize potential bias owing to confounding variables. Both studies' analytic strategy for data was thorough and appropriate.
Study Weaknesses The instrument used in both studies to assess intervention fidelity has unknown psychometric properties. One study used a preexperimental design and had high attrition. The other study did not provide adequate information on the services received by the control group, such as exposure to peer-led support groups and medications, which raises concerns about potential confounds.
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Readiness for Dissemination
Review Date: September 2010
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Copeland, M. E. (1999). Winning against relapse: A workbook of action plans for recurring health and emotional problems. Dummerston, VT: Peach Press.
Copeland, M. E. (2001). The depression workbook: A guide for living with depression and manic depression (2nd ed.). Oakland, CA: New Harbinger Publications.
Copeland, M. E. (2006). Wellness Recovery Action Planning (WRAP) project: WRAP group facilitator's kit.
Copeland, M. E. (2009). Facilitator training manual: Mental health recovery including Wellness Recovery Action Plan curriculum. Dummerston, VT: Peach Press.
Copeland, M. E. (2010). WRAP facilitator manual.
Copeland, M. E., & Mead, S. (2004). Wellness Recovery Action Plan and peer support: Personal, group, and program development. Dummerston, VT: Peach Press.
My WRAP [Participant binder]
Program Web site for facilitators, http://www.copelandcenter.com
Program Web site for participants, http://www.mentalhealthrecovery.com
University of Illinois at Chicago (UIC) Courses in Recovery Study: WRAP Fidelity Assessment
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.8
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4.0
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3.0
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3.6
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Dissemination Strengths An extensive array of well-developed implementation materials is available. All materials are consistent in content and approach, and they include guidance for adapting the program for use with specific populations. Extensive opportunities are available for facilitator trainings. The facilitator training manual is well organized and includes a comprehensive curriculum. The trainings cover all aspects of organizing, preparing, and conducting group sessions, with training activities and discussions closely following the content of the manuals. Online training options make this program accessible to those who cannot attend an in-person facilitator training session. Extensive support materials (e.g., handouts, worksheets) are available for participants and facilitators, and many of these materials are accessible at the participant and facilitator resource Web sites. A certification program for facilitators helps to ensure fidelity to the model. The fidelity tool includes both content and process questions, and information derived from use of the fidelity tool can be discussed with a local program coordinator.
Dissemination Weaknesses Use of some self-help tools may require peer or facilitator support because of the these tools' complex and dense language. The use of the fidelity tool is not emphasized in program materials. The role and expectations of the local program coordinator, who provides fidelity monitoring support, are not fully discussed.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
Item Description
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Cost
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Required by Developer
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Facilitator Training Manual: Mental Health Recovery Including Wellness Recovery Action Plan Curriculum
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$129 each
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Yes, one source of implementation guidance is required
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Wellness Recovery Action Plan [book]
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$10 each
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Yes, one source of implementation guidance is required
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Assorted books and videos for facilitators and participants
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$2-$60 each
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Yes, one source of implementation guidance is required
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Online participant materials
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Free
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No
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Wellness Recovery Action Plan and Peer Support: Personal, Group, and Program Development
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$24.95 each
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No
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Winning Against Relapse: A Workbook of Action Plans for Recurring Health and Emotional Problems
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$16.95 each
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No
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The Depression Workbook: A Guide for Living With Depression and Manic Depression
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$24.95 each
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No
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5-day, off-site facilitator training at various locations across the United States
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$1,200 per participant
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No
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5-day, off-site advanced facilitator training at various locations across the United States
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$1,400 per participant
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No
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Correspondence course
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$299 per participant
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No
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On-site consultation
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Cost varies depending on site needs
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No
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
Cook, J. A., Copeland, M. E., Corey, L., Buffington, E., Jonikas, J. A., Curtis, L. C., et al. (2010). Developing the evidence base for peer-led services: Changes among participants following Wellness Recovery Action Planning (WRAP) education in two statewide initiatives. Psychiatric Rehabilitation Journal, 34(2), 113-120. ![Pub Med icon](https://webarchive.library.unt.edu/web/20130217021525im_/http://nrepp.samhsa.gov/images/icon-pubmed.gif)
Copeland, M. E. (2002). Wellness Recovery Action Plan: A system for monitoring, reducing and eliminating uncomfortable or dangerous physical symptoms and emotional feelings. Occupational Therapy in Mental Health, 17(3), 127-150.
Davidson, L. (2005). Recovery, self management and the expert patient: Changing the culture of mental health from a United Kingdom perspective. Journal of Mental Health, 14(1), 25-35.
Doughty, C., Tse, S., Duncan, N., & McIntyre, L. (2008). The Wellness Recovery Action Plan (WRAP): Workshop evaluation. Australasian Psychiatry, 16(6), 450-456. ![Pub Med icon](https://webarchive.library.unt.edu/web/20130217021525im_/http://nrepp.samhsa.gov/images/icon-pubmed.gif)
Gordon, J., & Cassidy, J. (2009). Wellness Recovery Action Plan (WRAP) training for BME women: An evaluation of process, cultural appropriateness and effectiveness. Retrieved from http://www.scottishrecovery.net/View-document-details/65-Wellness-Recovery-Action-Plan-WRAP-Training-for-BME-women-full-report.html
Higgins, A., Callaghan, P., DeVries, J. M. A., Keogh, B., Morrissey, J., Nash, M., et al. (2010). Evaluation of the Mental Health Recovery and WRAP education programme: Report to the Irish Mental Health & Recovery Education Consortium. Retrieved from http://www.imhrec.ie/wp-content/uploads/2010/08/TCD-Evaluation-Report-13-05-10.pdf
Scottish Centre for Social Research & Pratt, R. (2010). An evaluation of wellness planning in self-help and mutual support groups. Retrieved from http://www.scottishrecovery.net/Latest-News/wrap-research-reports-overwhelmingly-positive-results.html
Starnino, V. R., Mariscal, S., Holter, M. C., Davidson, L. J., Cook, K. S., Fukui, S., et al. (2010). Outcomes of an illness self-management group using Wellness Recovery Action Planning. Psychiatric Rehabilitation Journal, 34(1), 57-60.
Sterling, E. W., von Esenwein, S. A., Tucker, S., Fricks, L., & Druss, B. G. (2010). Integrating wellness, recovery, and self-management for mental health consumers. Community Mental Health Journal, 46(2), 130-138. ![Pub Med icon](https://webarchive.library.unt.edu/web/20130217021525im_/http://nrepp.samhsa.gov/images/icon-pubmed.gif)
Zhang, W., Li, Y., Yeh, H.-S., Wong, S. Y., & Zhao, Y. (2007). The effectiveness of the Mental Health Recovery (including Wellness Recovery Action Planning) Programme with Chinese consumers. Retrieved from http://www.tepou.co.nz/file/Knowledge-Exchange-stories/bo-ai-she-the-effectiveness-of-the-mental-health-recovery-research-paper.pdf
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