Wellness Self-Management
Wellness Self-Management
Veterans with schizophrenia, other serious mental illnesses (SMI), and Post Traumatic Stress
 Disorder (PTSD) are at elevated risk for co-occurring chronic medical conditions resulting in
 increased risk of disability, high health care spending, reduced quality of life and early
 mortality. Physical wellness is increasingly recognized as a key component of the VA's
 commitment to developing recovery-oriented and Veteran-centered mental health treatment.
 There is also growing recognition of the value of interventions that promote and improve
 patient self-management of chronic medical conditions. Building on the established efficacy
 of consumer facilitated medical illness self-management programming used in the general
 population and two recent adaptations for use with SMI adults in the public health sector
 (including the investigators' own evaluation of an intervention called Living Well), the
 investigators propose to complete a randomized controlled effectiveness trial of the Living
 Well intervention and simultaneously conduct a well specified process evaluation to optimize
 knowledge accrual regarding important factors that may improve future adoption,
 implementation and sustainability of the Living Well intervention in the VA system of care.
Background:

 Veterans with schizophrenia, other serious mental illnesses (SMI), and Post Traumatic Stress
 Disorder (PTSD) are at elevated risk for co-occurring chronic medical conditions resulting in
 increased risk of disability, high health care spending, reduced quality of life and early
 mortality. Physical wellness is increasingly recognized as a key component of the VA's
 commitment to developing recovery-oriented and Veteran-centered mental health treatment.
 There is also growing recognition of the value of interventions that promote and improve
 patient self-management of chronic medical conditions. Building on the established efficacy
 of consumer facilitated medical illness self-management programming used in the general
 population and two recent adaptations for use with SMI adults in the public health sector
 (including the investigators' own evaluation of an intervention called Living Well), the
 investigators propose to complete a randomized controlled effectiveness trial of the Living
 Well intervention and simultaneously conduct a well specified process evaluation to optimize
 knowledge accrual regarding important factors that may improve future adoption,
 implementation and sustainability of the Living Well intervention in the VA system of care.

 Aims:

 Primary AIM 1: Complete a randomized controlled effectiveness trial of the Living Well
 intervention with 242 Veterans with mental illness and at least one co-occurring chronic
 medical condition and evaluate the intervention's effects on functional and service related
 outcomes. The investigators hypothesize that those randomized to the Living Well intervention
 will, in comparison to those randomized to a medical illness education and support group,
 demonstrate improved general health functioning including physical and emotional functioning
 as well as reduced rates of medical emergency room visits for management of a chronic medical
 condition. The investigators will also evaluate intervention effects on more proximal
 attitudinal and behavioral outcomes and assess how these factors mediate improvement in the
 functional and services related outcomes.

 Primary AIM 2: Complete a well specified process evaluation based on the RE-AIM evaluation
 framework to better understand contextual factors that can improve the Reach, Effectiveness,
 Adoption, Implementation and Maintenance which together determine the potential public health
 impact of the Living Well intervention.

 Methods:

 A mix of temporally overlapping quantitative and qualitative methods will be used to maximize
 integration and synthesis of data streams across the two aims to optimize knowledge accrual.

 Impact:

 Despite the growing recognition that self-management strategies hold enormous promise for
 improving quality and outcomes of care for chronic medical illnesses, and the fact that
 self-management is gaining prominence as a mental health recovery oriented treatment focus,
 there are currently no evidence-based peer facilitated medical illness self-management
 interventions available for dissemination within the VA mental health system. The proposed
 study is designed to both generate evidence supporting the effectiveness of a peer
 co-facilitated intervention and to help speed throughput to public health impact by
 collecting important contextual information about factors that may improve future
 dissemination and implementation efforts.
Inclusion Criteria:

 -  a diagnosis of schizophrenia/ schizoaffective disorder

 -  bipolar disorder

 -  major depression with psychotic features

 -  post traumatic stress disorder

 -  or psychosis not otherwise specified (NOS)

 -  age between 18 and 80

 -  chart documented presence of at least one of the following chronic medical conditions:

 -  a respiratory condition (e.g. asthma, COPD)

 -  diabetes

 -  arthritis

 -  cardiovascular condition (e.g. congestive heart failure, hypertension, etc.)

 -  receiving mental health services at a designated study site

 -  willing and able to provide consent to participate

 -  deemed clinically stable enough to participate in the study by a treatment provider

 Exclusion Criteria:

 -  Severe or profound mental retardation

 -  Because participants must be able to attend the intervention if assigned to either
 condition, we will also require potential participants to verify their availability
 during screening

 -  Participation in current ongoing study 'Reducing Internalized Stigma in People with
 Serious Mental Illness"