Feature

For psychologist Chuck Wallace, PhD, publishing in journals leaves a lot to be desired when it comes to getting information into the hands of practitioners who treat serious mental illness (SMI).

"We've got to get the knowledge down to the people who can act on it, but doing so is no small effort," says Wallace, an adjunct psychiatry professor at the University of California, Los Angeles. "No matter how much one publishes, it just doesn't begin to hit sufficient numbers of people to be able to influence practice."

That's why Wallace is so pleased that several of the assessment tools and interventions he has developed are included in APA's new "Training Grid Outlining Best Practices for Recovery and Improved Outcomes for People with Serious Mental Illness."

Produced by the APA Committee for the Advancement of Professional Practice (CAPP) Task Force on Serious Mental Illness and Severe Emotional Disturbance, the training grid offers one-stop shopping for psychologists, administrators, students, policy-makers, advocates, consumers and others interested in learning more about state-of-the-art assessment and intervention strategies for adults with SMI (see sidebar). The task force is funded by CAPP and facilitated by APA's Practice Directorate.

The grid offers tools to help practitioners and others move beyond the current trend of overreliance on medication and providing a restricted array of services in hospitals, says Richard H. Hunter, PhD, past-chair of the task force and president of Clinical Outcomes Group Inc., in Marion, Ill. Over the last decade, he says, that overuse of medication, coupled with the lack of comprehensive services, has resulted in worsening outcomes, alarming rates of overmedication and reliance on sometimes-deadly seclusion and restraint.

The grid's "catalog of best practices" counterbalances that medicine-centric approach, says Hunter, with its psychological and behavioral interventions that produce new opportunities for recovery.

A user-friendly resource

For easy reference, the grid features over 150 assessment tools, therapeutic interventions, program supports, and training and dissemination methods, plus e-mail addresses, Web sites and other contact information for the clinicians and researchers associated with them. It includes sections on everything from how to assess and treat people with SMI to how to train staff and give them the information they need to deliver effective treatment. Also included are interventions designed to raise awareness of trauma and to reduce the use of coercion.

The listed programs are all effective alternatives to what Hunter calls the "drugs and TV therapy" approach to hospital care. That "drugs and TV" model doesn't promote recovery even for those who respond to medication, he says, noting that drugs aren't effective for 40 percent of people with SMI.

"Many of us were aware that the value of medication was oversold," he says, pointing to the recent discovery that much-hyped new schizophrenia drugs are no more effective than older, cheaper drugs. "We always knew the value of providing concomitant psychological, behavioral and psychosocial services."

Yet while access to psychological services was being restricted, notes Hunter, psychologists were spending the last decade developing interventions that could get these patients out of hospitals and back into the community.

Hunter started compiling a list of effective interventions for use in his own consulting practice, then approached the task force with a proposal for an expanded version. The 2003 publication of the President's New Freedom Commission on Mental Health report and its call to transform the mental health system provided added impetus.

The result is a resource that fulfills the New Freedom Commission's emphasis on promoting resilience and recovery rather than suppressing symptoms and accepting long-term disability, say Hunter and others.

A wide-ranging resource

The grid is a unique resource, says Steven M. Silverstein, PhD, the task force's chair-elect and an associate psychiatry professor at the University of Illinois at Chicago.

"Certainly there are review papers that summarize findings from multiple studies and individual Web sites where you can find information about specific interventions," says Silverstein, who led the task force committee responsible for expanding the grid into its current format as a comprehensive reference tool. "But there's no other document that provides information about so many different types of services and that has contact information for the principal developers and researchers for each of them."

To create the grid, Silverstein and his committee consulted with task force members and other SMI experts.

Evidence of effectiveness was one of the primary selection criteria, says Silverstein, noting that the grid also includes programs that appear promising even though randomized controlled trials have yet to be conducted. Replicability of implementation was another key criterion. The committee also looked for programs that embodied consumer values and desires, such as peer support and wellness-recovery action plans.

The task force plans to update the grid annually.

In the field

Now the task force and others are working to get the word out.

The National Association of State Mental Health Program Directors has circulated the grid among state mental health commissioners and hospital superintendents, for example. The U.S. Department of Veterans Affairs has circulated it. Leaders at the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health have received copies. And individual task force members are talking it up wherever they go. Hunter, for instance, is working with several psychology department chairs to explore ways of incorporating the grid into training programs.

Many of the psychologists listed in the grid are already reporting increased interest in the interventions they have developed or studied.

Susan A. Pickett-Schenk, PhD, an associate professor of psychology in psychiatry at the University of Illinois at Chicago, has noticed a spike in inquiries about a course she has evaluated called "Journey of Hope," which targets families of adults with SMI. So far, she's heard from advocates, family members and even some state-level folks looking for tools to adopt in their states.

Before the grid came out, says Pickett-Schenk, people searching for family-oriented interventions might only find out about Journey of Hope if they already knew enough about it to find it on the Web or elsewhere. The grid not only provides a brief description and contact information for Journey of Hope, she says, but also alerts them to all kinds of other family-education programs.

The grid could also help psychologists themselves, says Pickett-Schenk.

"There are a lot of people doing a lot of good work out there, and it would be nice if we could all find a way to come together," she says. "The training grid offers an opportunity to establish those collaborative relationships."

Michael Sullivan, PhD, assistant executive director for state advocacy in APA's Practice Directorate, says the grid can transform care for those with SMI.

He points to an intervention on page 10 of the grid. The Social Learning Program-developed by Gordon L. Paul, PhD, the Hugh Roy and Lillie Cranz Cullen Distinguished Professor of Psychology at the University of Houston-trains health-care providers to carefully monitor what happens before and after a patient with SMI shows symptomatic behavior. Instead of just medicating away the symptoms, says Sullivan, this intervention pinpoints what is actually triggering and reinforcing such behavior. The results, he says, show that patients who undergo the intervention leave hospitals with better treatment outcomes and prognoses.

"That's just one example," says Sullivan. "That's what's so great about the training grid. It has all kinds of examples of innovative and creative things like this that are rooted in strong psychological research."

Further Reading

To download a free copy of the training grid, go to www.apa.org/practice/grid.html.

Rebecca A. Clay is a writer in Washington, D.C.

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