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The Role of Consumer-operated Services in Adherence and Empowerment

Investigators: Patrick Corrigan, Psy.D., and Jonathan Larson, Ed.D.

Consumer-operated services impact service participation and empowerment from a different perspective.  The goal here is not to directly use strategies meant to enhance empowerment to lead to greater and enhanced service participation leading to improved outcomes; e.g., motivational interviews (Davidson SRP) yields greater and more competent participation in medicine regimen resulting in diminished outcomes related to psychiatric outcomes.  Participation in consumer-operated services (the empowerment approach) is believed to be valuable in its own right.  Hence, one important hypothesis is whether initial participation in consumer-operated services leads to continued participation in its own right and concomitant enhancement of personal empowerment.  Secondarily, we hypothesize that participation in consumer-operated services leads to more frequent and better participation in medication and psychiatric rehabilitation services.  Finally, preference for treatment versus control can influence research participation (Corrigan & Salzer, 2003).  A final aim of this project is to examine the impact of treatment preference on research findings.

Consumer-operated services (COSs) are programs developed by people with serious mental illness for people with serous mental illness (Davidson et al., 1999).  Key principles focus on peers and helpers (Clay, Schell, Corrigan, & Ralph, 2005).  According to the peer principle, there is no hierarchy between program service administrators, providers, and consumers.  As peers, all forms of engagement and interaction are encouraged and promoted. Individuals in helper roles share with strategies and resources that they have found helpful in addressing life goals blocked by the mental illness.  Sharing experiences enhance self-efficacy and self-esteem.  Perhaps primary to COSs is choice;  i.e., in support of self-determination, people can and should choose how to enroll and engage with a COS.


Eighty people with psychiatric disabilities will be recruited for this program from NAMI-DuPage County and randomized to treatment-as-usual or TAU plus Peer-to-Peer.  Considerations about dropouts are addressed as laid out earlier in this Core.  Psychiatric disability is defined here as the inability to meet work or independent living goals in the past year because of mental illness.  Inability to attain these goals may reflect determinations of the social security administration. Mental illness is defined as DSM-IV Axis I diagnoses in the schizophrenia, anxiety, or affective disorder spectrum.  Given its prominence, people with dual disorders will be included.

The well-documented Peer-to-Peer course consists of one 2-hour session per week for 9 weeks conducted. Each class contains a combination of lecture and interactive exercise material and closes with Mindfulness Practice (techniques offered to develop and expand awareness). Each class builds on the one before: attendance each week is highly recommended. A team of three trained mentors with mental illnesses, teach the 18-hour course in specific areas.  Through a train-the-trainer model, mentors are trained in a 2-day session, supplied with teaching manuals, paid a stipend for attending the training, paid stipends for training the course, and required to earn an 80% score on the train-the-trainer fidelity. Trainers receive: binders of handouts; advance directive tools; relapse prevention worksheets; feelings, thoughts, and behavior check sheets; mindfulness exercises; and survival skill tools.  After completion of the 9-week course, we plan to incorporate six bimonthly booster Peer-to-Peer sessions (3 months) to provide ongoing mutual support and problem-solving skill implementation. Our data collection process ends after the final bi-monthly ongoing support session (6 months total). Analyses will conducted on group comparisons to show impact on outcome measures related to empowerment, adherence, and self-determination.