Buiding Social Support for Individuals with SPMI: Results from the Community Awareness through Psychoeducation Intervention
Seth A. Kurzban, MSW, Columbia University, Ellen P. Lukens, PhD, Columbia University, and Helle Thorning, PhD, New York State Psychiatric Institute.
There is evidence linking social support and subjective quality of life for those with severe and persistent mental illness (SPMI) (Lam, 1991, Lehman, Slaughter, and Myers, 1991; Sullivan, Wells, and Leake, 1991), and quality of life is in turn an indicator of treatment adherence and rehabilitation (Sullivan, Wells, and Leake, 1991; Oliver, et al., 1996). Having social supports has also been found to predict that individuals with SPMI experience fewer psychiatric symptoms (Rogers, Anthony, & Lyass, 2004; Calsyn and Morse 1992). Given the recursive cycles of relapse these individuals experience, social workers have struggled to increase positive social support and community integration, thus reducing social isolation and increasing community tenure. Family group psychoeducation has been found to reduce relapse rates and increased functioning for persons with SPMI (Leff, 1989; Leff, et al., 1990; McFarlane, et al., 1995a; McFarlane, et al., 1995b; Zhang and Yao, 1993; Zhang, et al., 1998). Through this process, family members and consumers increase their understanding of risk and protective factors,promote their own and others' recovery, and address the barriers caused by the illness. Community Awareness through Psychoeducation (CAPE), is a psychoeducational group intervention that build on the family psychoeducation model but targets the consumers, particularly regarding issues related to loneliness, functioning in everyday activities, and perception and awareness of skills related to functioning and coping. The intervention was piloted at two community sites in New York City. The CAPE groups include 12 weekly 1.5-hour sessions. The sessions cover a proscribed psychoeducational curriculum, with an emphasis on stress and coping, hope and resilience, and building self and community awareness as well as individual and community supports. We tested a pscyhoeducational curriculum that we enhanced through focus groups, discussions, and open sessions with consumers at an assertive community treatment team (ACT). Using an experimental design, we assigned 40 participants to either a CAPE group or a waitlist control. We used a mixed method approach to collect demographic data and measures of loneliness, recovery, community living, and perceived social support, along with detailed ethnographic field notes, process recordings, and post intervention focus groups. Findings show that the intervention temporarily improved participants' treatment outcomes at post-test, as measured by a reduction in social isolation, an increased ability to adhere to treatment plans and to meet treatment goals, and a reduction in substance use. Formative evaluation data indicated that consumer participants were increasingly able to support, network, and communicate with one another over time as they attended the psychoeducational group sessions.