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Implementation of illness management and recovery in the Veterans Administration: an on-line survey.

McGuire AB, White DA, White LM, Salyers MP. Implementation of illness management and recovery in the Veterans Administration: an on-line survey. Psychiatric Rehabilitation Journal. 2013 Dec 1; 36(4):264-71.

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OBJECTIVE: This study explores the implementation of illness management and recovery (IMR) across Veterans Affairs Medical Centers (VAMCs). The implementation of illness management programming has been mandated in certain programs within VAMCs. IMR is consistent with the Department of Veteran Affairs (VA) emphasis on recovery-oriented, evidence-based treatments. This study examines both the penetration of IMR within the VA system and the barriers and facilitators to implementation. METHODS: An online survey was sent to local recovery coordinators, who, in turn, identified other local IMR experts. RESULTS: Respondents from 107 clinics (representing 101 VAMCs) answered the survey. Less than half of VAMCs provide IMR services. Psychosocial Rehabilitation and Recovery Centers (PRRC), which specialize in services for Veterans with psychiatric disabilities, are more likely to provide IMR; however, more than one third do not. Few respondents had access to IMR implementation tools such as training, consultation, or fidelity monitoring. Only about one fifth of IMR providers have been trained in IMR. Respondents reported several facilitators to implementation, such as knowledgeable staff members and peer support. Common barriers to implementation included limited staff availability and "intimidating" workbook materials. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The VA is well underway in its implementation of IMR; however, there is room for expansion. Implementation tools such as training and consultation are needed to ensure dissemination and quality within VA. Given the comparative resources and infrastructure of VA, it is likely that equal or greater implementation tools are necessary in other systems of care.

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