Michelle Salyers
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The ACT Center has been working since 2001 to conduct research and provide training and consultation that supports recovery in adults with severe mental illnesses. Some of the models of care include Assertive Community Treatment (ACT) and Illness Management and Recovery (IMR) programs, which seek to enhance services that support people with mental illness to lead productive lives in their own communities rather than accessing jail, homeless shelters and more costly medical care.
The ACT Center began as a collaboration of the Department of Psychology at Indiana University-Purdue University Indianapolis (IUPUI) and Adult & Child Mental Health Center of Indianapolis. The ACT Center partnership has grown to include a number of other schools on campus, researchers at other universities, and a variety of clinical settings including the Roudebush VA, Four County Counseling Center, and Midtown Mental Health Center. ACT Center collaborators include researchers, clinicians, consultants, educators, consumers, and family members.
The ACT Center has federal funding from a variety of sources, including NIH, PCORI, SAMHSA, and VA. The ACT Center is also an IUPUI designated Signature Center through the School of Science. In addition to research and training, the ACT Center also informs policy makers about methods for funding services that seek to help consumers utilize less costly services and lead productive lives. This translational research exemplifies taking many years of research findings and incorporating models into everyday practice that has a direct impact on people with mental illness and the communities in which they live.
Professor Salyers' work with the ACT Center is yet another way IUPUI faculty are TRANSLATING their RESEARCH INTO PRACTICE.
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Item Do Adolescents Consider Mind-Body Skills Groups an Acceptable Treatment for Depression? Results from a Pilot Study(BMC, 2021) Cunningham, Lindsey D.; Salgado, Eduardo F.; Aalsma, Matthew C.; Garabrant, Jennifer M.; Staples, Julie K.; Gordon, James S.; Salyers, Michelle P.; Psychology, School of ScienceBackground Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents’ perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. Methods Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. Results A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. Conclusions Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group.Item A new look at the attribution model: Considerations for the measurement of public mental illness stigma.(APA, 2021) Johnson-Kwochka, Annalee; Minor, Kyle S.; Ashburn-Nardo, Leslie; Wu, Wei; Stull, Laura G.; Salyers, Michelle P.; Psychology, School of ScienceMultiple versions of the Attribution Model and the corresponding Attribution Questionnaire have been used to assess public mental illness stigma. The objective of the current study was to examine (a) the factor structure of the Attribution Questionnaire and (b) relationships between constructs in the Attribution Model. Analyzing a sample of 334 U.S. adults recruited from Amazon Mechanical Turk, the authors employ confirmatory factor analyses to test three proposed factor structures of the Attribution Questionnaire and latent variable path analyses to reexamine relationships between variables in the stigmatization of people who experience mental illness. Confirmatory factor analyses of three previously examined versions of the Attribution Model revealed that the model proposed by the initial version of the Attribution Questionnaire had the best fit with the data comparative fit index (CFI = 0.92, root-mean-square error of approximation [RMSEA] = 0.07, standardized root-mean-square residual [SRMR] = 0.05). Subsequent path analyses among contructs in the model revealed acceptable model fit (CFI = 0.92, RMSEA = 0.07, SRMR = 0.06) and individual paths largely supported the hypotheses suggested by the Attribution Model. Analyses supported the original version of the Attribution Model and questionnaire with slight modifications, demonstrating that attributions of dangerousness and personal responsibility are associated with the endorsement of coercive treatment, and that attributions about dangerousness are associated with a lower desire to help. These findings suggest modifications in the current measurement of public mental illness stigma.Item Inpatient Mental Healthcare before and during the COVID-19 Pandemic(MDPI, 2021-11) McGuire, Alan B.; Flanagan, Mindy E.; Kukla, Marina; Rollins, Angela L.; Myers, Laura J.; Bass, Emily; Garabrant, Jennifer M.; Salyers, Michelle P.; Psychology, School of SciencePrior studies have demonstrated disruption to outpatient mental health services after the onset of the COVID-19 pandemic. Inpatient mental health services have received less attention. The current study utilized an existing cohort of 33 Veterans Health Affairs (VHA) acute inpatient mental health units to examine disruptions to inpatient services. It further explored the association between patient demographic, clinical, and services variables on relapse rates. Inpatient admissions and therapeutic services (group and individual therapy and peer support) were lower amongst the COVID-19 sample than prior to the onset of COVID-19 while lengths of stay were longer. Relapse rates did not differ between cohorts. Patients with prior emergent services use as well as substance abuse or personality disorder diagnoses were at higher risk for relapse. Receiving group therapy while admitted was associated with lower risk of relapse. Inpatient mental health services saw substantial disruptions across the cohort. Inpatient mental health services, including group therapy, may be an important tool to prevent subsequent relapse.Item Mobile Enhancement of Motivation in Schizophrenia: A Pilot Randomized Controlled Trial of a Personalized Text Message Intervention for Motivation Deficits(APA, 2020-10) Luther, Lauren; Holden, Richard; McCormick, Bryan; Fischer, Melanie W.; Johnson-Kwochka, Annalee V.; Minor, Kyle S.; Lapish, Chris L.; Salyers, Michelle P.; Psychology, School of ScienceObjective: Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. Method: Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. Results: Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. Conclusion: Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS.Item Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment(BMC, 2020-10-08) Johnson-Kwochka, A.; Dir, A.; Salyers, Michelle P.; Aalsma, Matthew C.; Psychology, School of ScienceBackground Substance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model. Methods In this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS). Results Organizationally, staff from community mental health centers reported more “red tape” and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions. Conclusions While both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.Item Psychiatric Rehabilitation Journal in the Era of COVID-19(APA, 2020) Resnick, Sandra G.; Roe, David; Salyers, Michelle P.; Psychology, School of ScienceThe global health crisis caused by the coronavirus pandemic (COVID-19) has brought about previously unimaginable changes to all of health care, including the field of psychiatric rehabilitation. Given these dramatic changes, we pose this editorial to contemplate our mission and how we can best serve the field. We raise questions about how psychiatric rehabilitation will evolve and restate our steadfast commitment to publishing impactful research that shapes the field. We also remain hopeful, knowing psychiatric rehabilitation practitioners, researchers, and participants are pragmatic, persistent, and resilient, and will find opportunities for creativity and innovation even during this difficult time.Item The long and winding road to postsecondary education for U.S. veterans with invisible injuries(American Psychological Association, 2019-06-27) Rattray, Nicholas A.; True, Gala; Natividad, Diana M.; Salyers, Michelle P.; Frankel, Richard M.; Kukla, Marina; Medicine, School of MedicineObjective: Veterans with “invisible injuries” (a mental health diagnosis or a traumatic brain injury) often pursue higher education to enhance employment and community reintegration, but frequently experience challenges to success. This mixed methods study examined how the educational experiences of Veterans with invisible injuries become intertwined with broader transitions between military and civilian life and the resulting implications for rehabilitation services. Method: Thirty-eight veterans with mental illness or a traumatic brain injury who served in a post-9/11 conflict and attended a post-secondary institution within the past 60 months completed in-depth interviews and questionnaires. We used a constant comparative approach to analyze barriers and facilitators to educational functioning and community reintegration. Results. Managing school-specific challenges, coping with mental and physical health problems, forming a new sense of self, and forging new career pathways were major factors influencing education experiences and reintegration. Participants discussed the challenges of balancing these processes while progressing toward an academic degree, which often resulted in a longer, non-linear educational pathway. While some participants attempted to “compartmentalize” educational goals, separate from health and family concerns, these aims were inevitably interlaced. In addition, multiple and longer military deployments tended to lengthen the time to degree completion. Conclusions and Implications for Practice: Many Veterans with invisible injuries face complex challenges stemming from military experiences, the family dynamics to which they return, and reintegration issues that demand novel forms of resilience. Collaboration between university staff and health practitioners may be important in enhancing support for student Veterans coping with invisible disabilities.Item Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis(Springer, 2021) Treichler, Emily B. H.; Rabin, Borsika A.; Spaulding, William D.; Thomas, Michael L.; Salyers, Michelle P.; Granholm, Eric L.; Cohen, Amy N.; Light, Gregory A.; Psychology, School of ScienceBackground Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs.Item Work-Focused Cognitive Behavioral Therapy to Complement Vocational Services for People With Mental Illness: Pilot Study Outcomes Across a 6-Month Posttreatment Follow-Up(APA, 2019) Kukla, Marina; Salyers, Michelle P.; Strasburger, Amy M.; Johnson-Kwochka, Annalee; Amador, Emily; Lysaker, Paul H.; Psychiatry, School of MedicineObjective: People with mental illness frequently have trouble obtaining and keeping competitive employment and struggle with on-the-job performance. To address these issues, the manualized, group-based, 12-session Cognitive Behavioral Therapy for Work Success (CBTw) intervention was developed and tested in an open trial. Although posttreatment work outcomes were promising, lasting effects associated with the intervention are unknown. Method: This article presents the 6-month posttreatment work outcomes of the open trial of CBTw in 52 adults with mental illness who were concurrently receiving VA vocational services. Work outcomes included work status, hours worked and wages earned, steady work status, and work performance and effectiveness. Data were analyzed using repeated measures analysis of variances (ANOVAs) and within groups t tests. Results: Findings demonstrate that 75% of unemployed participants at baseline obtained competitive work during the study period. During the 6-month follow-up period, 73% of workers attained steady work status (i.e., working at least 50% of the follow-up period). In addition, during the 6-month follow-up period, working participants averaged significantly more hours of work per week and higher wages earned per hour as compared with the baseline period and the 12-week postintervention period. Finally, among workers, reports of work effectiveness remained high at 6 months and work productivity disruptions remained low at follow-up. Conclusions and Implications for Practice: These findings suggest that CBTw may potentially be a useful tool to enhance the effects of vocational programs. Future work should test CBTw in a randomized controlled trial and examine strategies for implementation in real-world vocational service settings.Item The link between formal thought disorder and social functioning in schizophrenia: A meta-analysis(Cambridge University Press, 2020-03-23) Marggraf, Matthew P.; Lysaker, Paul H.; Salyers, Michelle P.; Minor, Kyle S.; Psychology, School of ScienceBackground. Formal thought disorder (FTD) and social functioning impairments are core symptoms of schizophrenia. Although both have been observed for over a century, the strength of the relationship between FTD and social functioning remains unclear. Furthermore, a variety of methodological approaches have been used to assess these constructs—which may contribute to inconsistency in reported associations. This meta-analysis aimed to: (a) systematically test the relationship between FTD and social functioning and (b) determine if the methodology used to assess FTD and/or social functioning moderates this relationship. Methods. Following Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a targeted literature search was conducted on studies examining the relationship between FTD and social functioning. Correlations were extracted and used to calculate weighted mean effect sizes using a random effects model. Results. A total of 1,478 participants across 13 unique studies were included in this meta-analysis. A small-medium inverse association (r = −0.23, p < 0.001) was observed between FTD and social functioning. Although heterogeneity analyses produced a significant Q-statistic (Q = 52.77, p = <0.001), the relationship between FTD and social functioning was not moderated by methodology, study quality, demographic variables, or clinical factors. Conclusions. Findings illustrate a negative association between FTD and social functioning. Despite differences in the methodological approach used and type of information assessed, measurement type and clinical factors did not moderate the relationship between FTD and social functioning. Future studies should explore whether other variables, such as cognitive processes (e.g., social cognition), may account for variability in associations between these constructs.