Psychosocial Rehabilitation Centers Research Articles

Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers.

The aim of the present study was to explore the characteristics of psychotropic treatment and of psychosocial functioning associated with self-reported medication adherence in persons with psychosis engaged in rehabilitation. The study was performed in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. Treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). The associations between MARS score (categorized as "low" < 7 vs. "high" ≥ 7) and functioning or psychotropic treatment characteristics were explored using multivariate analyses in 326 participants with schizophrenia spectrum disorders. Regarding psychotropic treatment, high anticholinergic load was the only characteristic associated with poor medication adherence (adjusted OR, aOR 1.98, 95% CI 1.07-3.66). Regarding functioning measures, participants with poor medication adherence were more likely to present with lower stage of recovery (aOR 2.38, 95% CI 1.31-4.32), poor quality of life (aOR 2.17, 95% CI 1.27-3.71), mental well-being (aOR 1.68, 95% CI 1.03-2.72) and self-esteem (aOR 1.74, 95% CI 1.05-2.87), and higher internalized stigma (aOR 1.88, 95% CI 1.09-3.23). Self-reported poor medication adherence is a marker of poor functioning in persons with psychosis. The MARS is a quick and simple measure of adherence that may be helpful in clinical and rehabilitation settings to identify persons with specific rehabilitation needs.

Psychometric examination of care quality measures in VA psychosocial rehabilitation and recovery centers (PRRCs).

The Veterans Health Administration (VHA) developed Psychosocial Rehabilitation and Recovery Centers (PRRCs) to enhance recovery-oriented mental health services to large populations of veterans diagnosed with serious mental illness (e.g., psychotic disorders, bipolar disorder) and significant functional challenges. Psychosocial Rehabilitation and Recovery Centers were designed to support a rehabilitation framework to help veterans obtain needed skills and support to integrate into meaningful, self-determined community roles. This study used data collected as part of VHA's development and implementation of a national system to monitor PRRC performance with the purpose of evaluating the psychometric properties and latent structure of outcome measures used in PRRCs. Baseline self-report data from 5,086 veterans and their assigned PRRC staff providers were collected and reviewed. Exploratory factor analyses were used to evaluate the psychometric properties of the Veteran-Rated Psychiatric Symptom Items (VR-PSI), the Clinician-Rated Psychiatric Symptom Items (CR-PSI), and the Internalized Stigma of Mental Illness 10-item scale (ISMI-10). Four latent factors were identified for the VR-PSI and CR-PSI for the total sample, while the ISMI-10 was reduced to 8-items to assess self-stigma as a unitary measure. All measures demonstrated good psychometric properties. This study provides initial support for the latent factor structures and psychometric properties of measures used to assess national VHA PRRC performance. Implications and limitations are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers.

Few studies have explored whether high-anticholinergic load may hamper rehabilitation in persons with schizophrenia. We aim to explore the associations between anticholinergic load of psychotropic treatment and functioning or cognitive performances of persons with psychosis engaged in psychosocial rehabilitation. The study was performed using data collected at baseline assessment in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. The composite-rating scale developed by Salahudeen et al. was used to rate the anticholinergic load of psychotropic drugs prescribed at baseline assessment. The associations between total anticholinergic load score (categorized as 'low' <3 v. 'high' ⩾3) and functioning or cognitive characteristics were explored using multivariate analyses. Of the 1012 participants with schizophrenia spectrum disorders identified in the REHABase, half used at least two psychotropic drugs with anticholinergic activity and one out of three was prescribed at least one psychotropic drug with high-anticholinergic activity. High-anticholinergic load was significantly associated with lower stage of recovery [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.05-2.76, p = 0.03], poor mental well-being (OR = 1.55, 95% CI 1.02-2.33, p = 0.04) and poor self-rated medication adherence (OR = 2.14, 95% CI 1.29-3.53, p = 0.003). Regarding cognition, a high-anticholinergic score was associated with poorer delayed-episodic memory (OR = 1.69, 95% CI 1.01-2.85, p = 0.05) and at the trend level with faster completion time on the test exploring executive performance (OR = 0.67, 95% CI 0.43-1.04, p = 0.07). The psychosocial rehabilitation plan of persons with psychosis should integrate optimization of psychotropic treatment in order to lessen the functional and cognitive impact of high-anticholinergic load.

Psychosocial rehabilitation of people living with mental illness: Lessons learned from community-based psychiatric rehabilitation centres in Gujarat.

Introduction:Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life. However, such psychosocial rehabilitation centers are limited in India.Aims:The present study assesses psychosocial rehabilitation centers (of urban day-care and rural residential rehabilitation center) operated by Ashadeep Charitable Foundation, a civil service organization and its effect on health outcomes of patients living with chronic mental illness.Materials and Methods:Records of 170 cases were retrieved for secondary analysis of demographic information, diagnosis, duration of stay, and health outcomes.Results:Rehabilitation activities included yoga, light physical exercises, group discussion, training for daily living skills, social skills, life skills, vocational training, individual, and family counseling. In addition, extensive outreach activities, mental health camps were also integral part of the rehabilitation activities. Patients who have accessed rehabilitation services were diagnosed with schizophrenia, psychosis, bipolar disorder, depression, and intellectual disability. The average duration of rehabilitation of patients (other than persons with intellectual disability) was ranged from three to four months. Out of those rehabilitated, 69% of them were successfully re-integrated with the family.Conclusion:Combination of pharmacological and psychosocial interventions are effective for re-integrate patients with mental illness to the family. This model of community-based rehabilitation has potential for scale-up.

Job Burnout Among Mental Health Staff at a Veterans Affairs Psychosocial Rehabilitation Center.

Mental health providers who serve clients with severe mental illness may be particularly prone to job burnout given the nature of the work. This study examined levels of job burnout among mental health providers who serve clients with severe mental illness. Forty-two mental health staff at a Veterans Affairs psychosocial rehabilitation center completed an online survey that assessed burnout and work-life balance. Maslach Burnout Inventory (MBI) scores were compared to published scores of workers in other professions. Participants reported moderate MBI Emotional Exhaustion, Depersonalization, and Personal Accomplishment scores and overall had lower burnout scores than other healthcare providers and service workers. Being younger and white were associated with higher MBI Emotional Exhaustion scores. These findings suggest job burnout among mental health staff is a concern that should be closely monitored even among staff who express a sense of personal accomplishment from the work.

Functioning and cognitive characteristics of clozapine users referred to psychosocial rehabilitation centers: A REHABase cohort study

ObjectivesTo explore whether clozapine users have specific rehabilitation needs compared to users of other antipsychotics. MethodsThe study was performed using the REHABase collecting data on persons referred to a French network of psychosocial rehabilitation centers. It was restricted to persons with schizophrenia spectrum disorder using antipsychotics. Multivariate analyses were used to compare baseline functioning and cognitive characteristics in clozapine users vs. users of other antipsychotics. ResultsOf the 675 patients identified in the REHABase, one out of ten (n = 70) used clozapine. Compared to users of other antipsychotics, clozapine users had been more frequently hospitalized in psychiatry and presented less frequently with psychoactive substance use. Functional measures did not significantly differ between the two groups. Clozapine users had poorer short-term verbal memory performance than users of other antipsychotics and did not differ on executive performance. ConclusionClozapine users may reach a recovery level comparable to that obtained in persons without treatment-resistant schizophrenia. In order to reduce the negative impact of memory deficits on the recovery process of clozapine users, it is necessary to optimize their psychotropic treatment and to promote their access to cognitive remediation programs addressing their specific needs.

Impact sur la prescription de psychotropes des conseils thérapeutiques formalisés dans un centre référent de réhabilitation psychosociale

IntroductionThe improvement of prescription constitutes a major challenge for public health. In France, medication is the third cause of serious adverse reaction. The report of the Parliamentary Commission for Evaluation of Health Policy on adequate use of psychotropics mentions their overconsumption. Promoting practices’ dissemination and guidelines’ respect is one of the missions of the referral psychosocial rehabilitation centers. Therapeutic advice that is offered consists of suggestions for revision in the patient's treatment with the aim of improving the patient's health. To our knowledge, to date no study has focused on the evaluation of therapeutic advice in psychiatry. The present study aimed at analyzing benefits of therapeutic advice for the patients. To this end: (1) a state of things related to actual practices was carried out: psychotropics prescriptions’ problems and therapeutic advice proposed by psychiatrists (quantitative and qualitative assessment); (2) the impact of advice on prescription was assessed; (3) patients’ benefits were identified. MethodThis monocentric trial was carried out at the referral psychosocial rehabilitation center of Lyon. This audit was a retrospective observation of electronic medical records (software CortexteNet V2.6). This project was developed by a multidisciplinary staff (pharmacists and psychiatrists) during summer 2015. All patients treated in this center between September 2010 and December 2014 were included. The collection of data was made by two auditors (pharmacist students) thanks to a collection grid with six parts: identification and epidemiology of patients with therapeutic advice, coding tips, benefits, quantitative and qualitative assessment of prescriptions before and after advice. ResultsOf the 601 records explored during this study, 66 advices (8.3% of patients) were identified. Patients concerned by therapeutic advice were mainly men with schizophrenia between 35 and 40 years, living in a town and addressed by public psychiatrists. Advice was taken into account in 81.7%, partially in 8.1%, and was beneficial in 97%. The main benefits were clinical improvement (48.5%) and reduction of adverse drug events (36.4%). There were no statistically significant differences between prescriptions (quantitatively and qualitatively) before and after therapeutic advice. ConclusionIn most cases, prescriptions of psychotropics were adequate since only 66 advices (8.3% of patients) were given. Psychosocial rehabilitation centers give medication prescribing advice and promote respect of the guidelines. The collaboration between rehabilitation's psychiatrists and other psychiatrists optimizes patient management. It reduces iatrogenic disorders and improves quality and safety of care. Very few studies deal with the prescription of psychotropics in adult psychiatry. This work highlights the positive effect of therapeutic advice for this population. Further controlled studies should clarify the benefits of therapeutic advice.

COMBINED USE OF ANIMAL-ASSISTED THERAPY AND PSYCHOTHERAPY IN THE REHABILITATION OF COMBATANTS

The work is devoted to solving the problems of definition, etiology and pathogenesis of primary diagnostics of posttraumatic stress disorder in combatants of the antiterrorist operation, who had rehabilitation in sanatorium and resort conditions. As a result of the study, the positive impact of hyppotherapy on the psychological state of combatants in the antiterrorist operation was shown, which was applied on the basis of the Psychosocial Rehabilitation Center Feldman Ecopark in sanatorium and resort conditions with medical and psychological rehabilitation. The main groups (clusters) of neurotic, pathopersonological and psychopathological manifestations in this contingent of patients are identified. The study also showed that the testees experienced childhood sexual abuse (or forcing entry into sexual relations with someone from the immediate environment of the child) correlated with higher levels of both depressive and anxiety symptoms later in adulthood. Premorbid personality characteristics of patients with posttraumatic stress disorder are heterogeneous. Although people in natural conditions that provoke anxiety are especially likely to develop post-traumatic stress disorder, these disorders often arise in obsessive, dependent and even schizoid personality type. However, it would be logical to expect that those individuals accessed via the questionnaire with higher level of neuroticism (or «big anxiety») are more likely to develop symptoms of posttraumatic stress disorder than those of phlegmatic temperament.

Experiences of the family living with severe mental illness: a qualitative study in Navarre

It is estimated that 1% of the general population suffers from severe mental illness (SMI). In most cases, families are the ones providing support and direct care to the ill relative, which in turn results in the family being the unit that lives with the mental illness. In Spain, two key aspects have been barely explored: the relationship between the family and the mental health system; and the knowledge of families and the possible transfer of such knowledge to other families. The aim of this paper is to contribute to exploring these two aspects. A qualitative study with a narrative approach was implemented in the Foral Community of Navarre (Spain). The study consisted of in-depth interviews with families living with SMI. Two interviews were conducted with each family (which included the individual diagnosed with a mental illness). A multimodal analysis (structural, thematic and dialogical) was conduc-ted with each family. Comparative analyses between families were also performed. A total of 6 families were interviewed with a total of 18 participants. Findings were grouped around two central catego-ries: requirements of families and family to family. The first category includes improving relationships with mental health provi-ders, medications, psychosocial rehabilitation centers and supporting families. The second category includes recommendations from the perspective of the relative with a SMI and those without it. Families would like to receive a higher degree of support from mental-health providers. At the same time, families should be considered as important sources of knowledge and support for the treatment of other families living with SMI.

Analysis of the elapsed time since a patients’ disease is diagnosed till they come to a rehabilitation center

IntroductionThe elapsed time since a patients’ disease is diagnosed till these patients come to rehabilitation centers is usually long. In this study in our sanitary area, we have checked the average length of time since the patient is diagnosed till they come to the rehabilitation center.ObjectivesTo calculate and analyze the years of evolution of the disease in patients who come to the rehabilitation center in the Talavera area during year 2014. Classify them by sex.MethodsRetrospective cross-sectional descriptive study. We carried out a register of all the patients who come to the Psychosocial and labor Rehabilitation center in 2014. Classified them by sex, and the time lapsed since they were diagnosed until 2014.ResultsFrom all 135 patients: 92 men (68.15%) and 43 women (31.85%). Less than 2 years of evolution: 1 patient (1%) 1 men, 0 women; between 2 and 5 years of evolution: 7 patients (5%) 5 men, 2 women; between 6 and 10 years evolution: 13 patients (10%) 7 men, 6 women; more than 10 years: 114 patients (84%).ConclusionsIt is evident that the number of patients increases proportionally to the number of years since the diagnosis. The majority of patients who come to the center (84%) were diagnosed more than 10 years ago. This leads us to wonder why the patients in our sanitary area with recent diagnosis of diseases such as schizophrenia do not come to the mentioned centers earlier.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation.

Recovery narrative photovoice: Feasibility of a writing and photography intervention for serious mental illnesses.

The primary purpose of this article is to describe the development and feasibility of the Recovery Narrative Photovoice intervention. The nature of this intervention will be discussed, including facilitating empowerment and a positive sense of identity among people with serious mental illnesses. We will also describe the integration of Photovoice methodology with psychoeducational components, informed by principles of the recovery movement and narrative therapy. Sixteen participants with serious mental illnesses from a psychosocial rehabilitation and education center in the Northeast participated in a pilot study evaluating this new 10-week intervention with a pre-post test design. To assess feasibility, descriptive statistical analyses were conducted of attendance data and number of works produced. The pilot study was implemented in 2 consecutive waves with 8 participants each. High rates of attendance (69%) and production of photovoice works (82%) were demonstrated over the course of the 2 waves of the pilot. Findings support the feasibility and acceptability of the Recovery Narrative Photovoice for individuals with serious mental illnesses. These results reflect the potential for using this intervention in psychiatric rehabilitation settings to facilitate recovery-related outcomes, including empowerment, positive identity, and community integration. Future research will require a replication of pre-post assessment of this intervention to further establish the efficacy of this program.

Art appreciation for veterans with severe mental illness in a VA Psychosocial Rehabilitation and Recovery Center

Considerable research has shown the positive effects of art, music and drama therapy on mental health and well-being. In September 2012, a weekly Art Appreciation class was initiated at the Veterans Affairs (VA) West Los Angeles (WLA) Psychosocial Rehabilitation and Recovery Center (PRRC) for veterans with severe mental illness. There are 106 VA PRRCs throughout the USA, designed to be transitional learning centers with curriculum-based interventions to help veterans re-integrate into the community and develop meaningful activities independent of the hospital setting. The VA WLA PRRC Art Appreciation class includes classroom sessions and community outings to local museums and other institutions holding art works of interest. It is taught at a college level and designed to lack the stigma of being a therapy group. Preliminary evidence from self-report measures indicates positive effects on mood, self-esteem, socialization and community participation among the veteran participants and recognition among staff that the course aids the veterans' recovery process. Appreciating art thus appears to promote both subjective and objective improvement in recovery and community re-integration for veterans who are experiencing chronic and disabling emotional distress.

Accessebility to Psychiatric Services in Georgia

Background: Heavy socio-economic condition and military conflicts negatively affected mental health condition of the population in recent years in Georgia. Eventually, prevalence of mental disorders has increased. Despite the fact that allocation of funds for state program on mental health has been annually increasing, it is still quite low and amounts only 2,11% of the total expenses on health care (2012). Scarcity of resources is also preconditioned by low development of relatively cost-effective, out-of-hospital, community-based mental health services in the country. The purpose of survey is to study accessibility to mental health services in Georgia, to identify gaps existing in mental health state program. Methodology: Within the qualitative study the in-depth interviews were conducted among the managers of medical institutions and medical personnel. Face-to-face interviews using specially designed questionnaire were conducted among mental health state program beneficiaries as part of the quantitative research. Findings and discussion: under-funding of the mental health programs negatively affects patients' health. A large number of patients, who do not require inpatient psychiatric care, remain in psychiatric institutions due to lack of development of out-patient, community based mental health services; while many of those discharged from hospitals often return there because of re-hospitalization needs. The problem is further aggravated by the lack of professional personnel, unequal distribution of services throughout the country's territory, fewer outpatient psychiatric services development, and difficulties in ensuring the proper material-technical capacity, equipment and finances. Conclusion: For the development of mental health sphere it is necessary to elaborate effective funding mechanism, which will be tailored to the needs of patients; to enhance knowledge and skills of specialists in the field and their appropriate level of compensation; to facilitate the development of psychosocial rehabilitation centers, shelters and other services in the country; to expand the state programs over a non-psychiatric diagnosis and treatment; to change the public attitude towards the patients and to reduce stigma.

Validación de la versión española del inventario de asertividad Gambrill y Richey en población con diagnóstico de esquizofrenia.

Objective: To validate the Spanish version of the questionnaire Gambrill and Richey Assertiveness for people with schizophrenia. Method: he sample comprised a total of 125 people with schizophrenia on treatment in one of the psychosocial rehabilitation centers participating in the study. The instruments used to assess convergent and discriminant validity are the Communication Skills Questionnaire(CSQ); the Social Functioning Scale(SFS); the Life Skills Profile(LSP); the Clinical Global Impression Scale(CGI) and the Global Functioning Scale (GAF). Results: Internal consistency of the instrument shows a Cronbach alpha of .935 in the full scale . The intraclass correlation coefficients to assess the instrument's internal consistency ranged between .21 and .78. The instrument shows a convergent validity with CSQ scale and the subscales of communication and social isolation (p &lt; .001-.05). With the rest of social functioning subscales shows divergent validity. With the CGI shows divergent validity with the probability of response, and convergent validity between the subscales of CGI and the degree of distress subscale of the instrument (p &lt; .012-.042). Conclusions: The instrument shows good psychometric characteristics and appears useful for assessing social skills in a sample of people with schizophrenia.

Internet Use Among Veterans With Severe Mental Illness

Internet Use Among Veterans With Severe Mental Illness

A qualitative study exploring facilitators for improved health behaviors and health behavior programs: mental health service users' perspectives.

Objective. Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1) facilitators that help mental health service users engage in better health behaviors and (2) the types of health programs mental health service users want to develop. Methods. A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. Results. Four major facilitator themes were identified: (1) factors of empowerment, self-value, and personal growth; (2) the need for social support; (3) pragmatic aspects of motivation and planning; and (4) access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. Conclusions and Implications for Practice. Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

REABILITACIJOS PROCESE DALYVAUJANČIŲ NUO NARKOTIKŲ PRIKLAUSOMŲ ŽMONIŲ ASMENYBĖS IR PSICHOLOGINĖS GEROVĖS

The main objective of this study was to research the personality traits of substance abusers in rehabilitation centers and correctional facilities, and their possible connections with well-being. To obtain this objective, four goals were set: 1. to evaluate personality traits of substance abusers and to compare it with Lithuania’s representative sample; 2. to evaluate the well-being of substance abusers and to compare it with Lithuania’s representative sample; 3. to evaluate possible connections between personality traits and well-being of substance abusers; 4. to presume future guidelines for studies in this particular field. Two instruments have been used – Minnesota Multiphasic Personality Inventory - 2TM (MMPI-2) and Lithuanian scale of well-being. There were 75 substance abusers, involved in this study, of which 28 were from correctional facilities and 47 from psychosocial rehabilitation centers. The results revealed such tendencies: 1. Personality traits of substance abusers and those of Lithuania’s representative sample differed in most of MMPI-2 scales (especially psychopathy). Personality traits of sentenced men were less likely to differ from norms than those of who were not sentenced. 2. Substance abusers were less satisfied in general and in most areas of life, comparing to Lithuania’s representative sample. However substance abusers were slightly more satisfied with their physical health than people in representative sample. 3. While comparing personality traits and well-being, strongest connections have been found with: psychopathy, paranoia, psychasthenia, depression, poor self-esteem and familial problems, negative emotionality, low satisfaction with interpersonal relations, low satisfaction with physical health and general well-being. 4. Larger samples of substance abusers should be researched in future studies, also other important aspects – such as methods of treatment – should also be taken into account.

Helping veterans with mental illness overcome civil legal issues: Collaboration between a veterans affairs psychosocial rehabilitation center and a nonprofit legal center.

This article describes the collaboration between a Department of Veterans Affairs (VA) community-based psychosocial rehabilitation center and a nonprofit legal center that primarily addresses the civil legal issues of veterans who have mental illness and/or are homeless. The legal center is located on-site at the VA psychosocial rehabilitation center and serves veterans who receive VA mental health treatment and other social services. Once veterans establish contact with the legal center and authorize the release of their health information, legal center staff members work closely with VA clinicians to help veterans address legal issues that may be obstacles to recovery. Development of this collaboration is described, along with the legal center's funding, clientele, and operations. The most common types of civil legal matters the legal center handles are also briefly described. Experiences of the legal center suggest that professional aid for civil legal problems provided within VA facilities may be beneficial for veterans and warrants empirical study.

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

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. An online survey was sent to local recovery coordinators, who, in turn, identified other local IMR experts. 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. 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.