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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Recent Submissions
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 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, M. 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 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.Item Mediational paths from supervisor support to turnover intention and actual turnover among community mental health providers(APA, 2019) Fukui, Sadaaki; Wu, Wei; Salyers, Michelle P.; School of Social WorkObjective: Turnover is a critical problem for community mental health providers, and supervisors may play an important role in mitigating turnover. The current study examined the potential impact of supervisory support on turnover intention and actual turnover among community mental health providers. Method: We conducted path analyses with data collected longitudinally from 186 direct clinical care providers at two community mental health centers. Results: Increased supervisory support was associated with lower turnover intention 6 months later, as well as reduced actual turnover 12 months later. Type of supervisory support mattered: supervisors’ emotional support was most strongly associated with reduced turnover intention and turnover. However, client goal alignment support (supporting providers to help consumers achieve their goals) was directly associated with increased turnover. Conclusions and Implications for Practice: The current study suggests an important role for direct supervisors to attend to care providers’ emotional support needs, which may reduce turnover intention and actual turnover. Differential supervisory support functions might impact turnover in unique ways; thus, examining more detailed change mechanisms would facilitate our understanding of factors that may prevent future turnover.Item Characteristics and Job Stressors Associated With Turnover and Turnover Intention Among Community Mental Health Providers(APA, 2020-03) Fukui, Sadaaki; Rollins, Angela L.; Salyers, Michelle P.; School of Social WorkObjective: This study aimed to examine the provider characteristics and job stressors that are related to turnover intention and actual turnover among community mental health providers. Methods: Secondary analyses were conducted with data collected from 186 community mental health providers from two agencies. Self-reported provider characteristics, job stressors, and turnover intention data were collected with the baseline survey, and actual turnover data were obtained from the agencies 12 months later. Bivariate analyses were conducted to examine factors associated with each turnover variable. Results: Turnover intention and actual turnover were correlated, yet a distinct set of variables was associated with each outcome. Namely, job stressors were related to turnover intention, while provider characteristics were related to actual turnover. Conclusions: Given that both turnover intention and actual turnover have important implications for both providers and agencies, it is critical to consider differential factors associated with each.Item Mind-Body Skills Groups for Adolescents with Depression in Primary Care: A Pilot Study(Journal of Pediatric Health Care, 2020) Aalsma, Matthew C.; Jones, Lindsey D.; Staples, Julie K.; Garabrant, Jennifer M.; Gordon, James S.; Richtsmeier Cyr, Lynda; Salgado, Eduardo F.; Salyers, Michelle P.Objective: To determine acceptability and preliminary effectiveness of Mind-Body Skills Groups (MBSGs) as a treatment for depressed adolescents in primary care. Methods: A single arm clinical trial was conducted. A 10-week MBSG program was implemented in primary care. Participants completed self-report measures at baseline, post-intervention, and 3-months following the MBSGs. Measures included the Children’s Depression Inventory-2, Suicidal Ideation Questionnaire, Mindful Attention Awareness Scale, Self-Efficacy for Depressed Adolescents, rumination subscale of the Children’s Response Style Questionnaire, and a short acceptability questionnaire. Results: Participants included 43 adolescents. The total depression scores significantly improved following the MBSG intervention and continued to improve significantly from post-treatment to follow-up. Mindfulness, self-efficacy, rumination, and suicidal ideation all had significant improvement following the intervention. Acceptability of the program was strong, and attendance was excellent. Discussion: Preliminary evidence suggests that MBSGs are an acceptable treatment for primary care settings and lead to improved depression symptoms in adolescents.Item Metacognition, Personal Distress, and Performance-Based Empathy in Schizophrenia(Oxford University Press, 2018-10-03) Bonfils, Kelsey A.; Lysaker, Paul H.; Minor, Kyle S.; Salyers, Michelle P.; Psychiatry, School of MedicineBackground People with schizophrenia experience significant deficits in the kinds of empathic skills that are the foundation for interpersonal relationships. Researchers have speculated that deficits in empathic skills in schizophrenia may be related to disturbances in metacognition and heightened levels of personal distress. To explore this issue, this study examined whether better metacognition and reduced personal distress would be associated with improved performance on cognitive and affective empathy tasks. Further, we tested whether metacognition moderated the relationship between personal distress and empathy. Method Fifty-eight participants with schizophrenia-spectrum disorders receiving community-based treatment completed a self-report questionnaire of personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognitive capacity. Results Correlation analyses revealed that metacognitive capacity, but not personal distress, was significantly associated with cognitive and affective empathy performance. Moderation results suggest the relationship between personal distress and affective empathy performance was significant for those with low metacognition, but that the relationship was the opposite of hypotheses–increased personal distress predicted better performance. This relationship changed at higher levels of metacognition, when increased personal distress became associated with reduced performance. Conclusions This study is the first of its kind to examine performance-based empathy with metacognition and personal distress. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills.