Measuring Strategies Used by Mental Health Providers to Encourage Medication Adherence

Abstract

Mental health clinicians rely on a range of legal mandates and interpersonal strategies of encouragement and pressure to address nonadherence to treatment. This paper describes the development and testing of a scale to assess formal and informal strategies used by clinicians to encourage adherence to medication. The 16-item measure was administered to 271 clinicians and analyzed using Rasch measurement modeling. Subsequently, items were revised and readministered to a second sample of 44 clinicians in an urban mental health clinic. Rasch analysis of the items yielded a coherent and internally consistent unidimensional measure of strategies used to promote adherence that vary on a continuum of pressure or social control. Criterion-related validity was assessed by observing the association of the measure with clinician ratings of client adherence. The resulting measure may be employed in future studies to examine the ways in which clinician behavior relates to medication adherence and to consumer perceptions of treatment alliance, quality of care, and perceived coercion.

Assertive community treatmentIssues from scientific and clinical literature with implications for practice

“…Surprisingly few studies have assessed medication adherence [18], largely because it is difficult to assess accurately [34]. This lack of research is a concern since some critiques of ACT ascribe the positive outcomes to this factor.…”

Reconceptualizing the Case Management Relationship in Intensive Treatment: A Study of Staff Perceptions and Experiences

“…These negative interactions are in some cases inevitable since clients and clinicians often disagree about treatment goals (Gibbons, Bedard, & Mack, 2005;Rosenheck & Lam, 1997) and because case management involves social control functions in addition to therapeutic and supportive ones (Kanter, 1988;Pescosolido, Wright, & Sullivan, 1995;Thornicroft, 2000). Several studies, for example, show that case managers regulate treatment adherence through the use of social influence or limit-setting strategies (Angell, 2006;Angell, Mahoney, & Martinez, 2006;Neale & Rosenheck, 2000), particularly in situations in which they are enforcing a court mandate for involuntary treatment (Draine & Solomon, 2001;Scheid-Cook, 1993). Unlike psychotherapists, case managers may perceive that the mental health system assigns them full responsibility for the safety and wellbeing of their clients, which translates into pressure to ensure that clients follow treatment recommendations Scheid, 2004).…”

Discharge Practices in a Time-Unlimited Intervention: The Perspectives of Practitioners in Assertive Community Treatment

“…For example, research suggests that ACT has generally not been successful in expanding clients' social relationships beyond ACT (Angell 2003;Angell and Test 2002;Calsyn et al 1998;Carton et al 2010). Other studies have explored the use of various forms of social control (e.g., pressure, persuasion, and coercion) as common strategies in ACT practice (Angell 2006;Angell et al 2006;Fisher and Ahern 2000;Gomory 1999;Neale and Rosenheck 2000). While the intent of such strategies is to enhance treatment adherence, without concomitant efforts to help clients develop self-care skills, such strategies may instead encourage overreliance on the team and hinder the principle of respect for client autonomy.…”