Evidence based treatment for first episode psychosis
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Evidence-Based Treatment for First Episode Psychosis. Robert K. Heinssen, Ph.D., ABPP Amy B. Goldstein, Ph.D Susan T. Azrin, Ph.D. July 28, 2014. Disclosures. I have no personal financial relationships with commercial interests relevant to this presentation

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Evidence-Based Treatment for First Episode Psychosis

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Evidence based treatment for first episode psychosis

Evidence-Based Treatment for First Episode Psychosis

Robert K. Heinssen, Ph.D., ABPP

Amy B. Goldstein, Ph.D

Susan T. Azrin, Ph.D.

July 28, 2014


Disclosures

Disclosures

  • I have no personal financial relationships with commercial interests relevant to this presentation

  • The views expressed are my own, and do not necessarily represent those of the NIH, NIMH, or the Federal Government


National programs for first episode psychosis

National Programs for First Episode Psychosis


Evidence based treatment for first episode psychosis

Early Intervention Principles

  • Early detection of psychosis

  • Rapid access to specialty care

  • Recovery focus

  • Youth friendly services

  • Respectful of clients’ autonomy & independence


Evidence based treatment for first episode psychosis

Early Intervention Services

  • Team-based, phase-specific treatment

  • Assertive outreach and engagement

  • Empirically-supported interventions

    • Low-dose antipsychotic medications

    • Cognitive and behavioral psychotherapy

    • Family education and support

    • Educational and vocational rehabilitation

  • Shared decision-making framework


Evidence based treatment for first episode psychosis

  • Evidence-based Treatments for First Episode Psychosis: Components of Coordinated Specialty Care

  • RAISE Early Treatment Program Manuals and Program Resources

  • OnTrackNY Manuals & Program Resources

  • RAISE Coordinated Specialty Care for First Episode Psychosis Manuals

  • Voices of Recovery Video Series

http://www.nimh.nih.gov/health/topics/schizophrenia/raise/coordinated-specialty-care-for-first-episode-psychosis-resources.shtml


Evidence based treatment for first episode psychosis

Ryan – Fulfilling My Dream


Evidence based treatment for first episode psychosis

Coordinated Specialty Care Model


Evidence based treatment for first episode psychosis

Coordinated Specialty Care Model


Evidence based treatment for first episode psychosis

Coordinated Specialty Care Model


Evidence based treatment for first episode psychosis

CSC Roles and Functions


Evidence based treatment for first episode psychosis

Must I hire 6 new FEP specialists?

  • In the RAISE initiative, clinicians from multiple disciplines learned, mastered, and applied the principles of CSC

  • Many providers achieved competency in more than one CSC function, and fulfilled dual roles on the treatment team

  • Many sites leveraged existing resources to create cost efficiencies that supported the CSC program


Evidence based treatment for first episode psychosis

CSC Team Model 1

Suburban Mental Health Center; 20-25 Clients

Clinical Roles

Percent Full Time Employee


Evidence based treatment for first episode psychosis

CSC Team Model 2

Urban Mental Health Center; 25-30 Clients

Clinical Roles

Percent Full Time Employee


Evidence based treatment for first episode psychosis

Revising the FY14 MHBG Plan

  • Depending on current capacity and set-aside amount:

    • Expand or augment existing CSC services

    • Fill gaps to create at least one operational program

    • Create infrastructure for a future CSC program


Evidence based treatment for first episode psychosis

Revising the FY14 MHBG Plan

  • Consider targeted investments to build core CSC capacities

    • Shared decision making tools and training

    • Supported employment specialists

    • Regional collaborations to build FEP expertise


Evidence based treatment for first episode psychosis

Goals for FY2015 and Beyond

  • Achieve and maintain fidelity to CSC model

  • Benchmark and monitor key quality indicators

    • Duration of untreated psychosis

    • Client retention at 3 months

    • Inpatient episodes, ED visits, crisis intervention

    • Academic, vocational, and social recovery

    • Health risk factors and medical comorbidities

    • All cause mortality (suicide behaviors, accidents, etc.)

  • Connect CSC programs into a “learning community” that shares expertise, resources, and quality monitoring data


Evidence based treatment for first episode psychosis

FEP Learning Healthcare System

FY2015

  • Science and informatics

  • Patient-clinician partnerships

  • Incentives aligned for value

  • Feedback loops for ongoing system improvement

  • Culture of continuous learning


Evidence based treatment for first episode psychosis

WA

ME

MT

ND

VT

OR

MN

NH

ID

SD

WI

MA

NY

CT

MI

RI

WY

IA

PA

NJ

NE

NV

OH

IL

IN

DE

UT

MD

WV

CA

CO

VA

KS

MO

KY

NC

TN

AZ

OK

SC

NM

AR

MS

AL

GA

LA

TX

FL

Thank you RAISE partners!

2 Studies

22 States

36 Sites

134 Providers

469 Participants


Evidence based treatment for first episode psychosis

RAISE Principal Investigators

  • RAISE Early Treatment Program

  • RAISE Connection Program

  • John Kane

  • Nina Schooler

  • Delbert Robinson

  • Lisa Dixon

  • Susan Essock

  • Jeffery Lieberman


For more information

For More Information

  • www.nimh.nih.gov/RAISE

  • [email protected]


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