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Bareis N, Edlund M, Ringeisen H, Guyer H, Dixon LB, Olfson M, Smith TE, Chwastiak L, Monroe-DeVita M, Swartz M, Swanson J, Sinclair Hancq E, Geiger P, Kreski NT, Stroup TS. Characterizing Schizophrenia Spectrum Disorders: Results of the U.S. Mental and Substance Use Disorders Prevalence Study. Psychiatr Serv 2024:appips20240138. [PMID: 39308173 DOI: 10.1176/appi.ps.20240138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
OBJECTIVE Current information on treatment and clinical characteristics of U.S. adults with schizophrenia spectrum disorders (i.e., schizophrenia, schizoaffective, and schizophreniform disorders) may help inform public health policy and service development for this population. METHODS Data were from the U.S. Mental and Substance Use Disorders Prevalence Study, conducted from October 2020 to October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 for past-year psychiatric and substance use disorder diagnoses among adults ages 18-65 years. Using sampling weights, the authors examined clinical and treatment characteristics among those with schizophrenia spectrum disorders and compared sociodemographic characteristics and comorbid behavioral health conditions of individuals with or without such disorders (N=4,764). RESULTS Among 114 adults with schizophrenia spectrum disorders, the most common comorbid conditions were major depressive episode (52%, 95% CI=34%-69%) and alcohol use (23%, CI=3%-43%), cannabis use (20%, 95% CI=1%-39%), and posttraumatic stress (17%, 95% CI=5%-30%) disorders. Global Assessment of Functioning scores were lower among people with than among those without schizophrenia spectrum disorders (mean±SE=44.8±2.0 vs. 77.2±0.5, p<0.01, respectively), indicating worse functioning. In the past year, 71% (95% CI=55%-87%) of adults with schizophrenia spectrum disorders received at least some mental health treatment, and 26% (95% CI=13%-38%) received minimally adequate treatment. CONCLUSIONS Individuals with schizophrenia spectrum disorders face substantial challenges in the United States, including high rates of comorbid mental health conditions and substance use; few received adequate treatment. A strong social safety net and active clinical interventions are required to address the socioeconomic challenges and unmet mental health service needs of this population.
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Mark Edlund
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Heather Ringeisen
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Heidi Guyer
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Thomas E Smith
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Lydia Chwastiak
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Maria Monroe-DeVita
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Marvin Swartz
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Jeffrey Swanson
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Elizabeth Sinclair Hancq
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Paul Geiger
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - Noah T Kreski
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq)
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Oluwoye O, Puzia M, Amram O, Weeks DL. The Role of Proximity to Coordinated Specialty Care For Early Psychosis And Program Engagement in Washington State: The Interaction of Travel Time, Race, and Ethnicity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01397-9. [PMID: 39046688 DOI: 10.1007/s10488-024-01397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Proximity to mental health services is a predictor of timely access to services. The present study sought to investigate whether travel time was associated with engagement in coordinated specialty care (CSC) for early psychosis, with specific attention to whether the interaction of travel time by race and ethnicity had differential impact. DATA SOURCE/STUDY SETTING Data collected between 2019 and 2022 as part of the New Journeys evaluation, the CSC model in Washington State. STUDY DESIGN This cross-sectional study included a sample of 225 service users with first episode psychosis (FEP) who had received services from New Journeys. DATA COLLECTION Service users' addresses, and the physical location of CSC were geocoded. Spatial proximity was calculated as travel time in minutes. Scheduled appointments, attendance and program status were captured monthly by clinicians as part of the New Journeys measurement battery. PRINCIPAL FINDINGS Proximity was significantly associated with the number of appointments scheduled and attended, and program status (graduation/completion and disengagement). Among Hispanic service users with spatial proximity further away from CSC (longer commutes) was associated with a lower likelihood of graduating/completing CSC compared to non-Hispanic service users (p = .04). Non-white services users had a higher risk of disengagement from CSC compared to white service users (p = .03); additionally, the effects of spatial proximity on disengagement were amplified for non-White service users (p = .03). CONCLUSIONS Findings suggest that proximity is associated with program engagement and partially explains potential differences in program status among ethnoracial group.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202-1495, USA.
| | - Megan Puzia
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Douglas L Weeks
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Myers NL, Wilkey J, Chacon M, Hutnyan M, Janssen C, Tarvin H, Cohen D, Holmes I, Klodnick VV, Mihiret MA, Reznik SJ, Shimizu TK, Stein E, Lopez MA. Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions. Early Interv Psychiatry 2024; 18:502-512. [PMID: 38030586 PMCID: PMC11133765 DOI: 10.1111/eip.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/29/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM Despite known prevalence of substance use (SU) among young people experiencing early psychosis and increasing evidence for the relationship between certain substances (e.g., cannabis) and psychosis, there are no specialized interventions developed for effectively addressing substance use among young people participating in coordinated early psychosis services. This study elicited the perspectives of young people with early psychosis participating in Coordinated Specialty Care (CSC) programs about their substance use, including their motivations and concerns around their use, and their ideas on how to best support young people who are interested in reducing or quitting substance use. METHODS We recruited young adults (ages 18 to 30) from CSC programs across Texas through flyers sent to program staff inviting young persons willing to talk about substance use to engage in a 60-90 min person-centered, semi-structured, audio-recorded Zoom interview. RESULTS A total of 22 young adults were recruited and 18 completed an interview. Participants described mixed positive and negative responses to substance use, and while many understood the importance of discontinuing substance use, many expressed ambivalence related to social, contextual, mental and physical factors that motivated them to keep using. Participants desired practical substance use information, opportunities to explore their substance use ambivalence in supportive relationships, positive peer communities to support healthy choices, help engage, with work, school, and hobbies, and strategies for addressing psychological and physical pain that did not include substance use. CONCLUSION Study findings illuminate what motivates young people with early psychosis to initiate, continue, or cut back on substance use, and ideas for CSC practices for exploring substances and helping young people to reduce substance use.
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Affiliation(s)
- Neely Laurenzo Myers
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin Wilkey
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Marne Chacon
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Matthew Hutnyan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Janssen
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Halle Tarvin
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Deborah Cohen
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Imani Holmes
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Vanessa Vorhies Klodnick
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Mesganaw A Mihiret
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Samantha J Reznik
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | | | - Emily Stein
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Molly A Lopez
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Oluwoye O, Nagendra A, Kriegel LS, Anglin DM, Santos MM, López SR. Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States. SSM - MENTAL HEALTH 2023; 3:100209. [PMID: 37475775 PMCID: PMC10355221 DOI: 10.1016/j.ssmmh.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to 'recovery.' In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Arundati Nagendra
- Center of Excellence in Psychosocial and Systemic Research, Massachusetts General Hospital/Harvard Medical School, 151 Merrimac Street, Floor 6, Boston, MA, 02114, USA
| | - Liat S. Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Deidre M. Anglin
- City University of New York, Department of Psychology, 160 Convent Ave, NAC Building, Room 7/120, New York, NY, 10031, USA
| | - Maria M. Santos
- Department of Psychology, California State University, San Bernardino, 5500 University Parkway, San Bernardino, CA, 92407, USA
| | - Steven R. López
- Department of Psychology, University of Southern California, Seeley G. Mudd Room 501, 3620 S. McClintock, Los Angeles, CA, 90089, USA
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Petros R, Walker DD, Davis A, Monroe-DeVita M. Provider Intentions to Implement Cannabis Use Intervention in First Episode Psychosis Treatment. Community Ment Health J 2023; 59:1479-1489. [PMID: 37162662 DOI: 10.1007/s10597-023-01133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
Young adults with first episode psychosis use cannabis at high rates. In light of progressively tolerant attitudes toward cannabis, decreased perceptions of risk, and limited implementation of substance use modules within coordinated specialty care (CSC) programs, this study sought to describe factors contributing to CSC providers' intentions to implement motivational enhancement therapy (MET) for cannabis reduction. Two focus groups were conducted with CSC providers (n = 14), with questions guided by theory of planned behavior. Content and thematic analyses were conducted to identify salient themes associated with the theory. Participants generally indicated intentions to implement MET; limiting factors included concerns about clients' willingness to discuss cannabis use, perception of support for abstinence-only goals, and concerns about intervention mechanics such as computerized assessments. To reduce barriers limiting provider intention to implement MET, authors recommend training on assessment protocols, the merits of harm-reduction, and strategies for lower-risk cannabis use.Please confirm if the author names are presented accurately and in the correct sequence. Author 1 Given name: [Ryan] Last name [Petros]. Author 2 Given name: [Denise D.] Last name [Walker]. Author 3 Given name: [Adam] Last name [Davis]. Author 4 Given name: [Maria] Last name [Monroe-DeVita]. Also, kindly confirm the details in the metadata are correct.Confirmed!
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Affiliation(s)
- Ryan Petros
- University of Washington School of Social Work, 4101 15th Ave. NE, Seattle, WA, 98105, USA.
| | - Denise D Walker
- University of Washington School of Social Work, 909 NE 43rd Street, Suite 304, Seattle, WA, 98105, USA
| | - Adam Davis
- University of Washington School of Social Work, 4101 15th Ave. NE, Seattle, WA, 98105, USA
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 35991, Seattle, WA, 98104, USA
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Cohen DA, Klodnick VV, Reznik SJ, Lopez MA. Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:861-875. [PMID: 37530982 PMCID: PMC10543575 DOI: 10.1007/s10488-023-01285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.
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Affiliation(s)
- Deborah A Cohen
- Dell Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, 1601 Trinity St., Bldg, B., Austin, TX, 78712, USA.
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
| | - Vanessa V Klodnick
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Samantha J Reznik
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Molly A Lopez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
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Hynes DM, Thomas KC. Realigning theory with evidence to understand the role of care coordination in mental health services research. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023; 26:55-61. [PMID: 37333504 PMCID: PMC10273861 DOI: 10.1177/20534345231153801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; Cecil G. Sheps Center for Health Services Research and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Dong F, Moore TM, Westfall M, Kohler C, Calkins ME. Development of empirically derived brief program evaluation measures in Pennsylvania first-episode psychosis coordinated specialty care programs. Early Interv Psychiatry 2023; 17:96-106. [PMID: 35343055 DOI: 10.1111/eip.13298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 02/17/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM The Pennsylvania first episode psychosis program evaluation (PA-FEP-PE) core assessment battery was developed as a standard and comprehensive clinical assessment and data collection tool in Pennsylvania coordinated specialty care programs (CSC). To reduce administrative time and maximize clinical utility by maintaining acceptable levels of precision, we aimed to generate a short form using item response theory (IRT)-based computer-adaptive test (CAT) simulation and analyse the implementation and acceptability of the short form among providers from PA-CSC. METHODS FEP participants (n = 759; age 14-36) from nine coordinated specialty care programs completed 156 items drawn from the PA-FEP-PE battery. Multidimensional IRT-based CAT simulations were used to select the best PA-FEP-PE items for abbreviated forms. RESULTS A 67-item PA-FEP-PE short form was developed to capture six factors: (1) positive affect and surgency (with negative loadings on Anxious-Misery items); (2) psychiatric services satisfaction; (3) antipsychotic side effect severity; (4) family turmoil and associated traumas; (5) trauma load; and (6) psychosis. The total number of items was reduced more than 50% in the PA-FEP-PE shortened forms. The short form demonstrated good psychometric properties, and it was well accepted by our providers in the implementation. CONCLUSIONS The empirical derivation and implementation of abbreviated measures of key domains and constructs in FEP care have streamlined and facilitated PA-FEP program evaluation. Our work supports potential application of IRT based methods to empirically reduce core assessment battery measures in large-scale data collection efforts such as in the Early Psychosis Intervention Network.
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Affiliation(s)
- Fanghong Dong
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Megan Westfall
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
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10
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Munson MR, Jaccard J, Moore KL, Rodwin AH, Shimizu R, Cole AR, Scott LD, Narendorf SC, Davis M, Gilmer T, Stanhope V. Impact of a brief intervention to improve engagement in a recovery program for young adults with serious mental illness. Schizophr Res 2022; 250:104-111. [PMID: 36399899 PMCID: PMC9742319 DOI: 10.1016/j.schres.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/03/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Serious mental illnesses (SMI) commonly emerge during young adulthood. Effective treatments for this population exist; however, engagement in treatment is a persistent challenge. This study examines the impact of Just Do You (JDY), an innovative intake-focused intervention designed to improve engagement in treatment and enhance personal recovery. METHODS The study used a parallel group randomized trial to examine if and how JDY improved recovery among 121 young adults with SMI from low-resourced communities referred to personalized recovery-oriented services (PROS). Measures of engagement (buy-in and attendance) and personal recovery in this pilot study were assessed at baseline and 3-month follow-up. RESULTS Participants in JDY reported more positive engagement outcomes; that is, relative to the control group they reported higher past two week attendance (b = 0.72, p < 0.05, Cohen's d = 0.56) and higher levels of buy-in to treatment (b = 2.42, p < 0.05, Cohen's d = 0.50). JDY also impacted young adults' personal recovery (b = 0.99, p < 0.05, Cohen's d = 1.15) and did so largely by increasing their level of buy-in to the treatment program. CONCLUSION This study suggests that an engagement intervention for young adults that orients, prepares, and empowers them to be active and involved in the larger treatment program makes a difference by improving engagement and enhancing recovery. Data also support conceptualizing and examining engagement beyond treatment attendance; in this study what mattered most for recovery was the level of buy-in to treatment among young adults.
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Affiliation(s)
- Michelle R Munson
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA.
| | - James Jaccard
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Kiara L Moore
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Aaron H Rodwin
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Rei Shimizu
- University of Alaska, School of Social Work, 3211 Providence Drive, Anchorage, AK 99508, USA
| | - Andrea R Cole
- Fairleigh Dickinson University, 1000 River Rd, Teaneck, NJ 07666, USA
| | - Lionel D Scott
- Georgia State University, School of Social Work, 55 Park Pl, Atlanta, GA 3030, USA
| | - Sarah C Narendorf
- University of Houston, Graduate College of Social Work, 3511 Cullen Blvd, Houston, TX 77204, USA
| | - Maryann Davis
- University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Todd Gilmer
- University of California San Diego, Department of Family Medicine and Public Health, 9500 Gilman Drive, San Diego, CA, USA
| | - Victoria Stanhope
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
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11
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Tatar O, Abdel-Baki A, Wittevrongel A, Lecomte T, Copeland J, Lachance-Touchette P, Coronado-Montoya S, Côté J, Crockford D, Dubreucq S, L'Heureux S, Ouellet-Plamondon C, Roy MA, Tibbo PG, Villeneuve M, Jutras-Aswad D. Reducing Cannabis Use in Young Adults With Psychosis Using iCanChange, a Mobile Health App: Protocol for a Pilot Randomized Controlled Trial (ReCAP-iCC). JMIR Res Protoc 2022; 11:e40817. [PMID: 36427227 PMCID: PMC9736767 DOI: 10.2196/40817] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cannabis use is the most prevalent among adolescents and young adults; frequent consumption is associated with cannabis use disorder (CUD) and psychosis, with a high prevalence (up to 50%) of CUD in individuals with first-episode psychosis (FEP). Early Intervention Services (EIS) for psychosis include face-to-face psychosocial interventions for CUD, because reducing or discontinuing cannabis use improves clinical and health care service use outcomes. However, multiple barriers (eg, staff availability and limited access to treatment) can hinder the implementation of these interventions. Mobile health (mHealth) interventions may help circumvent some of these barriers; however, to date, no study has evaluated the effects of mHealth psychological interventions for CUD in individuals with FEP. OBJECTIVE This study describes the protocol for a pilot randomized controlled trial using a novel mHealth psychological intervention (iCanChange [iCC]) to address CUD in young adults with FEP. iCC was developed based on clinical evidence showing that in individuals without psychosis, integrating the principles of cognitive behavioral therapy, motivational interviewing, and behavioral self-management approaches are effective in improving cannabis use-related outcomes. METHODS Consenting individuals (n=100) meeting the inclusion criteria (eg, aged 18-35 years with FEP and CUD) will be randomly allocated in a 1:1 ratio to the intervention (iCC+modified EIS) or control (EIS) group. The iCC is fully automatized and contains 21 modules that are completed over a 12-week period and 3 booster modules available during the 3-month follow-up period. Validated self-report measures will be taken via in-person assessments at baseline and at 6, 12 (end point), and 24 weeks (end of trial); iCC use data will be collected directly from the mobile app. Primary outcomes are intervention completion and trial retention rates, and secondary outcomes are cannabis use quantity, participant satisfaction, app use, and trial recruiting parameters. Exploratory outcomes include severity of psychotic symptoms and CUD severity. For primary outcomes, we will use the chi-square test using data collected at week 12. We will consider participation in iCC acceptable if ≥50% of the participants complete at least 11 out of 21 intervention modules and the trial feasible if attrition does not reach 50%. We will use analysis of covariance and mixed-effects models for secondary outcomes and generalized estimating equation multivariable analyses for exploratory outcomes. RESULTS Recruitment began in July 2022, and data collection is anticipated to be completed in July 2024. The main results are expected to be submitted for publication in 2024. We will engage patient partners and other stakeholders in creating a multifaceted knowledge translation plan to reach a diverse audience. CONCLUSIONS If feasible, this study will provide essential data for a larger-scale efficacy trial of iCC on cannabis use outcomes in individuals with FEP and CUD. TRIAL REGISTRATION ClinicalTrials.gov NCT05310981; https://www.clinicaltrials.gov/ct2/show/NCT05310981. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40817.
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Affiliation(s)
- Ovidiu Tatar
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Amal Abdel-Baki
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Anne Wittevrongel
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Jan Copeland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | | | - Stephanie Coronado-Montoya
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - José Côté
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Simon Dubreucq
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sophie L'Heureux
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
- Clinique Notre-Dame des Victoires, Institut universitaire en santé mentale, Centre intégré universitaire de soins et services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Clairélaine Ouellet-Plamondon
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
- Clinique Notre-Dame des Victoires, Institut universitaire en santé mentale, Centre intégré universitaire de soins et services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Early Psychosis Program, Halifax, NS, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur les dépendances, Montreal, QC, Canada
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12
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Stokes B, Fraser E, Kriegel L, Oluwoye O. Exploring Provider Perspectives on Implementing Coordinated Specialty Care: A Qualitative Study. Community Ment Health J 2022; 58:1321-1328. [PMID: 35091877 PMCID: PMC8799406 DOI: 10.1007/s10597-022-00939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to explore clinician roles and experiences related to the implementation and sustainability of coordinated specialty care (CSC) programs for first episode psychosis. Qualitative interviews were conducted with 20 CSC providers and team members, recruited from five CSC programs. Using a semi-structured guide, interviews explored experiences with the delivery of CSC in the context of community-based outpatient mental health agencies and the challenges with implementation. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Themes were parsed into two overarching categories, provider, and organizational-level factors, and further distilled into subthemes which interacted with one another to form an interacting web of barriers to successful programmatic implementation for CSC programs. Study findings have important implications for development of future policy for financing mental health agencies, the creation of additional materials, supports for the model, and hiring and retention of staff for future implemented CSC programs.
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Affiliation(s)
- Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Department of Human Development, Washington State University, Pullman, WA, USA.,Washington State Center for Excellence in Early Psychosis, Seattle, WA, USA
| | - Elizabeth Fraser
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center for Excellence in Early Psychosis, Seattle, WA, USA
| | - Liat Kriegel
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA. .,Washington State Center for Excellence in Early Psychosis, Seattle, WA, USA.
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13
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The History of Coordinated Specialty Care for Early Intervention in Psychosis in the United States: A Review of Effectiveness, Implementation, and Fidelity. Community Ment Health J 2022; 58:835-846. [PMID: 34519947 DOI: 10.1007/s10597-021-00891-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
Coordinated Specialty Care (CSC) is a multidisciplinary team approach to providing care for young and emerging adults having their first episode of psychosis. CSC programs have expanded rapidly throughout the United States going from 12 programs in 2008 to over 160 programs a decade later. The purpose of this historical review is to document the process and conditions that led to the accelerated dissemination of these programs across the country. CSC models began in the US in the early 2000s, but nationwide expansion followed the 2008 Recovery After an Initial Schizophrenia Episode trial. As programs have grown, debates have risen about fidelity to CSC models. The challenges facing CSC programs today include lack of evidence on what are the core components of CSC and how fidelity monitoring relates to positive client outcomes.
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14
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O’Connell N, O’Connor K, McGrath D, Vagge L, Mockler D, Jennings R, Darker CD. Early Intervention in Psychosis services: A systematic review and narrative synthesis of the barriers and facilitators to implementation. Eur Psychiatry 2021; 65:e2. [PMID: 34913421 PMCID: PMC8792869 DOI: 10.1192/j.eurpsy.2021.2260] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services target the early manifestation of psychosis and provide multidisciplinary care. They demonstrate effectiveness and cost-effectiveness. Implementation of EIP services is inconsistent and piecemeal. This systematic review and narrative synthesis aims to identify barriers and facilitators to EIP service implementation. METHODS We conducted an electronic search of databases (EMBASE, Medline, Web of Science, and PsychINFO) to detect papers reporting EIP service implementation findings and associated barriers and facilitators. The search occurred between June to August 2020, and again in January 2021. Articles meeting inclusion criteria were extracted and narratively synthesized. A quality assessment was conducted using the Mixed Methods Appraisal Tool. RESULTS Twenty-three studies were selected. The most common study design was descriptive accounts of implementation. Patient age ranged varied from 14 to 35 years. We identified three barrier and facilitator domains: (a) system; (b) services; and (c) staff, and a range of subdomains. The most frequent subdomains were "funding" and "strength of collaboration and communication between EIP and outside groups and services". Associations between domains and subdomains were evident, particularly between systems and services. CONCLUSIONS A range of barriers and facilitators to EIP implementation exist. Some of these are generic factors germane across health systems and services, while others are specific to EIP services. A thorough prior understanding of these challenges and enablers are necessary before implementation is attempted. Accounting for these issues within local and national contexts may help predict and increase the likelihood of services' success, stability, and longevity.
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Affiliation(s)
- N. O’Connell
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - K. O’Connor
- National Clinical Programme for Early Intervention in Psychosis,
Health Service ExecutiveDublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of
Psychiatry, University College Cork
| | - D. McGrath
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - L. Vagge
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - D. Mockler
- Rise, South Lee Mental Health Services, Cork & Department of
Psychiatry, University College Cork
- Trinity College Dublin Library, Trinity College
Dublin, Dublin, Ireland
| | - R. Jennings
- National Clinical Programme for Early Intervention in Psychosis,
Health Service ExecutiveDublin, Ireland
| | - C. D. Darker
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
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15
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Tanzer JR, Redding CA, Mikhalyuk I, Bennett B, Lamoureux B, Achin D, Bassett S, Martin R, Stein LAR. Implementing Coordinated Specialty Care in CMHC Youth and Young Adults with Severe Mental Illness: Preliminary Outcome Assessment. Community Ment Health J 2021; 57:1348-1359. [PMID: 33438137 DOI: 10.1007/s10597-020-00763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
This study assessed impact of Coordinated Specialty Care (CSC), expanded to include both first episode psychosis (FEP) and severe mental health disorders (e.g., depression, bipolar disorder, trauma) in youths attending Community Mental Health Centers (CMHCs). Eligible youth and young adults (ages 16-26 years, N = 201) were recruited from two CMHCs and assessed every 6 months. Paired sample t-tests were performed comparing pre- and post-treatment observations. Statistically significant decreases from pre to post were found in sad and anxious feelings and in days hospitalized for psychiatric emergency and increases were found in subjective health ratings and employment status. This preliminary assessment supports the effectiveness of expanded inclusion criteria for participation in the CSC model.
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Affiliation(s)
- Joshua Ray Tanzer
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA.
| | - Colleen A Redding
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Irena Mikhalyuk
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | | | | | - Denise Achin
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, USA
| | - Shayna Bassett
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | | | - L A R Stein
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, USA
- Brown University School of Public Health, Providence, USA
- RI Training School, Cranston, USA
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16
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mHealth for Young Adults with Early Psychosis: User Preferences and Their Relationship to Attitudes About Treatment-Seeking. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:667-676. [PMID: 34604506 PMCID: PMC8476976 DOI: 10.1007/s41347-021-00223-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/12/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
A long duration of untreated psychosis reduces benefits of early intervention for early psychosis. Digital technologies have potential to encourage help-seeking and reduce barriers to care. Because of high rates of smartphone ownership, mobile health (mHealth) interventions may be particularly well-suited to increase access. There is a lack of available information on the specific features that may be most appealing to young adults with early psychosis. The present study remotely recruited 77 young adults with psychosis and surveyed their interest in mHealth features, delivery modalities, and attitudes toward treatment. Overall, respondents reported high utilization of digital health and high interest in psychosis-specific mHealth. They expressed the highest interest (ordered by mean score by item) in information about medications and side effects (n = 69, 89.6% reporting being “interested” or “very interested”), managing stress and improving mood (n = 67, 89.3%) and symptoms of psychosis (n = 66, 88%), as well as in tracking changes in symptoms (n = 70, 90.9%), and goals (n = 66, 86.9%). They also reported high interest in content being delivered as text (n = 69, 89.6%) and also in communicating directly with providers. Respondents were less interested in social features, and those with most negative attitudes toward help-seeking had particularly low interest in features related to disclosing symptoms to others. These results suggest mHealth may have potential to engage individuals with early psychosis, and that the most effective strategies may be those that are most straightforward, including direct psychoeducational information.
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17
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Patel SR, Bello I, Cabassa LJ, Nossel IR, Wall MM, Montague E, Rahim R, Mathai CM, Dixon LB. Adapting coordinated specialty care in the post-COVID-19 era: study protocol for an integrative mixed-methods study. Implement Sci Commun 2021; 2:72. [PMID: 34225817 PMCID: PMC8256216 DOI: 10.1186/s43058-021-00178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordinated Specialty Care (CSC) programs provide evidence-based services for young people with a recent onset of a psychotic disorder. OnTrackNY is a nationally recognized model of CSC treatment in New York state. In 2019, OnTrackNY was awarded a hub within the Early Psychosis Intervention Network (EPINET) to advance its learning health care system (LHS). The OnTrackNY network is comprised of 23 CSC teams across New York state. OnTrack Central, an intermediary organization, provides training and implementation support to OnTrackNY teams. OnTrack Central coordinates a centralized data collection protocol for quality improvement and evaluation of program fidelity and a mechanism to support practice based-research. OnTrackNY sites' breadth coupled with OnTrack Central oversight provides an opportunity to examine the impacts of the COVID-19 crisis in New York State, and supplementary funding was awarded to the OnTrackNY EPINET hub in 2021 for that purpose. METHODS This project will examine the implications of modifications to service delivery within the OnTrackNY LHS during and after the COVID-19 crisis. We will use the Framework for Reporting Adaptations and Modification-Enhanced (FRAME) to classify systematically, code, and analyze modifications to CSC services and ascertain their impact. We will utilize integrative mixed methods. Qualitative interviews with multi-level stakeholders (program participants, families, providers, team leaders, agency leaders, trainers (OnTrack Central), and decision-makers at the state and local levels) will be used to understand the process of making decisions, information about modifications to CSC services, and their impact. Analysis of OnTrackNY program data will facilitate examining trends in team staffing and functioning, and participant service utilization and outcomes. Study findings will be summarized in a CSC Model Adaptation Guide, which will identify modifications as fidelity consistent or not, and their impact on service utilization and care outcomes. DISCUSSION A CSC Model Adaptation Guide will inform CSC programs, and the state and local mental health authorities to which they are accountable, regarding modifications to CSC services and the impact of these changes on care process, and participant service utilization and outcomes. The guide will also inform the development of tailored technical assistance that CSC programs may need within OnTrackNY, the EPINET network, and CSC programs nationally. TRIAL REGISTRATION NCT04021719 , July 16th, 2019.
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Affiliation(s)
- Sapana R Patel
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA.
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA.
| | - Iruma Bello
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work at Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Ilana R Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
| | - Melanie M Wall
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, 10032, USA
| | - Elaina Montague
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Reanne Rahim
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Chacku M Mathai
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
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