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Li S, Chan SY, Higgins A, Hall MH. Sensory gating, neurocognition, social cognition and real-life functioning: a 2-year follow-up of early psychosis. Psychol Med 2023; 53:2540-2552. [PMID: 37310299 DOI: 10.1017/s0033291721004463] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Diminished sensory gating (SG) is a robust finding in psychotic disorders, but studies of early psychosis (EP) are rare. It is unknown whether SG deficit leads to poor neurocognitive, social, and/or real-world functioning. This study aimed to explore the longitudinal relationships between SG and these variables. METHODS Seventy-nine EP patients and 88 healthy controls (HCs) were recruited at baseline. Thirty-three and 20 EP patients completed 12-month and 24-month follow-up, respectively. SG was measured using the auditory dual-click (S1 & S2) paradigm and quantified as P50 ratio (S2/S1) and difference (S1-S2). Cognition, real-life functioning, and symptoms were assessed using the MATRICS Consensus Cognitive Battery, Global Functioning: Social (GFS) and Role (GFR), Multnomah Community Ability Scale (MCAS), Awareness of Social Inference Test (TASIT), and the Positive and Negative Syndrome Scale (PANSS). Analysis of variance (ANOVA), chi-square, mixed model, correlation and regression analyses were used for group comparisons and relationships among variables controlling for potential confounding variables. RESULTS In EP patients, P50 ratio (p < 0.05) and difference (p < 0.001) at 24-month showed significant differences compared with that at baseline. At baseline, P50 indices (ratio, S1-S2 difference, S1) were independently associated with GFR in HCs (all p < 0.05); in EP patients, S2 amplitude was independently associated with GFS (p = 0.037). At 12-month and 24-month, P50 indices (ratio, S1, S2) was independently associated with MCAS (all p < 0.05). S1-S2 difference was a trending predictor of future function (GFS or MCAS). CONCLUSIONS SG showed progressive reduction in EP patients. P50 indices were related to real-life functioning.
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Affiliation(s)
- Shen Li
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Department of Psychiatry, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Shi Yu Chan
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Translational Neurosciences, Singapore Institute for Clinical Sciences 117609, Singapore
| | - Amy Higgins
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Mei-Hua Hall
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
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Zhao L, Bo Q, Zhang Z, Chen Z, Wang Y, Zhang D, Li T, Yang N, Zhou Y, Wang C. Altered Dynamic Functional Connectivity in Early Psychosis Between the Salience Network and Visual Network. Neuroscience 2022; 491:166-175. [DOI: 10.1016/j.neuroscience.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
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DeLuca JS, Novacek DM, Adery LH, Herrera SN, Landa Y, Corcoran CM, Walker EF. Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:176-197. [PMID: 35815004 PMCID: PMC9258423 DOI: 10.1080/23794925.2022.2042874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.
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Affiliation(s)
- Joseph S. DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, , Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura H. Adery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Shaynna N. Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Pipkin A. Evidence base for early intervention in psychosis services in rural areas: A critical review. Early Interv Psychiatry 2021; 15:762-774. [PMID: 32657522 DOI: 10.1111/eip.13019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/03/2020] [Accepted: 06/24/2020] [Indexed: 01/18/2023]
Abstract
AIM Early Intervention in Psychosis teams (EITs) are a growing entity internationally, yet they remain under-researched given challenges facing their delivery. Model adaptations include stand-alone services, a hub-and-spoke model with various bases and integrating specialist staff into existing mental health teams. The present critical review focuses on reviewing the evidence base for the delivery of EITs in rural areas, first pertaining to evidence for model adherence and second to clinically outcomes. METHOD A systematic literature search was undertaken, finding 53 papers of interest. Nine papers met the inclusion criteria. A critical appraisal tool was used to consider the quality of the evidence and a narrative review of their findings is presented. RESULTS The five studies reporting clinical outcomes of rural EITs demonstrate positive outcomes of a hub-and-spoke and stand-alone EIT on reducing hospital admissions, psychotic symptoms and improving quality of life. One study directly comparing hub-and-spoke to stand-alone EIT found that hub-and-spoke EIT had more positive outcomes than a stand-alone service. Of the studies attempting to promote adherence to EIT model in rural areas, services show low overall adherence and report issues pertaining to funding and managerial support for practical barriers to implementation. CONCLUSIONS EIT services in rural areas may show similar positive outcomes to urban areas and adaptations to suit rural populations appear acceptable, such as using a hub-and-spoke model, though further research is required. Adherence to EIT service models in rural areas may be limited and training programmes to promote adherence benefit from managerial and financial support.
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Affiliation(s)
- Alastair Pipkin
- Oxford Institute for Clinical Psychology Training and Research, University of Oxford & Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Implementing Coordinated Specialty Care for First Episode Psychosis: A Review of Barriers and Solutions. Community Ment Health J 2021; 57:268-276. [PMID: 32472286 DOI: 10.1007/s10597-020-00644-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
Specialized early interventions (SEI) for individuals diagnosed with a first episode of psychosis (FEP) are effective treatment modalities (Azrin et al. in Psychiatr Ann 45(11):548, https://doi.org/10.3928/00485713-20151103-05 , 2015). SEI offered immediately or shortly following a first episode improves functional and clinical outcomes for those individuals with, and at risk for, serious mental illness (SMI; Correll et al. in JAMA Psychiatry 75(6):555-565, https://doi.org/10.1001/jamapsychiatry.2018.0623 , 2018). In the United States, SEI programs referred to as Coordinated Specialty Care (CSC), have been utilized to provide a beneficial, team-based, multi-component method of treating FEP. However, despite the success, CSC programming is still met with considerable challenges. This article reviews existing CSC literature to identify and explore relevant barriers to successful implementation of CSC. Identified barriers include stigma, cultural competence, disengagement, measurement and evaluation, workforce development, implementation in rural areas, and financial stability. The ongoing efforts to address these barriers are described and areas for continued improvements are discussed.
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Stain HJ, Halpin SA, Baker AL, Startup M, Carr VJ, Schall U, Crittenden K, Clark V, Lewin TJ, Bucci S. Impact of rurality and substance use on young people at ultra high risk for psychosis. Early Interv Psychiatry 2018; 12:1173-1180. [PMID: 28744989 DOI: 10.1111/eip.12437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 11/24/2016] [Accepted: 01/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Longitudinal research into early intervention for youth at ultra high risk (UHR) for psychosis demonstrates beneficial outcomes including increased treatment compliance and greater participation in education and the workforce. Despite known barriers for rural youth accessing mental health services, research comparing urban and rural UHR youth is lacking. The study included an examination of the impact of substance use on functioning of UHR youth. METHODS Youth aged 12 to 25 years were recruited from the urban area of Newcastle or the rural area of Orange, New South Wales, Australia, and identified as UHR by the Comprehensive Assessment of At Risk Mental States. Rural and urban youth were compared on clinical profiles, social and occupational functioning and substance use. RESULTS The rural youth showed different help-seeking behaviours and had greater functional impairment than urban youth. Substance use was common across the sample of 57 youth (mean age 16.5 years, 56% female) and a history of hazardous substance use was associated with higher levels of depression. Rural youth (n = 32) were more likely than urban youth to be taking antidepressants at baseline (44% compared with 16%). CONCLUSION Different patterns of help seeking by rural UHR youth suggest a need for greater access to psychosis informed primary care early intervention services. Interventions should target functional decline to prevent adverse outcomes such as reduced community participation and unemployment. In addition, interventions for substance use should be a priority for UHR youth, who should also be screened and monitored for depressive symptoms and treated for depression if indicated.
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Affiliation(s)
- Helen J Stain
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Sean A Halpin
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mike Startup
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Vaughan J Carr
- Schizophrenia Research Institute, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Ulrich Schall
- Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Kylie Crittenden
- Western New South Wales Local Health District, Bathurst, New South Wales, Australia
| | - Vanessa Clark
- Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Terry J Lewin
- Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Sandra Bucci
- School of Psychological Sciences, University of Manchester, Manchester, UK
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Bowman S, McKinstry C, McGorry P. Youth mental ill health and secondary school completion in Australia: time to act. Early Interv Psychiatry 2017; 11:277-289. [PMID: 27381567 DOI: 10.1111/eip.12357] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/01/2016] [Indexed: 12/30/2022]
Abstract
AIM This paper reviews the evidence of youth mental ill health and its impact on secondary school educational attainment. METHODS This narrative review presents the current research related to the mental ill health of young people in urban and rural Australia, their educational attainment and the effectiveness of mental health strategies implemented in secondary schools. RESULTS The prevalence of mental ill health is high for Australian young people and the onset of depression, anxiety, substance-use disorders and first episode psychosis (FEP) commonly occurs when the individual is at school. The prevalence is reported to be higher for rural young people and barriers to treatment exist. Current evidence suggests that 40% of young people experiencing depression or anxiety disorders are not completing secondary school. Further evidence shows that over 50% of individuals who experience FEP do not finish secondary school. Current mental health promotion strategies employed in secondary schools have not been shown to reduce rates of depression or anxiety in adolescence nor identify prodromal or acute FEP. These strategies have not led to interventions that assist young people with mental ill health to finish school. CONCLUSIONS Not completing secondary school can limit employment options, lead to severe levels of disadvantage and increased burden on welfare and healthcare systems. All young people, including those in rural areas, have the right to education and should not be disadvantaged in their educational aspirations because they have an emerging or current mental illness.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, Community and Clinical Allied Health & LaTrobe Rural Health School, College of Science, Health and Engineering, LaTrobe University, Melbourne, Victoria, Australia
| | - Carol McKinstry
- Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Bendigo, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
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Behan C, Masterson S, Clarke M. Systematic review of the evidence for service models delivering early intervention in psychosis outside the stand-alone centre. Early Interv Psychiatry 2017; 11:3-13. [PMID: 27061731 DOI: 10.1111/eip.12334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/07/2016] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Although early intervention in psychosis is an accepted policy internationally, the evidence base for this paradigm, originates mostly from the specialist model. In a real world setting, variations of this model are often implemented. The aim of this paper is to systematically evaluate the evidence for delivering early intervention outside the specialist stand-alone centre. METHODS A systematic search following the PRISMA guidelines was undertaken in Medline, PsycInfo, Embase and the Cochrane trials register. The search was limited to articles in English from 1990 to end of January 2016. Inclusion criteria for the review comprised comparative evaluations of services delivering early intervention in psychosis outside the specialist model. Exclusion criteria included prodromal services, descriptions of services without reference to a comparator and stand-alone specialist services evaluated in comparison to treatment as usual. RESULTS There were 637 unique citations. Twenty-eight papers were reviewed at second-stage screening. The majority were excluded as they compared specialist early intervention with treatment as usual, did not evaluate the first episode or had no comparator. Seven peer-reviewed publications and two conference papers fulfilled criteria evaluating models of delivering early intervention other than the specialist model. CONCLUSIONS There is a spaucity of evidence evaluating models other than specialist models in early intervention. Published studies are heterogeneous in design and outcome. Although there have been two recent trials evaluating integrated early intervention in comparison with treatment as usual, it remains unclear whether reported improved outcomes of specialist centres apply to other models.
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Affiliation(s)
- Caragh Behan
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Sarah Masterson
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Durbin J, Selick A, Hierlihy D, Moss S, Cheng C. A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario. Early Interv Psychiatry 2016; 10:485-493. [PMID: 25366518 DOI: 10.1111/eip.12201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 09/24/2014] [Indexed: 11/30/2022]
Abstract
AIM Ontario, Canada is a large province with a geographically dispersed population. Early psychosis intervention (EPI) programmes are available province-wide, with delivery approaches adapted to context. This study examined EPI programme delivery in relation to recently released provincial EPI Program Standards, and variations based on geographic context. METHODS The data source was a province-wide key informant survey of early psychosis programmes conducted after release of the Standards. Chi-squared tests compared large- and small-area programmes on selected programme structural features and perceived adherence to 19 service components. RESULTS Responses were obtained from 52 programme sites, including 21 small-area programmes with 1 to 2 staff. In general, frequency of EPI delivery was highest for individual assessment and treatment components, and moderate for social supports and family support. Implementation was lowest for public education, early detection and recovery planning. Small-area programmes reported lower implementation for over half of the components, with differences statistically significant for psychiatric assessment and physical health monitoring. CONCLUSION Since the release of the Standards, the Ontario Ministry of Health has partnered with a provincial network of EPI stakeholders to support practice improvement. This survey identified components where more implementation support is needed, overall and for rural area delivery. Ultimately, systematic monitoring of programme fidelity and measuring client outcomes are key to advancing the quality of EPI programme delivery.
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Affiliation(s)
- Janet Durbin
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Avra Selick
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Sarah Moss
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Chiachen Cheng
- First Place, Canadian Mental Health Association - Thunder Bay Branch, Thunder Bay, Ontario, Canada
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10
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Bowman S, McGorry P. The student safety net: a new angle for early intervention. Early Interv Psychiatry 2016; 10:279-81. [PMID: 27027719 DOI: 10.1111/eip.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, Community and Clinical Allied Health and La Trobe Rural Health School, College of Science, Health and Engineering, Latrobe University, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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Cheng C, Dewa CS, Langill G, Fata M, Loong D. Rural and remote early psychosis intervention services: the Gordian knot of early intervention. Early Interv Psychiatry 2014; 8:396-405. [PMID: 23841694 DOI: 10.1111/eip.12076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 06/02/2013] [Indexed: 11/26/2022]
Abstract
AIM One of the basic challenges of Early Psychosis Intervention (EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models (hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. METHODS This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chi-square tests were used to test differences between two groups. RESULTS The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). CONCLUSIONS The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations.
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Affiliation(s)
- Chiachen Cheng
- First Place Clinic and Regional Resource Centre, Canadian Mental Health Association, Thunder Bay, Ontario, Canada; Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Cheng C, deRuiter WK, Howlett A, Hanson MD, Dewa CS. Psychosis 101: evaluating a training programme for northern and remote youth mental health service providers. Early Interv Psychiatry 2013; 7:442-50. [PMID: 24164723 DOI: 10.1111/eip.12044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 01/15/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most of the early psychosis intervention (EPI) training has focused on family physicians participants. In Northern Ontario, there is a shortage of primary care. This paper will present evaluation results of a pilot training programme for rural and remote youth mental health service providers. METHOD A mixed methods approach was used. We evaluated a 2-day workshop about EPI for non-medical mental health workers delivered onsite and simultaneously by videoconferencing. There were 19 participants across four agencies. Seven were onsite and 12 were offsite. Participants' knowledge was measured using a validated questionnaire at pre-intervention and at 3-, 6- and 9-month follow up. A repeated measures ANOVA was used to evaluate knowledge acquisition between the two modes of training. At 6 months, focus group interviews were conducted to explore their experiences of the mode of intervention delivery and evaluation. Emerging themes were iteratively derived through a series of discussions involving independent coders. RESULTS Only 15 complete datasets were available of the 19 original participants. Differences in knowledge acquisition between the two groups did not reach statistical difference. Six-month focus group data indicated that participants improved their relationship with EPI services and they were part of a strengthened network with other providers in the region. Post-intervention, the accuracy of referrals from participating agencies increased dramatically, with an increase in proportion of referrals who were eligible for EPI services. The follow-up process engaged participants in learning and re-engaged them with the material taught during the training session. CONCLUSIONS The results about developing service partnerships and relationship with specialist services are encouraging for policy and service decision-makers to address mental health service needs in northern and remote areas.
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Affiliation(s)
- Chiachen Cheng
- Canadian Mental Health Association - Thunder Bay, First Place Clinic and Regional Resource Centre, Thunder Bay, Ontario, Canada; Centre for Addiction and Mental Health, Centre for Research on Employment and Workplace Health (CREWH), Toronto, Ontario, Canada
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13
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Cheng C, Dewa CS, Goering P. Matryoshka Project: lessons learned about early intervention in psychosis programme development. Early Interv Psychiatry 2011; 5:64-9. [PMID: 21272277 DOI: 10.1111/j.1751-7893.2010.00255.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This part of the Matryoshka project sought to understand the processes with which early intervention in psychosis (EIP) programmes were implemented and developed. The goals were to understand the key influences of programme implementation in the context of rapid EIP service growth and lack of specific provincial guidelines. METHODS Sampling was purposive and data were collected with semi-structured interviews. Five Matryoshka Project programmes were successfully contacted. All interviews were conducted by phone, recorded and transcribed verbatim. Emerging themes were analysed iteratively and discussed among authors. Key themes were validated with participants. RESULTS The new EIP services were significantly influenced by the provincial EIP network, advocacy groups and clinical mentors. EIP programme decision makers often relied on each other for guidance. Although the research evidence assisted programme decision makers to develop an effective EIP model for their region, implementation was often shaped by funding constraints. Programmes adapted their EIP models according to funding and local service characteristics. The lack of specific guidelines may have allowed innovation; programme creativity and diversity is consistent with EIP values. Despite the challenges related to geography and staffing, programmes experienced important successes such as partnerships across sectors, quality clinical service and the ability to engage hard-to-serve clientele. CONCLUSIONS Although important, research evidence played only a secondary role. Relationships among providers and services, coupled with the dedication of front-line staff, were more critical to knowledge exchange than written documents alone. These findings stress the importance of researcher-front-line relationships to the adoption of evidence-informed practice.
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Affiliation(s)
- Chiachen Cheng
- Canadian Mental Health Association - Thunder Bay Branch, First Place Clinic & Regional Resource Centre, Thunder Bay, Ontario, Canada.
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Kirkbride JB, Lunn DJ, Morgan C, Lappin JM, Dazzan P, Morgan K, Fearon P, Murray RM, Jones PB. Examining evidence for neighbourhood variation in the duration of untreated psychosis. Health Place 2009; 16:219-25. [PMID: 19875323 PMCID: PMC2812704 DOI: 10.1016/j.healthplace.2009.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 09/24/2009] [Accepted: 09/30/2009] [Indexed: 11/27/2022]
Abstract
Background Family involvement in help-seeking is associated with a shorter duration of untreated psychoses [DUP], but it is unknown whether neighbourhood-level factors are also important. Methods DUP was estimated for all cases of first-episode psychoses identified over 2 years in 33 Southeast London neighbourhoods (n=329). DUP was positively skewed and transformed to the natural logarithm scale. We fitted various hierarchical models, adopting different assumptions with regard to spatial variability of DUP, to assess whether there was evidence of neighbourhood heterogeneity in DUP, having accounted for a priori individual-level confounders. Results Neighbourhood-level variation in DUP was negligible compared to overall variability. A non-hierarchical model with age, sex and ethnicity covariates, but without area-level random effects, provided the best fit to the data. Discussion Neighbourhood factors do not appear to be associated with DUP, suggesting its predictors lie at individual and family levels. Our results inform mental healthcare planning, suggesting that in one urbanised area of Southeast London, where you live does not affect duration of untreated psychosis.
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Affiliation(s)
- J B Kirkbride
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Archie S, Hobbs H, Menezes N. Translating Best Practices into Service: Implementing Early Intervention for Psychosis across Canada. Psychiatr Ann 2008. [DOI: 10.3928/00485713-20080801-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stain H, Sartore GM, Andrews D, Kelly B. First-episode psychosis in rural, coastal and remote Australian communities. Australas Psychiatry 2008; 16:119-24. [PMID: 18335369 DOI: 10.1080/10398560701802177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate access to care and service delivery for first-episode psychosis (FEP) in rural, coastal and remote regions. METHOD Routine clinical outcome data were analysed for patients aged 10-25 years who presented to mental health services in either a rural, coastal or remote region of New South Wales over a 3-year period. RESULTS The results showed rural region FEP patients travelled significantly further to access services than non-FEP patients. Remote region FEP patients were older and more likely to be male and Aboriginal than non-FEP patients. Alcohol and drug problems were significantly more likely for FEP than non-FEP patients across all regions. Utilization of mental health services was more frequent for FEP than non-FEP children and adolescents. CONCLUSION The study highlights the importance of identification of FEP, particularly in the 10-18-year age group, where cognitive problems are likely to adversely affect schooling as well as be detrimental to social relationships. Service provision for FEP youth in rural areas requires innovation and coordination of limited resources, including better provision of training and ongoing clinical supervision.
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Affiliation(s)
- Helen Stain
- Centre for Rural and Remote Mental Health, University of Newcastle, Bloomfield Hospital, Orange, NSW, Australia.
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