PEPPNET Quarterly Newsletter /
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Summer 2016 | Issue:No. 02
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In Our Own Words

Why Our Voice Matters
by: Bonnie Hotz, Family Advocate, UC Davis SacEDAPT Clinic

Caregivers come in all shapes and sizes—parents, grandparents, aunts or uncles, siblings, spouses, and more. But one thing we all have in common is that we know our loved ones best. And that’s why our voice is such an important part of treatment and recovery. But often we hesitate to speak up, for a variety of reasons.

Our loved one may be an adult and, out of respect for his/her privacy, we hang back. If the loved one is a teenager, the decision might be more complicated. We may think letting him/her take charge teaches responsibility, or, on the flip side, we may dread the pushback that comes with telling a teen what to do, so take the path of least resistance. We want to respect our loved ones’ independence, either as a natural part of moving from childhood into adulthood, or as adults getting back on their feet and re-engaged in their lives. Few would argue these intentions are a bad thing.

On the other hand, some of us have no problem speaking up, maybe a tad too much. We speak for our loved ones even when they can speak for themselves. We take up limited appointment time discussing our own issues. We hesitate allowing our loved one to meet privately with his/her doctor or therapist, afraid that we might miss something important.

The good news? We care, and that’s no small thing. Studies show that people with mental illness get better faster and maintain their wellness more successfully with family support. However, mental health presents some unique challenges for us as caregivers and can make it hard to find the right balance between helping our loved ones recover while still respecting their independence and privacy. I know this after supporting my own daughter through her recovery, from her teenage years into adulthood, and I believe I have learned a thing or two:

1) We can help establish a routine for taking medication, and oversee that routine if needed. Caregivers can let the doctor know how successful our loved one is in following this routine. While some may resist taking medication, others may simply forget. Medication adherence can be the single most important factor in treatment, particularly in the beginning, and the clinical team often relies on family members to help present a complete picture.

2) We can provide transportation and encouragement to support our loved one's engagement in treatment.

3) We can share our observations by spending a few minutes in each appointment. Because we interact with our loved one daily, we will notice things that the clinical team will not. These observations can be extremely helpful, particularly with assessing how medication is working (or not working) to address symptoms, or alerting the doctor to the appearance of undesirable side effects. We rely on our loved one’s doctor and therapist to guide us on how best to support treatment, as the recovery process gains traction and functioning is regained, so that our support continues to be an asset rather than a liability.

As caregivers, we are an essential part of the recovery process and can be a valuable member of our loved one’s treatment team. Remember: Our voice matters!

In the News

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NIMH Funding Opportunity: Reducing the Duration of Untreated Psychosis

The National Institute for Mental Health has two active funding opportunities for reducing the duration of untreated psychosis. Earliest submission date was June 19, 2016; additional application due dates are July 19, 2016; November 18, 2016; March 17, 2017; July 18, 2017; November 17, 2017; March 19, 2018; July 18, 2018; November 19, 2018; March 19, 2019.

1. The planning grant Funding Opportunity Announcement (FOA) seeks planning grant applications that (1) identify a baseline rate of DUP in community settings that include CSC programs; (2) map referral pathways to CSC care, (3) identify bottlenecks and gaps in the pathway to CSC care, and (4) develop and pilot test feasible strategies for substantially reducing DUP among persons with FEP
. Learn More »

2. The research project Funding Opportunity Announcement (FOA) seeks research project grant applications that test practical, reproducible strategies for substantially reducing DUP among persons with FEP by eliminating bottlenecks or closing gaps in the pathway to CSC services More information »

From the Research Front

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First episode psychosis in the over 35s: Is there a role for early intervention?
by: Melissa Yanovitch, MSc, MS
Early intervention in psychosis is generally offered to young patients experiencing first episode psychosis (FEP) or prodromal symptoms of psychosis. The aim of this pilot study was to explore the impact of early intervention services in patients with FEP ages 35-65. The study is in response to the guidelines put forth by the National Institute of Clinical Excellence in the UK that recommend early intervention be available to any person experiencing FEP, regardless of age. The study sample consisted of 72 patients experiencing FEP over the age of 35. Data on hospitalizations, self-harm or harm to others, employment status, social supports and physical health comorbidity were collected at 1-year follow-up. Results from the study suggest that patients with FEP over the age of 35 represent a sizeable proportion of those referred for early intervention services, and significantly impacted provider caseloads. The researchers suggest that offering early intervention services to patients in the age range included in the study be accompanied by an increase in resources in order to ameliorate the impact on providers’ caseloads and enable them to continue to provide high quality care. Results also indicate that early intervention services may be indicated for patients in this age range, as participants benefitted from these services in many areas of functioning. The researchers added that early intervention should include trauma services as they found that the majority of patients in the sample reported a history of trauma. In addition to these suggestions, the researchers emphasize that patients with FEP in this age range be offered vocational training to support occupational functioning.

Greenfield, P., Joshi, S., Christian, S., Lekkos, P., Gregorowicz, A., Fisher, H. & Johnson, S. (2016). First episode psychosis in the over 35s: is there a role for early intervention? Early Intervention in Psychiatry, 1-7. doi: 10.1111/eip.12322

An exploration of what services users value about early intervention in psychosis services

This study aimed to explore the aspects of early intervention in psychosis services that service users found to be most valuable. A small sample of services users answered questions about their experiences with early intervention services, and the researchers found four areas that were described as being the most valuable: therapeutic relationship, medication, psychological interventions, and practical help and support. Of these, the researchers found that the most important factor cited by services users was therapeutic relationship. These findings are helpful in determining the factors that support services users in continued engagement with treatment, and can ultimately lead to improved treatment outcomes.

Barr, K., Ormrod, J. & Dudley, R. (2015). An exploration of what services users value about early intervention in psychosis services. Psychology and Psychotherapy: Theory, Research and Practice, 88, 468-480. DOI:10.1111/papt.12051

Spotlight On

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The STEP Program
By: Vinod Srihari, MD (Program Director), Jessica Pollard, PhD (Director of Clinical Services) and
John Cahill, BMBS, BMedSci. (Medical Director)

Funded by the Connecticut State Department of Mental Health and Addiction Services (DMHAS), the STEP Program ( has, since 2006, provided a model of Coordinated Specialty Care (CSC) to young people and families confronting the new onset of a psychotic disorder. In 2013, STEP completed the first U.S. randomized controlled trial of such care, reporting a 48% reduction in risk of psychiatric hospitalization in the first year after entry into the service, along with reductions in total number and duration of hospitalizations. Also, individuals receiving STEP care were markedly less likely (<10%) to drop out of the labor force compared to usual care (>30%). Following on these results, additional funding from DMHAS allowed conversion to a permanent service offering in 2014. In 2015, STEP launched a 3-year campaign to shorten the duration of untreated psychosis (DUP) in 10 surrounding towns. This addition of early detection to an established CSC model will test a comprehensive early intervention service for psychotic disorders. The campaign, funded by the National Institutes of Health (NIH) is called Mindmap ( and includes media messaging, outreach to community stakeholders and performance improvement approaches that all aim to halve historical delays into STEP care.

STEP attempts to engage into care all individuals between the ages of 16-35 in the target region who are within 3 years of psychosis onset. Two years of free care is offered to all, irrespective of insurance status, and includes diagnostic evaluation, medications, individual psychotherapy, groups targeting social cognition deficits, family education and services to support educational and employment goals.

The goal of STEP is to build a population health-based system of care in a defined region (population 400,000) by engaging a regional network of clinical and non-clinical care providers to transform pathways to and through care. We aim to model a cost-effective approach to early intervention that is primed for dissemination.

Over the past 10 years, STEP has assisted in the establishment of new services and provided consultation to established programs. We are currently building an online platform to support dissemination of this model of care. Learn more about the STEP Program:

Upcoming Events

Providing Coordinated Specialty Care Services for First Episode Psychosis in Rural and Frontier Settings: A webinar sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS)
Thursday, July 7, 2016, at 2:00-3:30 pm Eastern

Description: Providing clinical services in sparsely-populated rural areas can present a variety of challenges. The presenters will discuss issues related to the treatment of first episode psychosis (FEP) in remote settings, covering topics including: community education and outreach; considerations for infrastructure development; delivering medical and psychosocial interventions over distances; workforce development issues; and strategies for setting up a telehealth system. Time will be provided for audience questions.

  • Caroline Bonham, MD; Director of the Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences at the University of New Mexico Health Sciences
  • Tanya Brown, LMSW, FEP Team Leader at the Carey Counseling Center, Inc. (Tennessee)
To register visit: www.JBInternational.webex
SAMHSA Webinar Series: Addressing Serious Mental Illness: Effective Prevention, Treatment and Recovery Strategies
Through the summer, SAMHSA is sponsoring a four-part webinar series delivered by the partners in the Mental Health Block Grant Coalition, which has been developed and sponsored by SAMHSA. These webinars will describe new and emerging practices across a variety of services and explore how these approaches are financed, including state and local examples.
The 4 parts are:
  • Peer Webinar Series
  • Home and Community-Based Webinar Series
  • Children’s Webinar Series
  • Criminal Justice Webinar Series
For more information:
Developing and Financing Peer-To-Peer Support Services Across the Continuum
August 23-24, 2016, Boston MA

This 2-day training will cover modifications needed to tailor adult peer support models to develop youth peer services that address the developmental needs of young adults, while also addressing cross systems considerations in design and sustainability. Building understanding of the unique needs of young adults and the special considerations in planning for youth peer support will be emphasized. The training will include case examples from states that have been able to design, implement and sustain specialized youth peer support programs. Content will include:
  • Using strategies for establishing new or expanding existing peer support models
  • Establishing diverse array of funding options for youth peer support
  • Developing systems and policies regarding youth peer support services
Who Should Attend? Ideal teams would include grantee leaders (project director and youth coordinator), state Medicaid and/or behavioral health office, organizations that are current or potential employers of youth peer providers, youth peer providers and/or youth leaders.
For more information about this no-cost training, visit:
Looking Back Moving Forward: The 10th International Conference on Early Psychosis
Marriott Milan, Italy, October 20-22, 2016

The IEPA is a biannual international conference that has served as a forum for groundbreaking discussions that have led to many breakthroughs in the area of early intervention.
For more information visit
First Episode Bulletin is a quarterly newsletter produced by the Prodrome and Early Psychosis Program Network (PEPPNET). Funding has been provided by the Robert Wood Johnson Foundation.

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