PEPPNET FALL, 2019 NEWSLETTER
Spotlight On: The University of New Mexico
As a rural state with a small behavioral health workforce, New Mexico has faced ongoing challenges to the provision of and access to behavioral health services. Despite these challenges, for the past decade, The Department of Psychiatry and Behavioral Sciences, Health Sciences Center, University of New Mexico (UNM), has continued to offer the only specialized services for individuals experiencing early symptoms of psychosis in the state.
Originally part of the EDIPPP study funded by the Robert Wood Johnson Foundation in 2008 and later the RA1SE trial under Dr. Steven Adelsheim, the EARLY Program provides Coordinated Specialty Care (CSC) to residents across New Mexico, ages 15-30, who have experienced a first episode of psychosis within the past year. In addition, EARLY Program staff conduct statewide community outreach and psychoeducation, provider training, and case consultations. The EARLY Program is focusing the next phase of development on systematically increasing capacity and access to evidence-based care for early psychosis in a frontier state by:
· Offering in-person or web-based annual training on CSC and the early intervention of psychosis to New Mexico behavioral health providers.
· Implementing satellite EARLY Programs at interested community behavioral health agencies across the state.
· Offering ongoing supervision and consultation to satellite programs using the ECHO model.
Early intervention of psychosis in New Mexico was further propelled in September of 2018, as UNM was awarded a SAMHSA grant for the CONNECT Program to provide stepped care to individuals living in Bernalillo county, ages 12-25, who are determined - using a structured interview - to be at Clinical High Risk of Psychosis (CHR-P). Together, staff from both EARLY and CONNECT Programs are excited to pull together resources to expand CSC services to include social group activities, peer leadership opportunities, occupational therapy, and multi-family groups and psychoeducation.
As both EARLY and CONNECT Programs are based out of an academic center, there is an additional emphasis on contributing to the knowledge base for improving services for early psychosis. With a recently funded NIMH R34 trial, both programs will be partnering with the University of New Mexico’s Student Health and Counseling Center (SHAC) to determine the effect of screening and rapid referral on reducing the duration of untreated psychosis.
We are excited for the continued growth and development of early intervention services in New Mexico and would love to hear from other programs with regards to collaboration or feedback! Please feel free to reach out to us by calling: 1(888) 663-2759 or email: Rhoshel Lenroot, MD at firstname.lastname@example.org or Bess Friedman, MSc at email@example.com.
Contributed by Bess Friedman, Msc.
Highlights From: The Second National Early Psychosis Care Conference
Sponsored by PEPPNET (Psychosis-Risk and Early Psychosis Program Network), the American Psychiatric Association (APA), the National Institute of Mental Health (NIMH), and the Substance Abuse and Mental Health Services Administration (SAMHSA), this day-long conference was packed with sessions covering a wide range of topics relevant to the care of individuals with a first episode of psychosis, or clinical high risk for psychosis.
Over 300 conference attendees participated in sessions that touched on the many facets of early psychosis care. In addition to keynote speakers Lisa Dixon, M.D., Columbia University Department of Psychiatry, who spoke on moving early psychosis intervention from research to on-the-ground community practice, and Dost Ongur, M.D., from Harvard Medical School, who spoke on first episode affective psychosis, session topics included financing for early psychosis care, the role of peer support specialists in an early psychosis care settings, challenges and opportunities associated with transitioning from CSC, cannabis use and first episode psychosis, and strategies for delivering culturally competent care.
A highlight of the conference was the Larry Seidman award for outstanding leadership in the intervention and prevention of serious mental illness going to Tamara G. Sale, M.A., the director of EASA Center for Excellence at Oregon Health & Science University/Portland State University School of Public Health. Tamara has served as the director of EASA for over six years and has shown “vision, commitment, and outstanding leadership in implementing and sustaining the first state-wide early psychosis treatment system in the United States.” Congratulations Tamara!
For information about the Early Psychosis Care Conference 2020, stay tuned to the PEPPNET listserv for future announcements.
Conference presentations from this meeting can be found on the PEPPNET website at: http://med.stanford.edu/peppnet/events/second-national-early-psychosis-care-conference-in-the-united-st/early-psychosis-conference-presentations.html
(Photo: Tamara G Sale, right, with Adriana Furuzawa, LMFT, CPRP from the Felton Institute).
Spotlight On: The Research Front
Supported employment and education in comprehensive, integrated care for first episode psychosis: Effects on work, school and disability income.
Robert Rosenheck, Kim T. Meuser, Kyaw Sint, Haiqun Lin, David W. Lynde, Shirley M. Glynn, Delbert Robinson, Nina R. Schooler, Patricia Marcy, Somaia Mohamed, John M. Kane (2017). Schizophrenia Research, (182) 120-128.
For individuals experiencing a first episode psychosis (FEP), participation in a coordinated specialty care (CSC) program has been shown to improve their psychological and functional health, to increase their participation in meaningful work and school, and to improve their overall quality of life. CSC programs in the United States include NAVIGATE, Early Assessment and Support Alliance (EASA), OnTrackNY, the Connection Program, and Specialized Treatment Early in Psychosis (STEP). CSC programs include psychotherapy, family education and support, medication management, supported employment and education (SEE), and case management, and as a critical component of a CSC program, a goal of SEE is to encourage rapid engagement in either school, or competitive employment.
In reviewing prior research on the impact of programmatic interventions on both school and work for FEP patients, Rosenheck et al., noted mixed results. For example, while a meta-analysis of three randomized control trials (RCTs) comparing interventions with an explicit SEE component based on the Individual Placement and Support (IPS) Model showed significantly higher rates of employment for those in the SEE group (versus control group), other RCTs comparing five FEP programs that did not have an explicit vocational component had mixed results; three programs had higher rates of school and/or work engagement when compared to controls, whereas two programs showed no significant difference in work or school engagement when compared to controls. Rosenheck et al. also noted that for the three RCTs that had an explicit SEE component, one criteria for FEP participant study inclusion was an expressed interest in either work or school. By contrast, the other interventions that did not have an explicit SEE or vocational component did not require FEP participants to have expressed interest in either a work or school.
These mixed results from prior interventions, coupled with the different expectations for FEP participant interest in school or work led Rosenheck, et al., to ask the question: “What is the effectiveness of comprehensive FEP programs that incorporated an SEE component for the broader range of FEP patients, including those who do not demonstrate an interest in school or work?” And, to what extent are gains in school or work engagement mediated by participation in an SEE program? In other words, does SEE matter?*
To answer these questions, Rosenheck et al., conducted a secondary analysis of data from a cluster randomized trial, Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RA1SE-ETP) by Kane, et al. (2016), which compared a CSC program, NAVIGATE, to a usual community care condition. As a CSC model, NAVIGATE has an explicit SEE component, whereas the community care condition may, or may not have a vocational component. The outcomes of interest for Rosenheck et al. were days of paid employment and/or school attendance as analyzed using both dichotomous (did the participants engage in school or work, or did not they not engage in school or work), and continuous (if they did engage in school or work, for how many days over the prior month) measures during the two-year (24 month) trial.
The results of Rosenheck et al’s analysis showed that overall, 68% of the NAVIGATE participants received three or more SEE contacts during the two-year trial, whereas only 24% of the community care (CC) as usual participants received assistance with either work or school three or more times. Further, between zero and six months, the number of NAVIGATE participants engaging in SEE contacts rose to about 50%, meaning that over half of the NAVIGATE participants who had not initially expressed an interest in SEE support, did so at six months or longer. Rosenheck et al. also showed that during the 24 months, NAVIGATE participants involvement with work or school increased 58%, whereas the CC participants showed only a 6% increase in involvement in either work or school. Further, NAVIGATE participants that had three or more SEE contacts had greater number of days of work or school per month than NAVIGATE participants who had less than three SEE visits.
From these results, Rosenheck et al concluded that SEE, when provided as a part of a CSC program for those seeking treatment for a FEP can significantly increase both school and work engagement over community care as usual, even when the community care as usual program offers vocational support. Further, that over half of the RA1SE-ETP study participants did not show an interest in either school or work engagement until after six months of participating in the NAVIGATE Program suggests that CSC programs that offer SEE might consider being flexible when allowing FEP patients to access SEE services over the duration of their participation in the CSC program. Finally, limitations of the RA1SE-EPT notwithstanding, Rosenheck et al’s analysis suggests that CSC programs that implement SEE, as in the NAVIGATE intervention, may result in greater school and work engagement for FEP patients.
*Though not reviewed here, in this study, Rosenheck et al. also examined the relationship between employment earnings, receipt of public income supports, and work and school.
Kane, J.M., Robinson, D.G., Schooler, N.R., Mueser, K.T., Penn, D.L., Rosenheck, R.A., Addington, J., Brunette, M.F., Correll, C.U., Estroff, S.E., Marcy, P., Robinson, J., MeyerKalos, P.S., Gottlieb, J.D., Glynn, S.M., Lynde, D.W., Pipes, R., Kurian, B.T., Miller, A.L., Azrin, S.T., Goldstein, A.B., Severe, J.B., Lin, H., Sint, K.J., John, M., Heinssen, R.K., 2016. Comprehensive versus usual community care for first-episode psychosis: 2- year outcomes from the NIMH RAISE early treatment program. Am. J. Psychiatry 173 (4), 362–372
Reviewed by J. Dauberman, Ph.D.
Peppnet offers monthly webinars on topics relevant to early psychosis. Most recent webinars include Cannabis and Psychosis, A Case Series on Hallucinations, Suicide Assessment and Prevention in Psychosis, and panel presentation on Support Employment and Education in first episode psychosis.
To view prior PEPPNET Webinars, go to:
Jennifer Foss-Feig on Autism and Psychosis
Jennifer Foss-Feig, Ph.D., on Autism and Psychosis
November 21, 2019, 10:00-11:00amPST/1:00-2:00pmEST
Autism and psychosis share an intertwined history. Clinically, individuals with psychosis have elevated rates of earlier autism diagnosis, and those with autism are at significantly higher risk for developing psychosis. Dr. Foss-Feig will review the historical context from which autism and psychosis journeyed from subtypes of a single disorder, to two non-overlapping disorders, to distinct but overlapping disorders sharing several genetic, neurobiological, and clinical features. Using both case examples and research findings, she will describe overlap in the clinical phenotype. She will also preview research on behavioral and neural findings between the two disorders. Finally, she will summarize current thinking about differential diagnosis of autism and psychosis and treatment recommendation when individuals with autism present with comorbid psychosis.
To register in advance:
Early Psychosis/Clinical High Risk for Psychosis Learning Community
The monthly webinars of the Early Psychosis/Clinical High Risk for Psychosis Learning Community are focused on best practices around clinical high risk (as differentiated from first-episode) with the goal of creating both a system of care and clinical infrastructure by sharing resources and providing opportunities for networking. The Learning Community is facilitated by the Oregon Health & Science University-Portland State University EASA Center for Excellence, and Stanford University's Department of Psychiatry and Behavioral Sciences, with the support of NTTAC and funded by SAMHSA.
For more information, go to: https://theinstitute.myabsorb.com
Early Psychosis Program Directory and Upcoming Events
Early Psychosis Program Directory
The programs represented on this map are from the Program Directory of Early Psychosis Intervention Programs, produced by The Early Assessment & Support Alliance (EASA) and the Foundation for Excellence in Mental Health Care (FEMHC).
Click on the map to go to the directory.
American Psychiatric Association Meeting 2020
The American Psychiatric Meeting 2020 will be held in Philadelphia, April 25-29th. Poster abstracts are being accepted through December 12, 2019.
For more information, go to: https://www.psychiatry.org/psychiatrists/meetings/annual-meeting