In the study, researchers at Yale University School of Medicine and other institutions randomly assigned patients with a first-episode psychosis to the STEP program (n=60) or usual care (n=57). Referrals were mostly from inpatient psychiatric units. The main outcome was hospital utilization; secondary outcomes were the ability to work or attend age-appropriate schooling or to seek these opportunities, and improved general functioning, assessed by the Social Functioning Scale.
STEP is located within the Connecticut Mental Health Center (CMHC). Patients are allowed to choose from a menu of options that included psychotropic medications, family education, cognitive-behavioral therapy (CBT), and case management focused on brokering with existing CMHC-based services for employment support and with area colleges for educational support.
Patients randomly assigned to usual treatment either continued treatment with existing outpatient providers or were referred on the basis of health insurance coverage.
After one year, STEP participants had less inpatient utilization compared with those in usual treatment; among STEP participants, 77 percent had no psychiatric hospitalizations versus 56 percent in usual treatment. Mean hospitalizations and mean bed-days were also lower. For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year. STEP participants also demonstrated better vocational engagement and showed trends toward improvement in global-functioning measures.
“This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses,” the researchers stated. “Such services can also support translational research and are a relevant model for other serious mental illnesses.”
For related information, see the Psychiatric News article "Early Intervention Trial for Youth at Risk of Psychosis Shows Improved Symptoms."