Thursday, October 3, 2019

Early Psychosis Treatment Succeeding but Challenges Remain for Sustainability

Early treatment of psychosis has moved out of the research arena into on-the-ground community practice, said Lisa Dixon, M.D., a professor of psychiatry at Columbia University and editor of the APA journal Psychiatric Services. She spoke yesterday at the “Early Psychosis Preconference” held in conjunction with APA’s IPS: The Mental Health Services Conference in New York.

There has been success reaching patients in need and improvements in the course of their illness and treatment outcomes, but achieving long-term sustainability is a challenge for early psychosis programs, requiring advocates to pay attention to public health policy, funding, and reimbursement. “In order to be successful, we must of course focus on patient care. But we need to do more,” Dixon said.

The preconference brought together some 350 mental health professionals involved in the identification and treatment of individuals with psychosis and included a rich variety of presenters.

Dixon presented an overview and evaluation of OnTrackNY, a program of the Center for Practice Innovations at Columbia University/New York State Psychiatric Institute and the New York State Office of Mental Health. Established in 2013, it now includes 23 sites in New York state and serves individuals aged 16 to 30 who have experienced nonaffective psychosis for less than two years.

OnTrackNY is one of the most well-established early psychosis programs in the United States, according to Dixon. Using a framework developed by health services researchers to evaluate program implementation known as RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), Dixon noted some of the lessons learned from the program to date:

Reach: OnTrackNY has served over 1,600 patients since 2013; the program has the capacity to care for 900 patients at a time. “While the growth of OnTrackNY has been remarkable, the actual need may be closer to 2,000 slots based on assumptions about the incidence of schizophrenia and nonaffective psychosis,” Dixon said.

Effectiveness: Rates of participation in treatment, data on rehospitalization, work and school status, and overall functioning are positive, but there is substantial variability across clinics. Also, more needs to be done to identify and help patients with poorer outcomes.

Adoption: The program has thrived in a diversity of sites and locations across the state, but the ability to serve individuals in rural areas remains a challenge.

Implementation: OnTrackNY developed training models to ensure “fidelity,” or the ability of clinics to abide by a model of treatment standardized across sites. Most teams within OnTrackNY have met that standard; the most common unmet domains are metabolic screening of patients and use of peer supports.

Maintenance: OnTrackNY has been fortunate in having the financial support of the state, but long-term funding remains a challenge. There is a need for a more systematic approach to discharge patients, step-down to less intensive services, and long-term follow-up.

“Progress in the implementation of early intervention programs for individuals experiencing early psychosis is palpable,” Dixon said. “The lessons learned inspire strategies for ongoing improvement.”

More coverage of the early psychosis conference and IPS will appear in future issues of Psychiatric News.

For related information, see the Psychiatric Services article “Results of a Coordinated Specialty Care Program for Early Psychosis and Predictors of Outcomes.”

(Image: Mark Moran)

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