Individuals with first-episode psychosis who received the wide range of services provided in coordinated specialty care (CSC) programs experienced improved symptoms, higher quality of life, and improved functioning, according to a study published today in Psychiatric Services. This was especially true for individuals who were treated in programs that adhered to the core components of CSC.
CSC is a recovery-oriented treatment model for people experiencing first-episode psychosis that provides a range of evidence-based services delivered through a multidisciplinary team. A variety of programs exist, but in 2014, the National Institute of Mental Health (NIMH) outlined the core components of CSC:
- Medication management
- Psychotherapy
- Case management
- Family education and support
- Supported employment
- Supported education.
This study demonstrates that “the six CSC components identified by NIMH may constitute the core essential ingredients that should be made available in all CSC programs, regardless of the specific model, and that fidelity to those components may enhance positive outcomes,” wrote Abram Rosenblatt, Ph.D., of the health care consulting firm Westat, and colleagues.
Rosenblatt and colleagues looked at patient- and clinician-rated measures of psychotic symptom frequency, quality of life, and social and role functioning for 770 individuals receiving CSC services in 36 federally funded programs; patients were assessed at time of entry and every six months for up to 18 months. All programs were also assessed for fidelity to the core components outlined by NIMH. Additional program-level variables assessed during the study included staff turnover rate and time spent on CSC services.
Overall, the average frequency of psychotic symptoms decreased among patients receiving CSC services from baseline to follow-up, while quality of life, social functioning, and role functioning scores all increased. In programs that had higher fidelity to the NIMH model, individuals showed a greater improvement in psychotic symptom frequency and social functioning. After accounting for the other program-level characteristics, the researchers also found that the more time the team leader spent on CSC program services, the greater the patient symptom improvement and social functioning.
Rosenblatt and colleagues said additional research is needed to identify how and whether services specific to existing models yield the most effective CSC programs, including the quality of services offered and received. “…[M]aximizing the value of CSC across a broad range of settings and diverse client populations requires further understanding of and attention to fidelity, implementation, and adaptation,” they wrote.
For related information, see the Psychiatric News article “Look for Hope and You Will Find It: Outlook for First Episode Psychosis Has Never Been Better.”
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