Evidence-Based Treatment for First Episode Psychosis

1. Evidence-Based Treatment for First Episode Psychosis Robert K. Heinssen, Ph.D., ABPP Amy B. Goldstein, Ph.D Susan T. Azrin, Ph.D. July 28, 2014

2. Disclosures • I have no personal financial relationships with commercial interests relevant to this presentation • The views expressed are my own, and do not necessarily represent those of the NIH, NIMH, or the Federal Government

3. National Programs for First Episode Psychosis

4. Early Intervention Principles • Early detection of psychosis • Rapid access to specialty care • Recovery focus • Youth friendly services • Respectful of clients’ autonomy & independence

5. Early Intervention Services • Team-based, phase-specific treatment • Assertive outreach and engagement • Empirically-supported interventions • Low-dose antipsychotic medications • Cognitive and behavioral psychotherapy • Family education and support • Educational and vocational rehabilitation • Shared decision-making framework

6. Evidence-based Treatments for First Episode Psychosis: Components of Coordinated Specialty Care • RAISE Early Treatment Program Manuals and Program Resources • OnTrackNY Manuals & Program Resources • RAISE Coordinated Specialty Care for First Episode Psychosis Manuals • Voices of Recovery Video Series http://www.nimh.nih.gov/health/topics/schizophrenia/raise/coordinated-specialty-care-for-first-episode-psychosis-resources.shtml

7. Ryan – Fulfilling My Dream

8. Coordinated Specialty Care Model

9. Coordinated Specialty Care Model

10. Coordinated Specialty Care Model

11. CSC Roles and Functions

12. Must I hire 6 new FEP specialists? • In the RAISE initiative, clinicians from multiple disciplines learned, mastered, and applied the principles of CSC • Many providers achieved competency in more than one CSC function, and fulfilled dual roles on the treatment team • Many sites leveraged existing resources to create cost efficiencies that supported the CSC program

13. CSC Team Model 1 Suburban Mental Health Center; 20-25 Clients Clinical Roles Percent Full Time Employee

14. CSC Team Model 2 Urban Mental Health Center; 25-30 Clients Clinical Roles Percent Full Time Employee

15. Revising the FY14 MHBG Plan • Depending on current capacity and set-aside amount: • Expand or augment existing CSC services • Fill gaps to create at least one operational program • Create infrastructure for a future CSC program

16. Revising the FY14 MHBG Plan • Consider targeted investments to build core CSC capacities • Shared decision making tools and training • Supported employment specialists • Regional collaborations to build FEP expertise

17. Goals for FY2015 and Beyond • Achieve and maintain fidelity to CSC model • Benchmark and monitor key quality indicators • Duration of untreated psychosis • Client retention at 3 months • Inpatient episodes, ED visits, crisis intervention • Academic, vocational, and social recovery • Health risk factors and medical comorbidities • All cause mortality (suicide behaviors, accidents, etc.) • Connect CSC programs into a “learning community” that shares expertise, resources, and quality monitoring data

18. FEP Learning Healthcare System FY2015 • Science and informatics • Patient-clinician partnerships • Incentives aligned for value • Feedback loops for ongoing system improvement • Culture of continuous learning

19. WA ME MT ND VT OR MN NH ID SD WI MA NY CT MI RI WY IA PA NJ NE NV OH IL IN DE UT MD WV CA CO VA KS MO KY NC TN AZ OK SC NM AR MS AL GA LA TX FL Thank you RAISE partners! 2 Studies 22 States 36 Sites 134 Providers 469 Participants

20. RAISE Principal Investigators • RAISE Early Treatment Program • RAISE Connection Program • John Kane • Nina Schooler • Delbert Robinson • Lisa Dixon • Susan Essock • Jeffery Lieberman

21. For More Information • www.nimh.nih.gov/RAISE • rheinsse@mail.nih.gov