First Episode Psychosis Programs in Pennsylvania: Laying the Groundwork for Systems Change 1
NAMI Keystone Pennsylvania’s grassroots advocacy initiative to bring awareness to Pennsylvania’s 9 FEP programs 2
Presentation Goals ● Comprehensive Overview of First Episode Psychosis and Coordinated Specialty Care ● Inside Look at the HOPE FEP Program ● The State’s Role ● #BackOnTrackPA Call to Action 3
4 ENGAGE: IMPROVING THE LIVES OF INDIVIDUALS EXPERIENCING FIRST-EPISODE PSYCHOSIS AND WORKING TO DECREASE THE CHANCES AND DURATION OF A SECOND EPISODE A program of Wesley Family Services Marci Sturgeon-Rusiewicz, MS, NCC, LPC, CPSS, Doctoral Candidate
5 WHAT IS HAPPENING TO AN INDIVIDUAL BEFORE THE ONSET OF PSYCHOSIS? • During the prodromal phase of psychosis , individuals usually display unspecific symptoms, such as: • anxiety and depression • abuse of alcohol or drugs • social decline • Psychotic episodes rarely occur out of the blue. • Almost always, a psychotic episode is preceded by gradual non- specific changes in: Thoughts • Perceptions • Behaviors • Functioning •
6 • Over the past 25 years, an increasing number of specialized treatment programs for early psychosis have been established around the world • There is now evidence that these programs can reduce the duration of untreated psychosis and produce better symptomatic and functional recovery • These treatment options yield better outcomes, are more cost-effective than standard models of mental health care, are individualized Wyatt RJ. Neuroleptics and the natural course of schizophrenia. Schizophrenia Bull. 1991;17(2):325 – 351
7 THE GOALS OF EARLY DETECTION: • reduce the period of time between the onset of psychosis and care • provide consistent and comprehensive care during the critical early years of illness • Effective care during the early years involves proactive engagement of psychosocial treatments as well as the introduction of low-dose anti- psychotic medication.
8 WHAT IS COORDINATED SPECIALTY CARE? • specialized, recovery-oriented treatment • promotes shared decision making • Psychotherapy • medication management • family education and support • case management • work or education support
9 PROGRAM PHILOSOPHY • The program philosophy is based on resiliency through empowerment , operating within a strengths- based model using multi-disciplinary specialty care and the promising practices of peer support • Empowering People to Reach their Full Potential: This service has been developed as part of a statewide effort which is looking for additional ways to improve the lives of people experiencing first-episode psychosis • The program (ENGAGE: Educate, Navigate, Grow and Get Empowered) involves exploring new areas and ideas for treating first episode psychosis by looking at ways of decreasing the duration of untreated psychosis
10 WHO DO WE HELP? • Young adults between the ages of 15 and 25 who are experiencing their first episode of psychosis and reside within Allegheny County HOW DO WE HELP? Through the use of a Coordinate Specialty Care (CSC) Team promotes shared decision making Team of specialists: Psychiatrist (low-dose medication and education) Case Manager (navigating resources) Therapist (CTR- and much more…) Supported Living/Supported Employment (job coaching and preparedness) Certified Peer Specialist (lived experience) Registered Nurse (education and wellness) Treatment is based upon the individual client’s needs and preferences
11 EDUCATE It is important to do the right thing at the right time! Coordinated Specialty Care is more effective than usual treatment approaches and is most effective when the participant has a shorter duration of untreated psychosis (ie: the length of time between the beginning of the psychotic symptoms and the beginning of the right treatment)
12 NAVIGATE • Common areas of program focus are listed below, but not limited to… • Developing personal plans • Increasing self worth through building mastery • Increasing introspection-awareness • Gaining confidence • Increasing personal growth • Building connections with community • Establishing and setting boundaries • Planning for transition/crisis planning • Advocating personal needs/developing communication • Understanding symptom management • Finding meaningful life activities/exploring interests • Identifying work skills/enhancing work skills • Enhancing resources
13 GROWTH FAMILY PSYCHOEDUCATION (FPE) AND MULTI-FAMILY PSYCHOEDUCATION (MFG) • A structured approach for partnering with participants and their families to support resiliency and recovery • To create a sense of community • Participants and families receive information about psychosis and learn problem-solving, effective communication and coping strategies
14 EMPOWERMENT ADVOCACY AND EDUCATION • Participants Share • Importance of early intervention • Importance of peer support • Need for collaborative and inclusive care
15 EARLY ADOPTION OF FEP: Maximize Hope End Stigma Whole Improve Treatment Health Outcomes Coordinate Care Decrease Duration
HOPE Joint Decision-Making Promises HOPE Denise Namowicz, MSW, LCSW Director of HOPE Children’s Service Center 16
What is HOPE at the Children’s Service Center First Episode Psychosis Program Ages 15-25 First episode within 2 years Early intervention of treatment Participant/Family Groups Monthly Events 17
Present Referral Status Approaching the 2 nd year of the Program 31 active cases as of 5/01/19 78 cases referred 38 cases denied/refused 18 discharged 18
Coordinated Specialty Care: A Collaborative Approach of Disciplines Recovery-oriented treatment program Collaborative approach of disciplines Luzerne-Wyoming Counties System of Care Initiative Community Care Behavioral Health Organization Northeast Counseling Services Children’s Service Center 19
A Collaborative Approach Produces: Symptom reduction Reduced hospital days/hospitalizations Growth in functional activities Decrease in future episodes of psychosis Strengthened social skills and engagement 20
Demographics Sex % Male 37 Female 53 Race % Caucasian 63 African American 8 Asian 2 Unknown 27 Age at: Mean Yrs. (s.d.) Admission 16.0 (2.7) Onset of Psychosis 14.9 (3.7) Duration of Psychosis: Mean Yrs. (s.d.) Prior to Admission 1.1 (2.3) 21
Adverse Behavior: 6 Month Follow Up 40% 35% 35% 31% 30% 27% 25% 20% 15% 15% 15% 15% 12% 12% 8% 10% 4% 4% 4% 5% 0% Legal Violent or Violent or Suicidal Suicidal Other Self Issues Aggressive aggressive Ideation Attempt injurous Ideation Behavior Behavior 22 Admission 6 Month Follow Up
Psychiatric Hospitalizations 50% 46% 45% 40% 35% 30% 25% 20% 15% 12% 10% 5% 0% Prior to During 6 months Admission to of Enrollment in FEP Program FEP Program Note: Data from participants (n=26) with 6-month follow-up 23 data. Among all participants admitted to HOPE (n=48), 46% had a hospitalization prior to admission.
Substance Use 25% 20% 20% 15% 12% 12% 12% 10% 8% 4% 5% 0% 0% 0% Alcohol Marijuana K2 Other Admission 6 Month Follow-Up 24
Competitive Employment 30% 27% 25% 20% 15% 12% 10% 5% 0% Admission 6 Month Follow-Up Note: Data from participants (n=26) with 6-month follow-up 25 data. Among all participants admitted to HOPE (n=48), 12% were competitively employed at the time of admission.
Coordinated Specialty Care for First Episode Psychosis (FEP) Office of Mental Health and Substance Abuse Services Jill Stemple Section Chief, Planning Bureau of Policy, Planning, and Program Development 26
History of FEP in Pennsylvania • Pennsylvania has provided grants to geographically-diverse FEP programs, for start up and ongoing development, using the 5% and 10% set-asides from the Community Mental Health Services Block Grant (CMHSBG) funding: – 2 FEP program sites in 2014-2015 – 4 FEP program sites in 2015-2016 – 8 FEP program sites in 2016-2017 – 9 FEP program sites in 2017-2018 – Pennsylvania Early Intervention Center in 2018-2019 27
FEP in Pennsylvania: 2019-2020 • Funding made available for up to two additional FEP Program Sites • Funding made available for up to four current FEP Programs to pilot a Stepped Care Model • In partnership with PEIC – Continued program evaluation for all FEP Sites – Continued in-person annual training for FEP Sites – Additional opportunities for ongoing training – Development of telephonic provider consultation for primary care and psychiatric providers in counties without a full FEP Team. 28
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