EarlyPsychosisProgramImplementa4oninCalifornia:
OverviewofCoordinatedSpecialtyCare(CSC)
TaraNiendam,Ph.D.AssistantProfessor,UCDavisDepartmentofPsychiatry
DirectorofOpera4ons,UCDavisEarlyPsychosisPrograms(EDAPT&SacEDAPTClinics)
Objec4ves
• ProvideanoverviewofCoordinatedSpecialtyCare(CSC)withintheUS
• Provideoverviewofpsychosocialtreatmentop4ons,includingtherapeu4cinterven4onsandaddi4onalsupportssuchasFamily/PeerAdvocateandSupportedEduca4on/Employment
• Providesugges4onsforprogramimplementa4on
USModelsofCoordinatedSpecialtyCare(CSC)
• RAISE,EASA,PIER,EDAPT,PREP…• Allarevaria4onsoncoordinatedspecialtycarewithsomenuancesforthetargetpopula4on– BothCHRandFirstepisode– Agesserved– Othercriteria?
• Substancedependence,IQ<70,Countyofresidence,Uninsured,Undocumented…
Heinssen,R.,A.Goldstein,andS.Azrin,Evidence-BasedTreatmentsforFirstEpisodePsychosis:ComponentsofCoordinatedSpecialtyCare.2014:Na4onalIns4tutesofMentalHealth.h[p://www.nimh.nih.gov/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf
CoordinatedSpecialtyCareModel
h[p://www.nimh.nih.gov/health/topics/schizophrenia/raise/coordinated-specialty-care-for-first-episode-psychosis-resources.shtml
CommunityOutreach&Educa9on↓S4gma↑Referrals
Coordina9onwithPrimary
Care
OtherStaffop4ons:• Nurse• Occupa4onalTherapy
OutcomesEvalua9on
RELAPSEPREVENTION&
CRISISMANAGEMENT
Outreach• Focuson“pointsoffirstcontact”formentalhealthservicesinyour
community– Communitymentalhealth– Emergencyrooms,Crisiscenters,hospitals– Schools,colleges– PrimaryCare– Jails,Proba4on,Police– Communityorganiza4ons,socialservicesagencies– SocialMedia
• Goals=Increaseknowledgeofearlysignsandsymptoms,awarenessofyourprogram(rapidreferrals),reduces4gma
• Ongoingprocess–youMUSTkeepdoingthistokeepreferralscomingin
Iden4fica4on&Assessment
• Screeningprocessbytrainedstafftodeterminepreliminaryeligibility
– Respondquickly– OverthephoneORinperson
– Mayincludevalidscreeningmeasure(PQ-B,Loewyetal.,2011)
Iden4fica4on&Assessment
• ComprehensiveEvalua4on– Semi-structuredassessmentofpsychosis,mood,trauma,andsubstanceusesymptoms:• FirstEpisode:StructureClinicalInterviewforDSM(SCID,Firstetal.,2002)
• HighRisk:StructuredInterviewforProdromalSyndromes(SIPS;McGlashanetal.,2001)
àWhendidpsychosisstart/worsenandimpactfunc4oning?
– Includecollateralinforma4on!Engagefamily/supportpersonsnow!
Iden4fica4on&Assessment
• ComprehensiveEvalua4on– ThoroughHistory:Prenatal/Perinatal,Developmental,Medical,PriorTreatment,FamilyMentalIllness,SocialFunc4oning,RoleFunc4oning,Cogni4on(IQ),Trauma• Whendidthingschange?
– RiskFactors:Relapse/hospitaliza4on,Suicide,Violence,Housingstability,RunningAway,etc
– Otherrelevantpsychosocialfactors:Support,Finances,etc.
TreatmentPlan• Recoveryispossible(vs.disability)!
– Recoveryisnottheabsenceofsymptoms,buttheimprovedmanagementofdistress
– Primarygoal=returntheclienttotheirbaselinefunc4oningandsupportdevelopmentofmeaningfulrolesandgoals
• Whataretheclient’sgoals?– Maynotbementalhealthrelated…– OKtofocusonwhatmo4vatesthemsoyoucanengagethemincare– Strengthsbased
• Howcansupportpersonsbeincludedintreatmentandsupportedtohelpclientachievetheirgoals?
• Whatcomponentsofyourtreatmentshouldtheypar4cipateintoachievetheirgoals?
InterdisciplinaryTeam-basedApproach• WeeklyTeamMee4ngs=CorePieceofthemodel!
– Reviewcases,treatmentrecommenda4ons,consensusdiagnosis
• Clinicianorcasemanagerassignedtoeachclient– Providepsychoeduca4on,therapy,crisissupport
• Psychiatricsupport– Assignedtoeachclient,availableregularapptsANDcrisisappts,partoftheteam,
availableforconsulta4onandcoordina4on(co-located)– Monitormedica4ons,referforlabs,coordinatecarewithothermedicalprac44oners
• Supporttomaintainacademicorvoca4onalfunc4oning– SupportedEduca4on&Employment
• Supportandpsychoeduca4onforfamily– Viagroupsorindividually– PeerandFamilyAdvocates
TeamLeadership&Support• ProgramManagerorDirector
– Overseesprogram,workswithcountyoncontractandbudget– Maydooutreachoreduca4onalpresenta4ons
• TeamLeader– Dailyoversight,supervisionofstafftoensurefidelity,mayprovidedirect
care– Ensuresqualityand4melinessofservices– Overseesoutcomesdatacollec4on
• Clericalsupport– Ini4alengagement,phonescreens– Managescheduling,records,labs,etctosupportthestaffandclients– Don’tunderbudgethere!!
• Allarepartoftheteam!
PsychosocialInterven4ons• Medica4onsdonottargetthefullrangeofsymptoms
• Individualsneedsupportwithbuildingskillstoimproveorreturntosocial/rolefunc4oning,evenoncesymptomshaveremi[ed
• PsychosocialInterven4onsaretargetedathelpingtheindividualmanagestressorstoavoidrelapseandlearncopingskillstomanageanyresidualsymptoms
EngagementinTreatment
• Reviewassessmentresults,currentriskfactors– Psychoeduca4onondiagnosis– SafetyPlanning– Laythefounda4onfortreatment
• Describetreatmentapproach– Whyshouldtheyengageinwhatyouareoffering?– Importantoffamily/collateralengagement
ImportanceofFamilyInvolvement
• Enhancedsupportsystemforrecovery– Familyprovidesignificantsupporttoindividualsintheearlystagesofpsychosis
• Improvedcommunica4on–howarethingsreallygoing?
• Increasedengagementintreatment• Needtoensurefamilyisthereforthelongterm
Vulnerability-StressModel
Threshold
Stre
ss
High
Low
Presence of Symptoms
Absence of Symptoms
Genetic VulnerabilityLow High
IndividualizedInterven4ons
Cogni4veBehavioralTherapyforPsychosis(CBTp)• CBTforpsychosishasbeenstudiedinover40randomizedcontrolledtrialsandvariousmeta-analysessincethe1990’s(Lecomte,et.al.,2014)
• CBTforpsychosisiseffec4ve,demonstra4ngacceptableeffectsizes,andthatitshouldbedeliveredrou4nelyaspartofatreatmentpackageofferedtopeoplewithschizophrenia(MorrisonandBarra[,2010).
Cogni4veBehavioralTherapyforPsychosis(CBTp)
• Cogni4veModel:Itistheinterpreta<onofanexperiencethatcausesthedistress,nottheexperienceitself.
Event Response(Emo4on/Behavior)
Event
Interpreta4onoftheEvent(thought)(assignmeaningto
theevent)
Response(Emo4on/Behavior)
Cogni4veBehaviorTherapy
• Peopleresponddifferentlytosimilarsitua4onsbasedonhowtheyarethinkingaboutthesitua4on
• CBTteachespeopletoobservetheirthinking,evaluateitforaccuracyandimpact,andchangeinaccuratethoughtsinefforttoreducedistress
Cogni4veBehaviorTherapy• Psycho4cthoughtsvs.depressedthoughtsvs.anxiousthoughts…what’s
thedifference?
• Psychosis=distorted/falsebeliefs,misinterpreta4onsoftheenvironment
• Psycho4cexperiencesareculturallyunacceptableinterpreta4onsofexperience
– PanicDisorder:“myheartisbea4ngquickly,mybreathingisaccelerated,Imustbedying”
– Psychosis:“myheartisbea4ngquickly,thegovernmentplantedachipinme”
– Anorexia:“I’mtoofat,Ican’teat,foodismakingmefat”– Psychosis:“MyfoodispoisonedthereforeIcan’teatit”
– SocialAnxiety:“Othersarelookingatmeandlaughing”– Psychosis:“Othersarelookingatmeandgoingtohurtme”
Cogni4veBehaviorTherapy• Conceptualizethepsycho4csymptomasthe“situa4on/event”
• Situa4on/Event:hearingvoices• Thoughts:interpreta4onofvoicesand/ortheircontent;nega4veautoma4cbeliefaboutvoices• Emo4on:fear,anxiety• Behaviors:responsetovoices
Situa4on/Event
Thought/Interpreta4on
Behavior/Emo4on
Cogni4veTechniques• CATCHIT:
– iden4fyautoma4cthoughts(contentofsymptom)andinterpreta9onsofthesymptomandtheresul4ngfeelings&behaviors
– evaluatelevelofconvic4onandimpactonbehavior,useSUDStomeasuredistresslevelofthe“thought”
• CHECKIT:– evaluateaccuracyofthethought– iden4fypa[ernsofdistor4on– evidenceforandagainst
• CHANGEIT:– generatealternateinterpreta4ons– morerealis4cbeliefs/interpreta4ons– normalize
Cogni4veTechniques
• Goalmaynotbetoremovedistortedbeliefen4rely– Simplytellingpersonthattheyarewrongwillnotchangethebelief
– Reduc4onofconvic4oncanbeveryhelpful
• Examinealternateexplana4onsfortheintrusion/experienceandseehoweachexplana4oneffectsconvic4onlevelandlevelofdistress(useSUDStomeasureeach4me)
GroupTreatmentApproaches
• Mul4-FamilyGroupTherapy(MFGT)
• FamilySupportGroup(FSG)
• SubstanceAbuseManagementGroup(SAM)
• PeerSymptomManagementGroup
• ExpressiveArtsGroup
Mul4familyGroupTherapy • Originallydevelopedinthe1960’s,adaptedbyWilliamMcFarlanein
the80’s– High“expressedemo4on”inthehomeisconsistentlyassociatedwithrelapse.
• Goalisenhanceproblemsolving,improvecommunica4onandreducedistress/conflictinenvironment– REDUCECri4cism,Hos4lity,Emo4onalOver-involvement– IncreaseWarmthandPosi4veRegard
• MainStagesofMFGTprogram1) Conduc4nganeduca4onalworkshopaboutpsychosisforfamilies2) Joining(i.e.,buildingrapport/alliance)amongindividualpa4entsand
families3) Problem-solvingfocusedgroupsa[endedbybothpa4entsandfamiliesMFGTisdeliveredbytwoclinicianstogroupsof5-8familiesovera2-yearperiod.
Mul4familyGroupTherapy• MFGGoals:gainknowledgeofpsychosisandlearnskills(problemsolving,communica4onandstressmanagement),reduceisola4on
• Leadstoimprovedillnesscourseandoutcomesthrough:– Familiesbenefitfromeachother'sexperiencesinsolvingproblems
– Increasingsocialnetworksizeandsupport,
• Acrossanumberofclinicaltrials,MFGhasbeenshowntodecreaserelapseandre-hospitaliza4onamongpa4entswithschizophreniaandtoimprovefamilywell-beingoverthe2-yeartreatmentperiod(McFarlaneetal.,2003).
FamilySupportGroup• Designedtoprovidepsychoeduca4onandsupporttofamilymembersoftheclient
– Helpsthemunderstandsymptoms(vs.developmentalprocesses,otherdisorders)
– Helpsthemmonitorsymptomsathomeandteachesthemhowtorespond(ex:donotdirectlychallengedelusions)
– Helpsthemgainsupportforsuppor4ngtheclientathome
– Problemsolvingfacilita4on/orienta4on
SubstanceAbuseManagementGroup
• BasedonSacPORTSubstanceAbuseManagementModule(SAMM)
• Harmreduc4on/recoveryorientedmodel• Learnaboutbiologicalimpactofsubstanceuse(psychoeduca4on)
• Learnmoreeffec4vecopingstrategies(behavioralandproblemsolvingorientedgroup)
PeerSymptomManagementGroup
• Skillsbasedgroup
• Iden4fysymptoms
• Reduceandmanagestressors
• Buildsocialskills
• Learnabouthealthyhabitsrelatedtodiet,sleep,etc.
• Gainpeersupport
ExpressiveArtsGroup• Non-verbal,ar4s4cexpressionofstressors,symptomsanddistress– Music,wri4ng,visualart,dance
• Gainsocialskills
• Gainpeersupport
• Learnsymptommanagementthroughbuildinghealthycopingskills
SupportedEduca4on/Employment• Returningtoworkorschoolisoxenakeywellnessgoalforour
clients• SEEservicesareanintegralcomponentofmentalhealth
treatmentratherthanaseparateservice(Crowtheretal.,2001)
• Servicesarebasedonclient'spreferencesandchoices– Assessmentofgoals– Educa4onaboutskillsneededtoreachgoals– Guidanceinobtainingsupport/skilldevelopment
• Servesastheliasonbetweenteamandotherservices(work,school)– EmploymentàCoachingonresume.Volunteertobuildjobskills
THENapplyforjobs– Educa4onàSupportvia504orIEPTHENreturntoregularseyng
Peer/FamilySupport• Directservicestarge4ngmentalhealth&func4oning
treatmentgoalsprovidedby• Peer:individualwithlivedexperiencewiththeillness• Family:haveafamilymemberwhoisaconsumerwiththe
illness• Integratedpartoftheteamatalllevels• Assessmentofneedsatthebeginningoftreatment• Supportstreatmentgoals–problemsolving,
communica4on,socialskills.– Co-leadsgroups(FSG,MFG)
• Sharesstory–provideshope• Assistsinaccessingbenefitsandservicesinthe
community• Supportsduringtransi4ontoongoingcareatendof2yrs
inprogram
Howdowestartaprogram?• WhatarethetrulyCOREcomponents?– Amul4-disciplinaryteam– Needatleastaclinician,psychiatriccare,andsupportstaff– Traininginassessmentandtreatment(CBTp,MFG)
• Someonewhocansuperviseyou/consultinanongoingway– Outreachtocommunityàneedtobereadywhenreferralscomein
– Canaddothercomponentsasyoubuildacensus• Makesureyouhavecross-trainingandcoverage!• Oktosharestaffwithotherprograms,BUTtheyhavetobeabletofunc4onintheteamandrespondtocrises
Sale,T.andS.Blajeski,StepsandDecisionPointsinStar4nganEarlyPsychosisProgram.2015:NASMHPDPublica4ons.h[p://www.nasmhpd.org/sites/default/files/KeyDecisionPointsGuide_0.pdf
SacEDAPT
CoordinatedSpecialtyCare
TreatmentApproach
TheModelinAc4on
Vigne[eBeginningofTreatment• Annaisa17yearoldAsianwomancompletestheini4alassessment
processwhichincludedbothclinicalandMDintakes.Herini4aldiagnosisisPsychosisNOSwithonsetofpsycho4csymptoms6monthsago.
• Annaliveswithherparents,twoyoungerbrothers,andpaternalgrandmotherinarentedhouse.HerparentsreportincreasedstressandtensionathomesinceAnnastartedexperiencingsymptoms.Theysharethattheyareunfamiliarwithmentalhealthdiagnosesanddonothaveanypriorexperienceofseekingmentalhealthservices.TheyareworriedaboutAnna’sabilitytorecoverandreturntoherdailyac4vi4es,aswellasherpoten4altohaveajobinthefuture.
Ø Clinicalteamreviewscase,determineseligibilityforservices.Ø AprimaryclinicianandMDareassignedtothecaseØ ClinicCoordinatorreachesouttoscheduleappointmentswiththeteam
Vigne[e• Annaexperiences:
– Auditoryhallucina4ons:Annahasreportedshehearsamalevoicethatiscri4calandcommentsnega4velyaboutherchoices.Shehasbeenobservedrespondingtothisvoicebyfamilyandfriends;thisgreatlydisturbsthemandembarrassesAnna.Somefriendsarestar4ngtoavoidher.
– Nega4vesymptomsincludinganhedoniaandavoli4on:Annahasbegunisola4ngherselfinherroomandavoidinginterac4onswithfamilyandfriends.
Ø ClinicianmeetswithAnnaandherfamilyforwelcomesession:providesfeedbackonthe
assessmentresults,psychoeduca<onaboutpsychosissymptoms,andtheSacEDAPTtreatmentmodel.Annaandfamilymembersareencouragedtopar<cipateingroupsandreturnforafollowupin1week.
Ø ClinicianworkswithAnnaandherfamilytodeveloptreatmentplanØ PsychiatristmeetswithAnnaandherfamilytodevelopmedica<ontreatmentplanØ FamilyAdvocate(FA)reviewstheclient’sclinicalassessmentandhertreatmentgoalsin
prepara<onformee<ngherandherfamily
Vigne[e• Oncean“A”student,Anna’sgradeshavebeenprogressivelyfallingthisyearandsheisnowindangeroffailingseveralclasses.Sheisatriskofnotgradua4ngon4mefromhighschool.Shestrugglestostayorganizedandhasdifficultycomple4ngassignments.Educa4onishighlyvaluedbyAnna’sfamilysothissitua4oniscausingmuchdistressathome.Ø Clinicianintroducesthefamilytotheclinic’sSupportedEduca<onservicesØ SupportedEduca<onSpecialist(SES)reachesouttoAnna’sparentstoschedule
aneedsassessmentØ FAreachesouttoAnna’sparentstoschedulefamilyneedsassessment.Shares
livedexperienceasamotherwhosedaughterhadasimilarexperienceandprovidesencouragementthatthingswillgetbeLer.Iden<fiesotherareaswherefamilyneedssupport.
Vigne[e• Inthepastyear,Annahasbeenhospitalizedtwicefordangertoself,
whichwaspromptedbyherrespondingtodirec4vesfromherauditoryhallucina4ons.Thisexperiencewasverytrauma4cforthefamily:ü Theywereshockedthattheirdaughterwouldthinkaboutharmingherselfü Theyhaddifficultycoordina4ngcarebetweenthehospitalandAnna’s
outpa4entproviderü Theydidnotfullyunderstandtheexplana4onoftreatmentprovidedby
Anna’spsychiatristinthehospitalü Annawasuncoopera4veandtriedtoleavethehospital,whichrequiredthe
useofrestraints
Ø Cliniciansystema<callyevaluatesDTS/DTOanddevelopsasafetyplanwithAnnaandherfamily,includinghowtocallpoliceifneeded.
Ø PsychiatristreviewsAnna’scurrentmedica<onstodetermineiftheyareadequatelycontrollinghersymptoms.
Vigne[e• FamilyAdvocatemeetswithfamily,introducesrole,and
thenassessestheirneeds.– Familyiden4fiesstrong4estotheirethniccommunity.Anna’sparentssharehowgrandmotherishavingtroubleunderstandingAnna’sexperienceasamentalillnessduetoaculturalbeliefinthespiritworld.GrandmotherismoreopentoAnnareceivingtreatmentaxeraspiritualcleansingritualperformedbyashamanfailedtoimproveherwell-being.
– Anna’sparentshavemanyques4onsaboutpsychosisandconcernsaboutmedica4on.Theyhaveaninterestinalsopursuingherbalremediesandothernon-Westerntreatments.
Ø FAgetsasenseofwhataddi<onalpsychoeduca<onwouldbehelpfulsothiscanbediscussedbytheteam.FAmakesanotetoalsoprovidematerialsingrandmother’sna<velanguage.
Ø FAmakesanotetoinformthepsychiatristaboutthefamily’sconcernaboutmedica<onandinterestinnon-Westernapproachestoencourageopencommunica<on.
Vigne[e• FamilyAdvocatemeetswithfamily,introducesrole,andthen
assessestheirneeds.– Anna’smotherlostherjobsixmonthsagoandishavingtrouble
findingwork.Computerskillswouldincreaseherchancesoffindingemployment.
Ø FAiden<fiespossiblelinkagetono-costcomputerliteracyprogramandresumeworkshopavailablethroughalocalorganiza<on.
– Anna’sfatherhasasteadyjobatawarehouse.However,thefamilyisstar4ngtoworryaboutpayingrentandtheirbills.Theyareworriedabouthavingtofileforbankruptcy.
Ø FAofferslinkagetobenefits,e.g.CalFresh,SSI,tohelpsupplementthefamily’sincome.FAiden<fieswaystoreducebillsviamoney-savingprograms,e.g.CALifeLineprogram,SMUDandPG&Eu<lityassistanceprograms.
Ø FAsuggestspossibleneedforreferralforno-costlegaladviceonbankruptcy.
Vigne[e• Anna’sfamilymembersarestrugglingtodealwiththechangeinher
behaviorsathome.OnesiblingisangrythatAnnadoesn’thavetodochoresanymore;theothersiblingisconfusedandafraidwhenAnnarespondstohervoices.Thishascausedconflictamongstthesiblingsandtheparentsarehavingdifficultyseyngboundariesandcommunica4ngeffec4vely.
• Regularconversa4onsnowseemtoescalateintoarguments.Anna’sparentsareworriedbecausetheconstantarguingisupseyngAnna.Theyhaveobservedhercryingonseveraloccasionsbecauseshefeelsbadlyforaffec4ngherfamily.
Ø Clinicianencouragesallfamilymemberstocometosessiontoproblemsolveandworkoncommunica<on.Clinicianprovidespsychoeduca<onaboutstressanditsroleinincreasingsymptoms.
Ø Clinicianencouragespar<cipa<oninMul<-familygroupandFamilySupportgroup
Vigne[e• Thefamilyisinterestedingeyngsupportforcommunica4on
butunsureabouta[endinggroup.Theystatetheydon’twantotherpeopletoknowabouttheirproblemsandarea“private”family.
Ø ClinicianinvitesFAtothenextsessiontosharelivedexperienceinMul<-FamilyGroup.
Ø FAworkstounderstandtheirconcernsandnormalizethefearandworryassociatedwithaLendinggrouptherapy.FAsharespersonalaccountsandaLemptstohelpthefamilyinunderstandingpoten<albenefits,despitethediscomforttheymightini<allyfeel.FAshareshowthegroupisawelcomingandunderstandingenvironment.
Ø FAandAnna’scliniciandiscusshowtohelpthefamilylearntorespondtoAnna’ssymptomsandcurrentleveloffunc<oning.
Vigne[e
Hospitaliza9on• Annaishospitalizedagainfordangertoself.Shehasstoppedtakinghermedica4on.Familyreportedthatshetriedtohurtherselfwithaknife,thepolicewerecalled,andshewastransportedtothehospital.
Ø ClinicCoordinatorreachesouttohospitalsocialworkertofacilitatecoordina<onofcare.Asksforhospitaltocoordinatemedica<onchangeswithPsychiatrist.
Ø FAreachesouttothefamily:1)iden<fiesneedtoreviewthehospitaliza<onexperiencewiththefamilyandoffersupport,2)FAprovidescollateralsupporttothefamilybyreviewingtheirrightsandop<onsduringthehospitaliza<on,includinghowtocommunicatewithhospitalstaff,3)FAofferstoaLenddischargeplanningmee<ngtoadvocate/supportthefamily
Vigne[eResump9onofOutpa9entTreatment• AnnaandherparentsarewelcomedtotheSacEDAPTprogrambyAnna’s
assignedclinicianandpsychiatrist.Ø ClinicCoordinatorensuresallhospitalrecordsandlabsareobtainedandavailablefor
theteam
• ThepsychiatristwantstorestartAnnaonan4psycho4cmedica4onandinvitesFAtojointhesession.ThepsychiatristdiscussestheuseofherbalremedieswithAnna’sparentsandprovidesfeedbackonpossibleinterac4ons.Annaissomewhatreluctanttotrythenewmedica4onsgiventhepossiblesideeffects.HerparentsarenotcomfortablewithAnnastar4ngmedica4on.Ø FAsharesherlivedexperiencefacingasimilardecisionØ FAencouragesAnnaandherparentstodiscusstheirconcernsfurtherwithher
psychiatrist
• Axerreviewingthepro’sandcon’sfurtherwiththepsychiatrist,Anna,withthesupportofherparents,decidestocompleteatrialofthemedica4ontoseeiftherewillbepoten4albenefits.
Vigne[e
ClinicianAppointment• StressathomeandconcernsaboutAnna’sperformanceinschooldominateshertherapysessions.Annafeelstoo4redandstressedtoa[endandhasbeenrefusingtogotoschool.Sheoxenisolatesinherroomathome,sayingshe“can’tdoanythingright!”
Ø ClinicianasksFAandSEStoreachouttoAnnaandherfamily.Ø TheFAworkswithAnna’sparentstohelpthemunderstandhowse[ngsmall
goalsandofferingpraisewillgiveAnnaasenseofprideandaccomplishmentfortaskssheisabletocomplete.
Ø TheSESsupportsAnna’sparentsinconnec<ngwithherschooltohelpherobtainanIEPforacademicsupport.
Vigne[eTeamMee9ng• Anna’sclinicianreportsthatAnna’sfamilyisnow
par4cipa4nginMul4-FamilyGrouptohelpwithcommunica4onandboundaryseyngathome.LastweekthisgroupworkedonhelpingAnna’sfamilyreestablishstructureathomeandbrainstormedideas;thefamilyselectedcrea4ngachorechart.
• PsychiatristreportsthatAnna’ssymptomsseemtobereducingonalowdoseofRisperdal.
• Supportededuca4onreportsthatsheisscheduledtoa[endtheIEPwiththefamilythefollowingweek.Ø TheclinicianasksFAtocheckinwiththefamilyontheirprogressathome.Ø FAcallsAnna’sparentstoaskhowthechorechartisworking,discussestheir
challengeswithge[ngstarted,andoffersencouragementtokeepgoing.
SacEDAPT
CoordinatedSpecialtyCare
TreatmentApproach
TheModelinAc4on
References&Resources• AnInventory&EnvironmentalScanofEvidence-BasedPrac4cesforTrea4ngPersonsinEarly
StagesofSeriousMentalDisorders.2016:Na4onalAssocia4onofStateMentalHealthProgramDirectors.h[p://www.nasmhpd.org/content/inventory-environmental-scan-evidence-based-prac4ces-trea4ng-persons-early-stages-serious
• Na4onalIns4tuteforHealthandCareExcellence,Psychosisandschizophreniainchildrenandyoungpeople:recogni4onandmanagement.2013,h[ps://www.nice.org.uk/guidance/cg155
• NHSEngland,theNa4onalCollabora4ngCentreforMentalHealthandtheNa4onalIns4tuteforHealthandCareExcellence,Implemen4ngtheEarlyInterven4oninPsychosisAccessandWai4ngTimeStandard:Guidance.2016,h[ps://www.england.nhs.uk/mentalhealth/wp-content/uploads/sites/29/2016/04/eip-guidance.pdf
• MinistryofHealthandLong-TermCare,EarlyPsychosisInterven4onProgramStandards.2011,Ontario:MinistryofHealthandLong-TermCare.h[p://www.health.gov.on.ca/english/providers/pub/mental/epi_program_standards.pdf
• MinistryofHealthServicesProvinceofBri4shColumbia,StandardsandGuidelinesforEarlyPsychosisInterven4on(EPI)Programs.2010,h[p://www.health.gov.bc.ca/library/publica4ons/year/2010/BC_EPI_Standards_Guidelines.pdf
• Addington,D.E.,etal.,Essen4alEvidence-BasedComponentsofFirst-EpisodePsychosisServices.PsychiatricServices,2013.64(5):p.452-457.
MoreReferences&Resources• EarlyPsychosisGuidelinesWri4ngGroup,AustralianClinicalGuidelinesforEarlyPsychosis,
2ndedi4on:ABriefSummaryforPrac44oners.2010,Melbourne:OrygenYouthHealth• Heinssen,R.,A.Goldstein,andS.Azrin,Evidence-BasedTreatmentsforFirstEpisode
Psychosis:ComponentsofCoordinatedSpecialtyCare.2014:Na4onalIns4tutesofMentalHealth.h[p://www.nimh.nih.gov/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf
• Mid-ValleyBehavioralCareNetworkOfficialPrac4ceGuidelinesforEarlyPsychosis.2004.h[p://www.sca[ergoodfounda4on.org/sites/default/files/EAST%20Prac4ce%20Guidelines.pdf
• EarlyPsychosisGuidelinesWri4ngGroupandEPPICNa4onalSupportProgram,AustralianClinicalGuidelinesforEarlyPsychosis,2ndedi4onupdate.2016,Melbourne:Orygen,TheNa4onalCentreofExcellenceinYouthMentalHealth
• Sale,T.andS.Blajeski,StepsandDecisionPointsinStar4nganEarlyPsychosisProgram.2015:NASMHPDPublica4ons.h[p://www.nasmhpd.org/sites/default/files/KeyDecisionPointsGuide_0.pdf
• CoordinatedSpecialtyCareforFirstEpisodePsychosis—ManualI:OutreachandRecruitment.2014,Rockville,Md:Na4onalIns4tuteofMentalHealth.Availableatprac4ceinnova4ons.org/Portals/0/RAISE/CSC-for-First-Episode-Psychosis-Manual-I-4-21-14.pdf
UpcomingWebinar
SAMHSA/CMHSWebinar–NewResourceMaterialsonAddressingFirstEpisodePsychosis:ProductOverviewTuesday,November15,2016,2:00-3:30pmEasternTime
Registerat:h[ps://jbsinterna4onal.webex.com/jbsinterna4onal/onstage/g.php?MTID=e8e8f5d4370c3bd91e22a94a44ccb1706
UpcomingWebinar
BHCOEWebinar-ManagingFirstEpisodesofPsychosisTheRoleofMedica<onsThursday,December15,2016,11:00-12:00pmPSTRegisterat:h[p://uc-d.adobeconnect.com/bhcoewebinar4/event/event_info.html
SuggestedVideos• Implemen4ngEarlyTreatmentofPsychosis:RAISEConnec4on• h[ps://www.youtube.com/watch?v=zNnP1qZJnVI
• Dr.AaronBeck:Cogni4veBehavioralTherapyforSchizophrenia• h[ps://www.youtube.com/watch?v=bpPoJnFjisY
• Cogni4veRestructuringinSchizophrenia– h[ps://www.youtube.com/watch?v=JG0w1Ig3eyA
• CBTTreatmentGoalsforSchizophrenia– h[ps://www.youtube.com/watch?v=eosGflfle3c
QUESTIONS??
