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Felton Institute’s Prevention and Recovery in First Episode Psychosis Adriana Furuzawa, MA, LMFT, CPRP Amanda Downing, MA Bruce Adams, MS, LMFT Michael Krechevsky August 26, 2017 1
Felton Institute’s Prevention and Recovery in First Episode Psychosis
Adriana Furuzawa, MA, LMFT, CPRP Amanda Downing, MA
Bruce Adams, MS, LMFT Michael Krechevsky
August 26, 2017 1
The Model
Adriana Furuzawa, MA, LMFT, CPRP - PREP Division Director
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The project described was supported by Cooperative Agreement Number 1C1CMS330991 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its
agencies. The research presented here was conducted by the awardee.
Felton PREP provides evidence-based coordinated specialty care services to approximately 250 individuals annually.
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THE FELTON PREP MODEL
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PREP Model Receives National Recognition
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THE FELTON PREP
MODEL
2014 Inspiring Hope:
Science to Service Award
2015 Inspiring Hope:
Peer Specialist of the Year Award
National Council for Behavioral Health
TIMELINE
2007 - Community-academic partnership developed between: Felton Institute | Family Service Agency of San Francisco
University of California San Francisco (UCSF)
County PREP San Francisco
PREP Alameda
PREP San Mateo
PREP Monterey
PREP San Joaquin
YEAR 2007 2010 2012 2013 2013 (until 2015)
Area Urban Urban Urban/Rural Predominantly Rural
Predominantly Rural
THE FELTON PREP
MODEL
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A clear
intervention model
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Comprehensive
training and
continuous quality
improvement
Fidelity Monitoring
(compliance with
model and EBPs)
Documentation and evaluation
standards
Outcome accountability
Show me the data!
THE FELTON PREP
MODEL
1 2 3 4 5
THE FELTON PREP
MODEL
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THE FELTON PREP
MODEL SERVICES Rigorous Diagnostic Assessment – SCID / SIPS
Individual Therapy – CBTp
Psychoeducational Multifamily Groups – MFG
Supported Employment and Education – IPS
Algorithm-Guided Medication Management
Intensive Care Coordination
Family Support (based on lived experience)
Peer Support (based on lived experience)
Support Groups
Computer-Based Cognitive Remediation Training
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THE FELTON PREP
MODEL SERVICES
Target Population
Individuals aged 14-35 within the first two years of experiencing
psychotic symptoms
Some counties may allow different age range or longer
duration of symptoms after onset
Duration
Up to Two years
Eligible Diagnoses
Schizophrenia
Schizoaffective Disorder
Schizophreniform Disorder
Unspecified Schizophrenia Spectrum Disorder and Other
Psychotic Disorders
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THE FELTON PREP
MODEL PREP MODEL EXPANSIONS
Clinical High Risk (CHR)
Psychosis Risk Syndrome
Attenuated Psychosis
Felton BEAM | Early Mood Disorders
Bipolar I Disorder
Bipolar II Disorder
Major Depression with Psychotic Features
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THE FELTON PREP
MODEL SITE TEAMS Clinical Program Manager
Staff Therapists
Psychiatric Nurse Practitioners | Psychiatrist
Employment and Education Specialist
Peer Support Specialist
Family Support Specialist
Office Manager | Administrative Assistant
Research Assistant
Felton Division Director
PSYCHOSIS
Bruce Adams III, MFT- PREP/BEAM Program Manager in San Mateo County
The word psychosis describes a condition when there is a loss of
contact with reality.
Early signs and symptoms or the first few times someone begins to have these
experiences.
community education ongoing outreach
Psychosis
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What is Psychosis? What is Early Psychosis? How is it identified?
Confusion about what is real/imaginary
Ideas of reference
Preoccupation with supernatural
Suspiciousness
Sensitivity to light/sound
Hearing/Seeing things that others do not
auditory
visual
Smelling, tasting, or feeling sensations that others do not
Poor personal hygiene
Odd behavior and appearance
Disorganized communication
Psychosis
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Unusual Thinking Perceptual Experiences Disorganized Behavior
Memory deficits
Slowed thought process
Trouble thinking clearly
Difficulty planning ahead &
solving problems
Impulsivity
Social Isolation
Poor eye contact, stiff body, monotonic voice
Lack of motivation
Loss of interest in pleasurable activities
Spends a lot of time engaging in passive activities (watching TV)
Difficulty experiencing and expressing emotions
Psychosis
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Disorganized Thoughts Losses associated with the experience of psychosis
THE SERVICES
Build alliances and explain model
Build on strengths to develop methods to cope with distress
Utilize general interventions: Normalization and Psychoeducation
Develop Formulations
Utilize specific interventions: Working with voices and unusual beliefs
Pacing at speed appropriate to individual
Agenda setting
Develop problem list
Developing practice work
Used to identify the link between thoughts, feelings, and behaviors
Raises awareness of current experiences and beliefs about self
Reveals a pathway to sustainable recovery
CBTp
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CBTp Overview Collaborative Process Formulations
Development of a good therapeutic relationship is essential.
May take longer if someone is paranoid or had bad experiences of services.
Therapeutic relationship takes precedence over assessment and intervention.
Emphasis on warmth, collaboration and mutual respect.
CBTp
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Therapeutic Relationship
Lived Experience
Trained in M.I.
Group social activities twice a week
Meet individually as scheduled
Breaking Isolation
Connection
Structure
Support
Hope
Collaborate with team during weekly case conference
Provide insights into participants socialization
Peer Support
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Peer Specialist Five Areas of Focus 360 Review & Collaboration
THE SERVICES cont…
Michael Krechevsky- Family Support Specialist at PREP/BEAM San Mateo
Peer Support Specialist with lived experience of a loved one recovering from psychosis
Facilitate Weekly Family Group
Meet one on one with families
Provide psychoeducational materials
Provide empathetic support through shared experiences
Collaborate with team members during weekly case conference
360 view of participant
Deepen the psycho/social awareness of the participant's world
Family Support
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Family Support Specialist Activities Collaboration
THE SERVICES cont…
Amanda Downing, MA- Supported Employment and Education Services Director
for the PREP Division
IPS (Individual Placement and Support)
Well researched and recovery focused effort to move away from sheltered employment, set aside positions, direct placement by agencies, long term assessment and skill building, and other approaches that do not promote community involvement and upward mobility.
There is a growing focus on applying the model towards school when working with young adults.
Not just an intervention, but an intention.
SEES
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Supported Employment and Education Services
SEES
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The Principles We Put Into Practice
Zero exclusion
Competitive employment and placement
Integrated services and team value
Benefits planning, resource connection
Rapid start to services
Employer relationships , school team contact
Time unlimited support
Participant preference as the priority
Principles into Practice!
Meet with the EES to share interests, build relationship, review history, make a plan!
Share the plan with the team and family to begin support and collaboration.
EES begins connecting with employers in the community and/or school contacts.
Coaching and follow along supports for successful transition to work and/or school.
Assistance offered to overcome barriers.
SEES
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Supported Employment and Education Services
OUTCOMES AND ACCOUNTABILITY
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Using Outcomes to Tell Stories of Recovery
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OUTCOMES AND ACCOUNTABILITY
Age Ethnicity
Population Served
16-25yr old
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Symptom Reduction
Symptoms Improvement 1 Year Mark
Additional Improvement
2 Year Mark
Hallucinations
Unusual / Bizarre Beliefs 64% 59%
Lack of Motivation
Social withdrawal
Diminished speech
Impaired attention
75% 95%
Evaluation Tools: QUICK Scale for the Assessment of Positive Symptoms - QSAPS QUICK Scale for the Assessment of Negative Symptoms - QSANS
OUTCOMES AND ACCOUNTABILITY
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Functional Improvements
Domains Improvement 1 Year Mark
Additional Improvement
2 Year Mark
Trauma-Related Coping 51% 52%
Community Connectedness 39% 38%
Residential Stability 65% 50%
Living Skills 43% 51%
Sustained Employment 52% 57%
Evaluation Tools: Child and Adolescent Needs and Strengths Assessment - CANS Adult Needs and Strengths Assessment - ANSA
OUTCOMES AND ACCOUNTABILITY
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Reduction in Psychiatric Hospitalizations | FY 2015-16
47%
Hospitalization EPISODES
OUTCOMES AND ACCOUNTABILITY
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Reduction in Psychiatric Hospitalizations | FY 2015-16
59%
Hospitalization DAYS
OUTCOMES AND ACCOUNTABILITY
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THANK YOU!!
Adriana Furuzawa | [email protected] Bruce Adams | [email protected]
Amanda Downing | [email protected] Michael Krechevsky | [email protected]
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Felton.org Prepwellness.org
