Early Stage Identification and Engagement to Reduce the Duration of Untreated Psychosis: Evaluating the Impact of Screening and Systematic Communication

PROJECT SUMMARY/ABSTRACT Studies find a substantial delay between the onset of psychosis and the initiation of specialty treatment for first episode psychosis (FEP), with the duration of untreated psychosis (DUP) typically over one year in the U.S. Better strategies are needed to improve identification of individuals with FEP and to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning. This study will investigate whether a U.S. adaptation of a successful detection approach from the Netherlands enhanced by an innovative model of communicating information about psychosis and treatment options to patients and families (ComPsych), can reduce DUP. Our collaborators in the Netherlands compared screening of a consecutive help-seeking population entering mental health services to clinician referral from mental health clinics and found that screening captured significantly more individuals at clinical high risk for psychosis (CHR) and with FEP. Based on the Dutch model, within the Mount Sinai Health System in New York, we have piloted and established the feasibility of screening help-seeking youth entering mental health services with the aim of improving early identification of FEP cases and rapid referral to specialty care (Early Stage Identification and Engagement to Reduce DUP study (EaSIE), supported by NIMH R34). Individuals entering services are screened with the Prodromal Questionnaire-Brief Version (PQ-B). Those who screen positive are assessed by Structured Interview for Psychosis Risk Syndromes (SIPS) and referred to stage-specific specialty care (FEP or CHR services). To facilitate service engagement we developed, piloted, and established feasibility of the ComPsych model. While our data showed that compared to clinician referral, systematic screening method (SM) can substantially reduce DUP by identifying a greater number of patients earlier in the course of illness, more research is needed to evaluate the impact of ComPsych on FEP treatment initiation and engagement in order to further reduce DUP. We will use a stepped-wedge cluster randomized controlled trial design to compare a systematic screening and communication method (SCM) to SM. Following a 6-month baseline period of SM, 12 mental health clinics will be randomized (2 clinics at a time) to transition from SM to SCM at 6-month intervals. In both conditions, individuals aged 12-30 who screen positive on PQ-B will be assessed with SIPS by trained clinicians in each clinic and referred to FEP and CHR services as appropriate. In SCM condition the ComPsych model will be used to facilitate initiation of CHR and FEP services. We will measure DUP for patients who meet psychosis criteria. We hypothesize that: (1) SCM will result in a higher number of individuals initiating CHR and FEP services compared to SM; (2) The mean DUP of FEP individuals in SCM condition will be lower than the mean DUP of FEP individuals in SM condition, due to the reduced time to initiate FEP services. We will also examine multi-level implementation factors that can inform the identification of implementation strategies for future deployment of SCM in routine practice.