Lessons from an aborted controlled trial on the impact of befriending in an early intervention in psychosis population

Author(s):  
Lars Hansen ◽  
Emma Bayford ◽  
Rachael Wood ◽  
Katherine Newman‐Taylor ◽  
Kyt Proctor ◽  
...  

2018 ◽  
Vol 7 (3) ◽  
pp. e000190
Author(s):  
Kirit Singh ◽  
Fatima Ghazi ◽  
Rebecca White ◽  
Benedicta Sarfo-Adu ◽  
Peter Carter

Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a ‘parity of esteem’ between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team’s performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.





2017 ◽  
Vol 21 (2) ◽  
pp. 102-109
Author(s):  
Hannah White ◽  
Laura Price ◽  
Tom Barker

Purpose Peer support (PS) has, over recent years, been implemented across a variety of NHS adult mental health settings. In November 2015, peer support workers (PSW) were introduced to an Early Intervention in Psychosis Service (EIS) in the Midlands. The purpose of this paper is to focus on organisational factors, asking how do PS impact on an early intervention in psychosis multi-disciplinary team (MDT). Design/methodology/approach Six EIS MDT members participated in an hour-long focus group. The data were analysed using thematic analysis, in line with a qualitative methodology (Braun and Clarke, 2006). Findings Two themes were generated, including “The values of PS” (consisting of three sub-themes: improving service engagement; personal qualities; and the peer relationship); and “The peer support role” (consisting of three sub-themes: living experience; boundaries; and alternative perspectives). Findings imply that PS in the current EIS related to: improved service engagement and greater understanding between service providers and users; which could be linked to better outcomes for service users (such as reduced duration of untreated psychosis (DUP)). Originality/value It has been suggested that PSWs facilitate an improved understanding between service providers and service users (Repper and Watson, 2012). However, research into organisational and team benefits of PS is lacking, with a need for more exploration (Repper, 2013). The current study begins to address the lack of literature regarding the organisational impact of PS, and even further regarding early intervention.



2020 ◽  
Vol 24 (4) ◽  
pp. 17-21
Author(s):  
Nandini Chakraborty ◽  
Richard Carr ◽  
Samuel Tromans


Author(s):  
Joanna Ward-Brown ◽  
David Keane ◽  
Gita Bhutani ◽  
Debbie Malkin ◽  
Bill Sellwood ◽  
...  

AbstractThe relationship between trauma and psychosis is well established with a large amount of overlap between the ICD/DSM (International Classification of Diseases/Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria for post-traumatic stress disorder (PTSD) and psychosis and/or schizophrenia. In spite of co-morbidity and evidence of the links and underlying mechanisms, trauma is rarely a focus of intervention in psychosis. Psychosis has often been on the list of exclusion criteria for PTSD research studies. There is a lack of literature on the impact of trauma work with people experiencing psychosis. The National Institute for Health and Care Excellence (NICE) (2014) suggests that Early Intervention in Psychosis (EIP) service users should be assessed for PTSD, and PTSD guidelines (NICE, 2005) followed for those who show signs of post-traumatic stress. There is a need to evaluate the effectiveness of therapeutic approaches for people with PTSD and co-morbid psychosis. These case studies aim to provide initial evidence of how two EIP clients experienced and responded to NICE-recommended psychological therapy for trauma. This study aims to test the feasibility of trauma work delivered via a phasic approach in a novel population. Two EIP clients received psychological therapy [including trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR)] for identified traumatic experiences. Assessment outcome measures were utilized to establish the effectiveness of the interventions. Both clients reported significant improvements following therapy, including reduced trauma-related distress, reduced distress from symptoms of psychosis and improved quality of life. Clients with co-morbid PTSD and symptoms of psychosis are likely to benefit from recommended psychological treatments for PTSD. Further research is required to address generalizability to a larger population.



2017 ◽  
Vol 50 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Katrine E. Karmisholt ◽  
Emily Wenande ◽  
Daniel Thaysen-Petersen ◽  
Peter A. Philipsen ◽  
Uwe Paasch ◽  
...  


2016 ◽  
Vol 56 (3) ◽  
pp. 268-277 ◽  
Author(s):  
Manuel E. Jimenez ◽  
Nathalie E. DuRivage ◽  
Orysia Bezpalko ◽  
Andrew Suh ◽  
Roy Wade ◽  
...  

Many young children identified with developmental concerns in pediatric settings do not receive early intervention (EI). We assessed the impact of a video decision aid and text message reminder on knowledge and attitudes regarding developmental delay and EI as well as referral completion. We conducted a pilot randomized controlled trial in an urban setting and enrolled 64 parent-child dyads referred to EI. Compared with controls, participants who received the intervention demonstrated increased knowledge regarding developmental delay and EI as well as more favorable attitudes in certain topics. Although we did not find a significant difference between arms in EI intake and evaluation, we found a pattern suggestive of increased intake and evaluation among participants with low health literacy in the intervention arm. Additional study is needed to identify strategies that improve the EI referral process for families and to understand the potential targeted role for decision aids and text messages.





Author(s):  
Emily J. Martin ◽  
Eric J. Roeland

This chapter summarizes the Dionne-Odom et al. randomized controlled trial evaluating the benefits of an early, nurse-led palliative care intervention to caregivers of patients with advanced cancer. The study examined the impact of early (at diagnosis) versus delayed (12 weeks later) intervention on caregiver quality of life, depressed mood, and burden. The study showed that early intervention caregivers had lower depression scores at three months compared to the delayed group caregivers. Terminal decline analyses also showed lower depression and stress burden scores in the caregivers who received the early intervention. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a clinical case.



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