Service Engagement in First-Episode Psychosis: Current Issues and Future Directions

Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. The purpose of this paper is to contribute to the literature about clients enrolled in first episode psychosis programs and psychosocial outcomes by examining the factors associated with paid employment among young adults who have experienced their first psychotic episodes. In this paper, we consider the association of socioeconomic factors to employment. Our results suggest that in addition to treatment, socioeconomic factors such as receipt of public disability benefits and educational attainment are associated with employment status. These results can help to inform future directions for the enhancement of psychosocial programs in FEP models to promote paid employment.

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Cultural and Contextual Adaptation of an eHealth Intervention for Youth Receiving Services for First-Episode Psychosis: Adaptation Framework and Protocol for Horyzons-Canada Phase 1 (Preprint)

10.2196/preprints.8810 ◽

2017 ◽

Author(s):

Shalini Lal ◽

John Gleeson ◽

Ashok Malla ◽

Lysanne Rivard ◽

Ridha Joober ◽

...

Keyword(s):

Service Providers ◽

First Episode Psychosis ◽

First Episode ◽

Web Based ◽

Initial Development ◽

Diverse Range ◽

Episode Psychosis ◽

Service Engagement ◽

Ehealth Intervention ◽

The Web

BACKGROUND eHealth interventions have the potential to address challenges related to access, service engagement, and continuity of care in the delivery of mental health services. However, the initial development and evaluation of such interventions can require substantive amounts of financial and human resource investments to bring them to scale. Therefore, it may be warranted to pay greater attention to policy, services, and research with respect to eHealth platforms that have the potential to be adapted for use across settings. Yet, limited attention has been placed on the methods and processes for adapting eHealth interventions to improve their applicability across cultural, geographical, and contextual boundaries. OBJECTIVE In this paper, we describe an adaptation framework and protocol to adapt an eHealth intervention designed to promote recovery and prevent relapses in youth receiving specialized services for first-episode psychosis. The Web-based platform, called Horyzons, was initially developed and tested in Australia and is now being prepared for evaluation in Canada. METHODS Service users and service providers from 2 specialized early intervention programs for first-episode psychosis located in different provinces will explore a beta-version of the eHealth intervention through focus group discussions and extended personal explorations to identify the need for, and content of contextual and cultural adaptations. An iterative consultation process will then take place with service providers and users to develop and assess platform adaptations in preparation for a pilot study with a live version of the platform. RESULTS Data collection was completed in August 2017, and analysis and adaptation are in process. The first results of the study will be submitted for publication in 2018 and will provide preliminary insights into the acceptability of the Web-based platform (eg, perceived use and perceived usefulness) from service provider and service user perspectives. The project will also provide knowledge about the adaptations and process needed to prepare the platform for evaluation in Canada. CONCLUSIONS This study contributes to an important gap in the literature pertaining to the specific principles, methods, and steps involved in adapting eHealth interventions for implementation and evaluation across a diverse range of cultural, geographical, and health care settings.

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Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions

Psychology Research and Behavior Management ◽

10.2147/prbm.s111593 ◽

2017 ◽

Vol Volume 10 ◽

pp. 119-128 ◽

Cited By ~ 13

Author(s):

Nicholas Breitborde ◽

Aubrey Moe ◽

Arielle Ered ◽

Lauren Ellman ◽

Emily Bell

Keyword(s):

Psychosocial Interventions ◽

First Episode Psychosis ◽

First Episode ◽

Future Directions ◽

Episode Psychosis

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Service Engagement in First Episode Psychosis

The Journal of Nervous and Mental Disease ◽

10.1097/nmd.0b013e31828e0e19 ◽

2013 ◽

Vol 201 (5) ◽

pp. 359-364 ◽

Cited By ~ 27

Author(s):

Angus MacBeth ◽

Andrew Gumley ◽

Matthias Schwannauer ◽

Rebecca Fisher

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Service Engagement

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Functional outcome and service engagement in major depressive disorder with psychotic features: comparisons with schizophrenia, schizoaffective disorder and bipolar disorder in a 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEP

CNS Neuroscience & Therapeutics ◽

10.1111/cns.12836 ◽

2018 ◽

Vol 24 (7) ◽

pp. 633-640 ◽

Cited By ~ 6

Author(s):

Tara Kingston ◽

Paul J. Scully ◽

David J. Browne ◽

Patrizia A. Baldwin ◽

Anthony Kinsella ◽

...

Keyword(s):

Bipolar Disorder ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

First Episode Psychosis ◽

First Episode ◽

Major Depressive ◽

Episode Psychosis ◽

Service Engagement ◽

Psychotic Features

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Evaluating the feasibility of a decision aid to promote shared decision making among young adults with first-episode psychosis: protocol for a pilot study

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00757-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yaara Zisman-Ilani ◽

Irene Hurford ◽

Andrea Bowen ◽

Mark Salzer ◽

Elizabeth C. Thomas

Keyword(s):

Decision Making ◽

Young Adults ◽

Antipsychotic Medication ◽

Decision Aid ◽

First Episode Psychosis ◽

First Episode ◽

Shared Decision ◽

Treatment As Usual ◽

Episode Psychosis ◽

Service Engagement

Abstract Background Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. Methods A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3- and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics. Discussion This protocol outlines the methodology for a feasibility pilot comparing the effect of a novel SDM Antipsychotic Medication encounter DA with treatment as usual on SDM, medication adherence, and service engagement in FEP care. SDM is endorsed as a framework for use in FEP and antipsychotic pharmacotherapy, but its impact on adherence and health outcomes is unclear. Understanding the potential contribution of an SDM Antipsychotic Medication DA compared with usual care in psychosis pharmacotherapy is critical. The study will help answer several key questions new to SDM research, including the contribution of personality and clinical relationships to SDM in mental health and psychosis in particular. The study will serve to gather feasibility data to inform future studies and scale-up. Trial registration Ethics approval was obtained through Temple University’s institutional review board (IRB) and the City of Philadelphia’s Department of Public Health IRB. The study has been retrospectively registered with ClinicalTrials.gov as NCT04373590 on 29 April 2020. https://clinicaltrials.gov/ct2/show/NCT04373590?term=NCT04373590&draw=2&rank=1

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