Applying intervention mapping approach to a program for early intervention in first-episode mental crisis of a psychotic type

Abstract Diabetes distress is a common negative emotional response to the ongoing burden of living with diabetes. Elevated diabetes distress is associated with impaired diabetes self-management and quality of life yet rarely identified and addressed in clinical practice. Health professionals report numerous barriers to the provision of care for diabetes distress, including lack of skills and confidence, but few diabetes distress training opportunities exist. The purpose of this paper is to describe how we utilized Intervention Mapping to plan the development, implementation, and evaluation of a novel diabetes distress e-learning program for diabetes educators, to meet a well-documented need and significant gap in diabetes care. A multidisciplinary team (combining expertise in research, health and clinical psychology, diabetes education, nursing, tertiary education, and website architecture) developed a diabetes distress e-learning program. We followed a six-step process (logic model of the problem, program outcomes and objectives, program design, program production, program implementation plan, and evaluation plan) known as Intervention Mapping. The program is underpinned by educational and psychological theory, including Bloom’s Taxonomy of Educational Objectives and social cognitive theory. We developed a short (estimated 4 h) e-learning program for diabetes educators, which draws on the content of the Diabetes and Emotional Health handbook and toolkit. It integrates a 7As model, which provides a stepwise approach to identifying and addressing diabetes distress. Our diabetes distress e-learning program has been developed systematically, guided by an Intervention Mapping approach. In the next phase of the project, we will trial the e-learning.

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“I’m truly free from my eating disorder”: Emerging adults’ experiences of FREED, an early intervention service model and care pathway for eating disorders

Journal of Eating Disorders ◽

10.1186/s40337-020-00354-9 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Rachel Potterton ◽

Amelia Austin ◽

Michaela Flynn ◽

Karina Allen ◽

Vanessa Lawrence ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Early Intervention ◽

Emerging Adults ◽

Care Pathway ◽

Support Network ◽

First Episode ◽

Service Model ◽

Access To Treatment ◽

Rapid Access

Abstract Background Eating disorders (EDs) typically start during adolescence or emerging adulthood, periods of intense biopsychosocial development. FREED (First Episode Rapid Early Intervention for EDs) is a service model and care pathway providing rapid access to developmentally-informed care for emerging adults with EDs. FREED is associated with reduced duration of untreated eating disorder and improved clinical outcomes, but patients’ experiences of treatment have yet to be assessed. Objective This study aimed to assess emerging adults’ experiences of receiving treatment through FREED. Method This study triangulated qualitative data on participants’ experiences of FREED treatment from questionnaires and semi-structured interviews. Participants were 106 emerging adults (aged 16–25; illness duration < 3 yrs) (questionnaire only = 92; interview only = 6; both = 8). Data were analysed thematically. Results Most participants reported psychological and behavioural changes over the course of treatment (e.g. reduction in symptoms; increased acceptance and understanding of difficulties). Participants identified five beneficial characteristics of FREED treatment: i) rapid access to treatment; ii) knowledgeable and concerned clinicians; iii) focusing on life beyond the eating disorder; iv) building a support network; v) becoming your own therapist. Conclusion This study provides further supports for the implementation of early intervention and developmentally-informed care for EDs. Future service model development should include efforts to increase early help-seeking.

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Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan–Monaghan early intervention service

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2021.54 ◽

2021 ◽

pp. 1-14

Author(s):

S. Fayyaz ◽

N. Nkire ◽

B. Nwosu ◽

N. Amjad ◽

A. Kinsella ◽

...

Keyword(s):

Early Intervention ◽

Negative Symptoms ◽

Education Programme ◽

First Episode ◽

Antipsychotic Treatment ◽

Term Outcome ◽

Long Term Outcome ◽

Research Findings ◽

Prospective Research ◽

Operational Activities

Objectives: As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. Methods: COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. Results: During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. Conclusions: COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

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The proximal prodrome to first episode mania a new target for early intervention

Bipolar Disorders ◽

10.1111/j.1399-5618.2008.00610.x ◽

2008 ◽

Vol 10 (5) ◽

pp. 555-565 ◽

Cited By ~ 67

Author(s):

Philippe Conus ◽

Janine Ward ◽

Karen T Hallam ◽

Nellie Lucas ◽

Craig Macneil ◽

...

Keyword(s):

Early Intervention ◽

First Episode

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Views of Young People in Early Intervention Services for First-Episode Psychosis in England

Psychiatric Services ◽

10.1176/ps.62.8.pss6208_0882 ◽

2011 ◽

Vol 62 (8) ◽

pp. 882-887 ◽

Cited By ~ 41

Author(s):

Helen Lester ◽

Max Marshall ◽

Peter Jones ◽

David Fowler ◽

Tim Amos ◽

...

Keyword(s):

Early Intervention ◽

Young People ◽

First Episode Psychosis ◽

First Episode ◽

Early Intervention Services ◽

Episode Psychosis ◽

Intervention Services

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Programma 2000: Celebrating 10 Years of Activity of an Italian Pilot Programme on Early Intervention in Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670802512032 ◽

2008 ◽

Vol 42 (12) ◽

pp. 1003-1012 ◽

Cited By ~ 39

Author(s):

Angelo Cocchi ◽

Anna Meneghelli ◽

Antonio Preti

Keyword(s):

Early Intervention ◽

High Risk ◽

Rating Scale ◽

Young Patients ◽

Skills Training ◽

First Episode ◽

Global Functioning ◽

Adult Intelligence Scale ◽

Cognitive Behavioural ◽

Early Intervention In Psychosis

Objective: This paper describes the structure and the organization of the single Italian programme specifically targeted at the early detection of and interventions for subjects at onset of or at high risk of psychosis, Programma 2000. Methods: Programma 2000 is a comprehensive multi-modal protocol of early intervention in psychosis, set up in Milan in 1999. The service has been very active since its opening, and at the time of writing (spring (April) 2008), more than 300 young patients have been evaluated through a detailed protocol that embraces Health of the Nation Outcome Scale (HoNOS), Brief Psychiatric Rating Scale (BPRS), Cognitive Behavioural Assessment 2.0, Disability Assessment Schedule, Camberwell Family Interview, Wechsler Adult Intelligence Scale and the Early Recognition Inventory Retrospective Assessment of Symptoms. The treatment includes psychoeducation, cognitive behavioural therapy (CBT), both structured and unstructured psychosocial interventions and pharmacotherapy, when necessary. Results: The programme focuses on young people aged 17–30 years: to date, a total of 132 subjects with definite psychosis or within the high-risk category have been enrolled in treatment after assessment. Patients with first-episode psychosis were, on average and expectedly, more severe than those in the at-risk group, and were more likely to be prescribed antipsychotic drugs. A large majority of patients in both groups received tailored CBT; individual sessions of skills training were provided to two-thirds of patients. In both groups, improvement was found in both the BPRS and HoNOS, and in the level of global functioning as assessed on Global Assessment of Functioning at 6 month and 1 year follow up. Global functioning was more sensitive to change than symptom severity, reflecting the intensive and personalized efforts to improve social and role functioning in patients. Conclusions: Programma 2000 is still in development but it has already gained the support of therapists and other relevant people involved in the life of subjects at onset, or at high risk of psychosis.

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Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01209.x ◽

2003 ◽

Vol 37 (4) ◽

pp. 414-420 ◽

Cited By ~ 94

Author(s):

P.J.R. Power ◽

R.J. Bell ◽

R. Mills ◽

T. Herrman-Doig ◽

M. Davern ◽

...

Keyword(s):

Early Intervention ◽

Treatment Group ◽

Young People ◽

Controlled Trial ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Randomised Controlled ◽

Suicidal Patients

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

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