Service users' views of moving on from early intervention services for psychosis

Abstract Background: Given the strong evidence for their effectiveness, early intervention services for psychosis (EIS) are being widely implemented. However, heterogeneity in the implementation of essential components, remains an ongoing challenge. Rapid learning health systems (RLHS), that embed data collection in clinical settings for real-time learning and continual quality improvement, can address this challenge. We therefore implemented a RLHS in 11 EIS in Quebec, Canada. This project aims to determine the feasibility and acceptability of implementing a RLHS in EIS, and to assess its impact on compliance with standards for essential EIS components. Methods: Following literature recommendations, the implementation of this RLHS involves six iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, provincial EIS association) are involved in all phases. Meaningful indicators of EIS quality (e.g., satisfaction, timeliness of response to referrals) were selected based on literature review, provincial guidelines, and stakeholder consensus on indicators prioritisation. A digital infrastructure was designed and deployed that comprises (a) a user-friendly interface for routinely collecting data from programs (b) a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life (c) data analytic, visualization and reporting functionalities to provide participating programs with real-time feedback on their performance over time, and in relation to standards and to other programs, along with tailored recommendations. Community of practice activities are being conducted that leverage insights from data to build capacity among programs to continually progress towards aligning their practice with standards/best practices. Guided by the RE-AIM framework, we are collecting quantitative and qualitative data on the Reach, Effectiveness Adoption, Implementation and Maintenance of our RLHS. These RE-AIM data will be analyzed to evaluate our RLHS’s impacts. Discussion: This project will yield valuable insights about how a RLHS can be implemented by EIS, along with preliminary evidence for its acceptability, feasibility and impacts on program-level outcomes. Its findings will refine our RLHS further and advance approaches that bring data, stakeholder voices and collaborative learning to improve outcomes and service quality in psychosis. Trial registration: NA

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Service users' views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care

British Journal of General Practice ◽

10.3399/bjgp12x630070 ◽

2012 ◽

Vol 62 (596) ◽

pp. e183-e190 ◽

Cited By ~ 22

Author(s):

Helen Lester ◽

Nagina Khan ◽

Peter Jones ◽

Max Marshall ◽

David Fowler ◽

...

Keyword(s):

Primary Care ◽

Early Intervention ◽

Qualitative Study ◽

Service Users ◽

Early Intervention Services ◽

Intervention Services

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Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Programme Grants for Applied Research ◽

10.3310/pgfar01030 ◽

2013 ◽

Vol 1 (3) ◽

pp. 1-168 ◽

Cited By ~ 9

Author(s):

SP Singh ◽

Z Islam ◽

LJ Brown ◽

R Gajwani ◽

R Jasani ◽

...

Keyword(s):

Early Intervention ◽

Ethnic Differences ◽

Help Seeking ◽

Research Programme ◽

Pathways To Care ◽

Service Users ◽

Early Intervention Services ◽

Faith Based ◽

Intervention Services ◽

Minority Ethnic

BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Bottom Line: Who Pays the Bill for Early Intervention Services?

ASHA Leader ◽

10.1044/leader.bml.18022013.26 ◽

2013 ◽

Vol 18 (2) ◽

pp. 26-27

Author(s):

Janet McCarty ◽

Laurie Havens

Keyword(s):

Early Intervention ◽

Private Insurance ◽

Infants And Toddlers ◽

Bottom Line ◽

Early Intervention Services ◽

Intervention Services

Medicaid, federal education funds and private insurance all cover the costs of speech-language and hearing services for infants and toddlers. Learn who pays for what.

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