First Episode Psychosis Programs in Pennsylvania: Laying the - - PowerPoint PPT Presentation

First Episode Psychosis Programs in Pennsylvania: Laying the Groundwork for Systems Change

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NAMI Keystone Pennsylvania’s grassroots advocacy initiative to bring awareness to Pennsylvania’s 9 FEP programs

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Presentation Goals

• Comprehensive Overview of First Episode

Psychosis and Coordinated Specialty Care

• Inside Look at the HOPE FEP Program
• The State’s Role
• #BackOnTrackPA Call to Action

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ENGAGE:

IMPROVING THE LIVES OF INDIVIDUALS EXPERIENCING FIRST-EPISODE PSYCHOSIS AND WORKING TO DECREASE THE CHANCES AND DURATION OF A SECOND EPISODE A program of Wesley Family Services

Marci Sturgeon-Rusiewicz, MS, NCC, LPC, CPSS, Doctoral Candidate

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WHAT IS HAPPENING TO AN INDIVIDUAL BEFORE THE ONSET OF PSYCHOSIS?

• During the prodromal phase of psychosis, individuals usually

display unspecific symptoms, such as:

• anxiety and depression
• abuse of alcohol or drugs
• social decline
• Psychotic episodes rarely occur out of the blue.
• Almost always, a psychotic episode is preceded by gradual non-

specific changes in:

• Thoughts
• Perceptions
• Behaviors
• Functioning

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• Over the past 25 years, an increasing number of

specialized treatment programs for early psychosis have been established around the world

• There is now evidence that these programs can reduce

the duration of untreated psychosis and produce better symptomatic and functional recovery

• These treatment options yield better outcomes, are

more cost-effective than standard models of mental health care, are individualized

Wyatt RJ. Neuroleptics and the natural course of schizophrenia. Schizophrenia

• Bull. 1991;17(2):325–351

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THE GOALS OF EARLY DETECTION:

• reduce the period of time between the onset of psychosis and care
• provide consistent and comprehensive care during the critical early years
• f illness
• Effective care during the early years involves proactive engagement of

psychosocial treatments as well as the introduction of low-dose anti- psychotic medication.

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WHAT IS COORDINATED SPECIALTY CARE?

• specialized, recovery-oriented

treatment

• promotes shared decision making
• Psychotherapy
• medication management
• family education and support
• case management
• work or education support

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PROGRAM PHILOSOPHY

• The program philosophy is based on resiliency

through empowerment, operating within a strengths- based model using multi-disciplinary specialty care and the promising practices of peer support

• Empowering People to Reach their Full Potential: This

service has been developed as part of a statewide effort which is looking for additional ways to improve the lives of people experiencing first-episode psychosis

• The program (ENGAGE: Educate, Navigate, Grow

and Get Empowered) involves exploring new areas and ideas for treating first episode psychosis by looking at ways of decreasing the duration of untreated psychosis

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WHO DO WE HELP?

• Young adults between the ages of 15 and 25 who are

experiencing their first episode of psychosis and reside within Allegheny County

HOW DO WE HELP?

 Through the use of a Coordinate Specialty Care (CSC)  Team promotes shared decision making  Team of specialists: 

Psychiatrist (low-dose medication and education)

 Case Manager (navigating resources)  Therapist (CTR-and much more…)  Supported Living/Supported Employment (job coaching and preparedness)  Certified Peer Specialist (lived experience)  Registered Nurse (education and wellness)  Treatment is based upon the individual client’s needs and preferences

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EDUCATE

It is important to do the right thing at the right time!

Coordinated Specialty Care is more effective than usual treatment approaches and is most effective when the participant has a shorter duration of untreated psychosis (ie: the length of time between the beginning of the psychotic symptoms and the beginning of the right treatment)

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NAVIGATE

• Common areas of program focus are listed below, but not limited to…
• Developing personal plans
• Increasing self worth through building mastery
• Increasing introspection-awareness
• Gaining confidence
• Increasing personal growth
• Building connections with community
• Establishing and setting boundaries
• Planning for transition/crisis planning
• Advocating personal needs/developing communication
• Understanding symptom management
• Finding meaningful life activities/exploring interests
• Identifying work skills/enhancing work skills
• Enhancing resources

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FAMILY PSYCHOEDUCATION (FPE) AND MULTI-FAMILY PSYCHOEDUCATION (MFG)

• A structured approach for partnering with participants

and their families to support resiliency and recovery

• To create a sense of community
• Participants and families receive information about

psychosis and learn problem-solving, effective communication and coping strategies

GROWTH

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ADVOCACY AND EDUCATION

• Participants Share
• Importance of early intervention
• Importance of peer support
• Need for collaborative and inclusive care

EMPOWERMENT

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EARLY ADOPTION OF FEP:

Whole Health

Maximize Hope

Improve Treatment Outcomes Decrease Duration

End Stigma

Coordinate Care

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HOPE

Joint Decision-Making Promises HOPE

Denise Namowicz, MSW, LCSW Director of HOPE Children’s Service Center

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What is HOPE at the Children’s Service Center

 First Episode Psychosis Program

 Ages 15-25  First episode within 2 years

 Early intervention of treatment  Participant/Family Groups  Monthly Events

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Present Referral Status

 Approaching the 2nd year of the Program  31 active cases as of 5/01/19  78 cases referred  38 cases denied/refused  18 discharged

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Coordinated Specialty Care: A Collaborative Approach of Disciplines

 Recovery-oriented treatment program  Collaborative approach of disciplines Luzerne-Wyoming Counties System of Care

Initiative

Community Care Behavioral Health Organization Northeast Counseling Services Children’s Service Center

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A Collaborative Approach Produces:

 Symptom reduction  Reduced hospital days/hospitalizations  Growth in functional activities  Decrease in future episodes of psychosis  Strengthened social skills and engagement

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Sex % Male 37 Female 53 Race % Caucasian 63 African American 8 Asian 2 Unknown 27 Age at: Mean Yrs. (s.d.) Admission 16.0 (2.7) Onset of Psychosis 14.9 (3.7) Duration of Psychosis: Mean Yrs. (s.d.) Prior to Admission 1.1 (2.3)

Demographics

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Adverse Behavior: 6 Month Follow Up

12% 15% 15% 35% 31% 27% 4% 4% 4% 15% 8% 12% 0% 5% 10% 15% 20% 25% 30% 35% 40% Legal Issues Violent or Aggressive Ideation Violent or aggressive Behavior Suicidal Ideation Suicidal Attempt Other Self injurous Behavior Admission 6 Month Follow Up

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Psychiatric Hospitalizations

46% 12% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Prior to Admission to FEP Program During 6 months

• f Enrollment in

FEP Program Note: Data from participants (n=26) with 6-month follow-up

• data. Among all participants admitted to HOPE (n=48), 46% had

a hospitalization prior to admission.

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Substance Use

12% 20% 0% 8% 12% 12% 0% 4% 0% 5% 10% 15% 20% 25% Alcohol Marijuana K2 Other Admission 6 Month Follow-Up

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Competitive Employment

12% 27% 0% 5% 10% 15% 20% 25% 30% Admission 6 Month Follow-Up Note: Data from participants (n=26) with 6-month follow-up

• data. Among all participants admitted to HOPE (n=48), 12% were

competitively employed at the time of admission.

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Coordinated Specialty Care for First Episode Psychosis (FEP)

Office of Mental Health and Substance Abuse Services

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Jill Stemple Section Chief, Planning Bureau of Policy, Planning, and Program Development

History of FEP in Pennsylvania

• Pennsylvania has provided grants to

geographically-diverse FEP programs, for start up and ongoing development, using the 5% and 10% set-asides from the Community Mental Health Services Block Grant (CMHSBG) funding:

– 2 FEP program sites in 2014-2015 – 4 FEP program sites in 2015-2016 – 8 FEP program sites in 2016-2017 – 9 FEP program sites in 2017-2018 – Pennsylvania Early Intervention Center in 2018-2019

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FEP in Pennsylvania: 2019-2020

• Funding made available for up to two additional

FEP Program Sites

• Funding made available for up to four current FEP

Programs to pilot a Stepped Care Model

• In partnership with PEIC

– Continued program evaluation for all FEP Sites – Continued in-person annual training for FEP Sites – Additional opportunities for ongoing training – Development of telephonic provider consultation for primary care and psychiatric providers in counties without a full FEP Team.

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PEIC Clinic Flow for Telehealth

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FEP Tele-Health Consultations and Remote Care for Rural Providers PEIC Provider Rural Provider

PEIC provides

• utreach to

rural providers regarding potential services Rural

• utpatient

physical or mental health provider contacts PEIC for services PEIC provides an MOU which is signed by both parties PEIC provider contacts rural provider and establishes expert consultation Can clinical needs be met through consultatio n alone?

YES NO

PEIC provider continues expert consultation until clinical need resolved, care

• ccurs

through rural provider. PEIC provider initiates tele- health sessions in the rural clinical space; care is provided until need is met.

Criteria for Rural Provider Sites

• These are current criteria and subject to change as program matures:

– Physical or mental health outpatient provider

• Unaffiliated with an inpatient hospital that would require PEIC staff to be separately

credentialed at their facility

– Willing to sign a Memorandum of Understanding (MOU) with UPenn – Willing to participate initially in expert consultation with an expectation that rural provider provides clinical care – Willing to evolve to tele-mental health visits between identified participant and PEIC providers in the rural clinic office – Clinical consultation and tele-health visits are covered by the PEIC

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Criteria for Rural Participants

• Ages 15+
• Documented First Episode of Psychosis (FEP) with onset < 18

months

• Willing to participate in tele-mental health visits
• No moderate or severe autism or intellectual disability

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Joint-Site Training

• Joint-Site FEP Training has been developed

utilizing in-state trainers from the University of Pennsylvania and The Beck Institute.

• Training includes FEP Program Implementation and

Recovery Oriented Cognitive Therapy.

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FY 2016-2017 Joint Site FEP Training Cost Savings National Joint Training Savings Per Site $74,000 $30,000 $44,000

Program Evaluation

• All CMHSBG FEP-funded programs are participating

in a joint program evaluation.

• Data is collected in REDCap, a secure online

research database maintained by the University of Pennsylvania.

– No PHI is collected in REDCap.

• Each site will have visits to monitor rater reliability

and fidelity to the FEP CSC model.

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Duration of Untreated Psychosis

Current USA: Mean DUP 196 weeks Median DUP 74 weeks WHO Recommendation: DUP no greater than 12 weeks FEP Program Admission DUP: Mean 41 Weeks

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Sources: https://www.ncbi.nlm.nih.gov/pubmed/25588418; http://www.iris-initiative.org.uk/silo/files/epd-concensus-statement-bertolote-and-mcgorry.pdf; PA-FEP-PE Quarterly Report 7.1.18, n=242

PA FEP Data: Demographics Demographics

• Age = 21 years old (mean)
• Gender: 61% Male, 35% Female, 1% Transgender
• Race: 45% White, 38% Black, 6% Asian

35 Source: PA-FEP-PE Quarterly Report 12.31.18

PA FEP Data: Hospitalization

• Hospitalizations at Admission
• Average 1.93 hospitalizations per participant
• Average 26.58 total nights per participant
• Estimated total inpatient cost prior to FEP admission is over

$20,000/per person

36 Source: PA-FEP-PE Quarterly Report 12.31.18

For participants who were hospitalized in the first six months, the number of days was reduced from an average of 28.81 to 3.97 nights.

PA FEP Data: Inpatient Admissions

37 Source: PA-FEP-PE Quarterly Report 12.31.18

PA FEP Data: Adverse Behaviors

38 Source: PA-FEP-PE Quarterly Report 12.31.18

PA FEP Data: Employment

39 Source: PA-FEP-PE Quarterly Report 12.31.18

PA FEP Data: Positive Outcomes

40 Source: PA-FEP-PE Quarterly Report 12.31.18

Referrals

41 Allegheny Columbia, Montour, Snyder, and Union STEP (Services for the Treatment of Early Psychosis) Connect 2 Empower Courtney Abegunde radliffece@upmc.edu Mary Lyn Cadman, mcadman@cmsu.org (412) 246-5599 (570) 275-5422 Dominick Agosti, dagosti@cmsu.org ENGAGE (Educate, Navigate, Grow, and Get Empowered) (570) 275-4962 Marcia Sturgeion-Rusiewicz, sturgeon@FSWP.org (412) 661-1670 Erie Dauphin Early Onset Recovery Program at Safe Harbor of UPMC Hamot Kathleen Shelly, shellyk@upmc.edu CAPSTONE (Clinical Assessment, Peer Support, Treatment (814) 451-2283 and Ongoing Education/Employment) Amanda Fooks, afooks@papsychinst.org Luzerne/Wyoming (717) 884-3819 HOPE (Helping Overcome Psychosis Early) Delaware Denise Namowicz, dnamowicz@e-csc.org (570) 825-6425 On My Way Christian Kitchen, ckitchen@childandfamilyfocus.org Philadelphia (610) 325-3131 PEACE (Psychosis, Education, Assessment, Care and Empowerment) Main Office (215)-387-3233 PERC (Psychosis Evaluation and Recovery Center) Bridgette Patton (215) 615-3295 Christian Kohler, kohler@mail.med.upenn.edu

FEP Statewide Contacts

OMHSAS FEP Supervisor Jill Stemple 717-409-3790 jistemple@pa.gov Pennsylvania Early Intervention Center

• Dr. Irene Hurford, MD

ihurford@pennmedicine.upenn.edu

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Engineering Public Policy with...

Charlie Lotz

Denny Civic Solutions

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Fundamental question: What can we do as advocates to ensure that Pennsylvania supports and expands upon existing CSC-FEP programs?

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Lessons learned from another mental health advocacy effort:

• The stigma is real
• Education is essential
• Your partners make all the difference
• The fight is worth it

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The Stigma Is Real

• For many, “psychosis” is a scary word
• Many people have never heard from

someone who has lived with psychosis in their own words.

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Education Is Essential

• Three primary audiences:

○ Lawmakers ○ PA Counties ○ The general public

• It takes time

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Your Partners Make All the Difference

• Video series: in their own words
• Petition:

https://tinyurl.com/BackOnTrackPA

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The Fight Is Worth It

• No one knows that better than all of you

here today.

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Take Action Today!

• Come talk to us
• Take a picture
• Sign the petition:

https://tinyurl.com/BackOnTrackPA

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Questions?

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