Mary Nichols, Psy.D. Research Psychologist Quality & Clinical - - PowerPoint PPT Presentation

Use of CANS data to screen for psychosis risk at a large children’s behavioral health agency

Mary Nichols, Psy.D.

Research Psychologist Quality & Clinical Outcomes Astor Services for Children & Families Rhinebeck, NY

Agenda

• I. Background on the use of agency CANS data
• II. Overview of Early Identification of Psychosis Project
• III. The psychosis screening algorithm
• IV. Other project activities: Diagnostic Evaluation,

Consultation, Technical Assistance and Follow-up

• V. Illustrative case example and outcomes data
• VI. Q/A

Astor Services for Children & Families

• Delivers nationally-acclaimed services for over

50 years.

• Offers a broad array of residential, educational,

and community based programs at more than 35 sites in the Hudson Valley Region and New York City area of New York State.

• Serves over 6,500 children, adolescents, and

their families each year.

Evolution of the CANS at Astor

• 2003: CANS implementation begins
• 2005: Use of CANS is fully established throughout clinical programs
• 2009: Centralization of data collection and outcomes management
• 2012: Change from CANS-MH to the CANS-NY, also explores use of an

electronic submission system

• 2013: Agency adopts an electronic health record (Qualifacts Carelogic),

continues paper CANS submission by programs

• July 2015: Switch to CANS completion within Electronic Health Record

Eligible youth participants were:

• Between the ages of 8 and 19
• Active clients in adolescent day treatment, school based

clinics, partial hospitalization, residential treatment, or home based crisis intervention programs Project goal:

• Fully screen 140 youth for psychosis risk
• Provide between 15 and 40 clients with comprehensive

diagnostic evaluation, technical assistance re: EBP, and long-term follow-up care coordination and evaluation of

• utcomes.

AMHF Early Intervention for Psychosis project

(2012-2014)

Research Background

• Literature on psychosis risk and identification in youth

(Cannon et al., 2008)

• The North American Prodrome Longitudinal Study
• Conversion to full blown psychotic disorders predicted

by the combined presence of:

• Genetic risk and a recent and dramatic deterioration in

functioning

• Unusual thought content
• Social impairment
• History of substance abuse

The Psychosis Risk Screening Algorithm

• To Screen positive, at least two of the risk factors shown in

the research to predict development of psychotic disorders needed to be present

• Starting with a large dataset of CANS, we applied a decision

rule in pre-screening process: – Clients were considered risk-positive if at least 2 of the below standards were true:

• Psychosis = 1, 2, or 3
• Substance Use = 2 or 3
• Social Functioning = 2 or 3

Evaluation of Screening Procedure

Evaluation Tools:

• Kiddie-SADS-Present and Lifetime Version (K-SADS-PL)
• Structured Interview for Psychosis Risk Syndromes (SIPS)
• CANS-NY

Consultation – EBP’s Recommended:

• Family Psychoeducation
• Social Skills Training
• Cognitive Remediation
• Care coordination
• Psychiatry/Medical

Evaluation and Consultation

Reliable Change Index (RCI)

Q & A

References

Axelson, D., Birmaher, B., Zelazny, J., Kaufman, J., & Gill, M. K. (2009). K-SADS-PL: 2009 working draft. Retrieved from http://www.psychiatry.pitt.edu/sites/default/files/Documents/assessments/KSADS-PL_2009_working_draft_full.pdf Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., . . . Heinssen, R. (2008). Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in North America. Archives of General Psychiatry, 65, 28-37. doi:10.1001/archgenpsychiatry.2007.3 Gearing, R. E. (2008). Evidence-based family psychoeducational interventions for children and adolescents with psychotic disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 17, 2-17. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247440/ Lyons, J. (2011). Child and Adolescent Needs and Strengths – NY [Measurement instrument]. Retrieved from https://canstraining.com/lschmidt/cans-new-york/node/printable-copy-of-the-manual Maier, W., Cornblatt, B.A., & Merikangas, K.R. (2003). Transition to schizophrenia and related disorders: Toward a taxonomy of risk. Schizophrenia Bulletin, 29, 693-701. doi:10.1093/oxfordjournals.schbul.a007039 McClellan, J., & Stock, S. (2013). Practice Parameter for the Assessment and Treatment of Children and Adolescents with Schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 976–990. doi:10.1016/j.jaac.2013.02.008 McGlashan, T. H., Walsh, B. C., & Woods, S. W. (2010). The psychosis-risk syndrome: handbook for diagnosis and follow-up. New York, NY: Oxford University Press.