Evidence-Based Treatment for
First Episode Psychosis
Robert K. Heinssen, Ph.D., ABPP
Amy B. Goldstein, Ph.D
Susan T. Azrin, Ph.D.
July 28, 2014
Disclosures
 I have no personal financial relationships
with commercial interests relevant to this
presentation
 The views expressed are my own, and do
not necessarily represent those of the NIH,
NIMH, or the Federal Government
National Programs for First Episode Psychosis
Early Intervention Principles
 Early detection of psychosis
 Rapid access to specialty care
 Recovery focus
 Youth friendly services
 Respectful of clients’
autonomy & independence
Early Intervention Services
 Team-based, phase-specific treatment
 Assertive outreach and engagement
 Empirically-supported interventions
—
—
—
—
Low-dose antipsychotic medications
Cognitive and behavioral psychotherapy
Family education and support
Educational and vocational rehabilitation
 Shared decision-making framework
• Evidence-based Treatments for First Episode Psychosis:
Components of Coordinated Specialty Care
• RAISE Early Treatment Program Manuals
and Program Resources
• RAISE Coordinated Specialty Care for First Episode
Psychosis Manuals
• OnTrackNY Manuals & Program Resources
• Voices of Recovery Video Series
http://www.nimh.nih.gov/health/topics/schizophrenia/raise/coordinatedspecialty-care-for-first-episode-psychosis-resources.shtml
Ryan – Fulfilling My Dream
7
Coordinated Specialty Care Model
Medication/
Primary Care
Case
Management
Psychotherapy
Client
Supported
Employment
and Education
8
Family
Education and
Support
Coordinated Specialty Care Model
Medication/
Primary Care
Case
Management
Psychotherapy
Client
Supported
Employment
and Education
9
Family
Education and
Support
Coordinated Specialty Care Model
Medication/
Primary Care
Case
Management
Psychotherapy
Client
Supported
Employment
and Education
10
Family
Education and
Support
CSC Roles and Functions
CSC Role
Services
Pharmacotherapy and
PC Coordination
Medication management; coordination with
primary medical care to address health issues
Licensed M.D.,
NP, or RN
Psychotherapy
Individual and group psychotherapy (CBT and
behavioral skills training)
Licensed clinician
Family Therapy
Psychoeducation, relapse prevention counseling,
and crisis intervention services
Licensed clinician
Care management functions provided in clinic
and community settings
Licensed clinician
Care Management
Supported employment and supported
Supported Employment
education; ongoing coaching and support
and Education
following job or school placement
Team Leadership
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Credentials
Outreach to community providers, clients, and
family members; coordinate services among
team members; provide ongoing supervision
BA; IPS training and
experience
Licensed clinician;
management skills
Must I hire 6 new FEP specialists?
 In the RAISE initiative, clinicians from
multiple disciplines learned, mastered,
and applied the principles of CSC
 Many providers achieved competency in
more than one CSC function, and fulfilled
dual roles on the treatment team
 Many sites leveraged existing resources
to create cost efficiencies that supported
the CSC program
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CSC Team Model 1
Suburban Mental Health Center; 20-25 Clients
Percent Full Time Employee
Clinical Roles
CSC Team Model 2
Urban Mental Health Center; 25-30 Clients
Percent Full Time Employee
Clinical Roles
Revising the FY14 MHBG Plan
Current CSC Capacity in the State or Territory
Set-Aside
Amount
≥ $1M
≥1 CSC
Program
≥1 Developing
Program
No CSC
Programs
> $100K, < $1M
< $100K

Depending on current capacity and set-aside amount:
— Expand or augment existing CSC services
— Fill gaps to create at least one operational program
— Create infrastructure for a future CSC program
Revising the FY14 MHBG Plan
Current CSC Capacity in the State or Territory
Set-Aside
Amount
≥ $1M
≥1 CSC
Program
≥1 Developing
Program
No CSC
Programs
> $100K, < $1M
< $100K

Consider targeted investments to build core CSC capacities
— Shared decision making tools and training
— Supported employment specialists
— Regional collaborations to build FEP expertise
Goals for FY2015 and Beyond
 Achieve and maintain fidelity to CSC model
 Benchmark and monitor key quality indicators
—
—
—
—
—
—
Duration of untreated psychosis
Client retention at 3 months
Inpatient episodes, ED visits, crisis intervention
Academic, vocational, and social recovery
Health risk factors and medical comorbidities
All cause mortality (suicide behaviors, accidents, etc.)
 Connect CSC programs into a “learning
community” that shares expertise, resources,
and quality monitoring data
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FEP Learning Healthcare System
FY2015
 Science and informatics
 Patient-clinician partnerships
 Incentives aligned for value
 Feedback loops for ongoing
system improvement
 Culture of continuous learning
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Thank you RAISE partners!
WA
ME
MT
ND
OR
VT
MN
ID
SD
NH
WI
IA
PA
NE
NV
IL
UT
CA
AZ
WV
NM
OK
MO
TX
VA
NC
TN
SC
AR
AL
RI
NJ
DE
MD
KY
MS
2 Studies
22 States
36 Sites
134 Providers
469 Participants
OH
IN
CO
KS
MA
NY
MI
WY
GA
LA
FL
RAISE Principal Investigators
RAISE Early Treatment Program
— John Kane
— Nina Schooler
— Delbert Robinson
RAISE Connection Program
— Lisa Dixon
— Susan Essock
— Jeffery Lieberman
For More Information
www.nimh.nih.gov/RAISE
rheinsse@mail.nih.gov