View this presentation. - National Association of State Mental Health

Delaware’s Plan to Implement
Project CORE
Community Outreach, Referral, and Early
Intervention to Prevent Psychosis
Kevin Huckshorn PhD, MSN, RN, CADC
Director: DE Division of Substance Abuse and
Mental Health Services
NASMHPD Conference
July 27-29
CORE Project Goals
1. Improve Long-Term Outcomes for 16-25 yr. old
Delawareans that are at high risk for psychotic disorders or
have experienced a first episode in the last year.
2. We plan to use a mix of RAISE and PIER models to address
these issues, using Federal Dollars to address first episode
psychosis in 16-25 yr. olds, as well as, using state General
Funds to pay for services targeted to the 12-15 yr. old
population that is exhibiting prodromal symptoms.
3. Increase public awareness of these issues, in young adults,
including information saturation on how to refer for care.
CORE Project Goals
4. Establish a network of current providers and stakeholders
to help identify, engage and refer high risk youth.
5. Establish personal contacts for all referrals within 48
hours of referral.
6. Deliver evidence-based assessments for all referrals within
one week.
7. Provide treatment to those youth that meet criteria for
8. Evaluate the effectiveness of these interventions and the
outcomes of these interventions.
CORE Project
 Delaware has partnered with the DE Kids Department to
respond to both the 5% BG Set Aside, as well as, the
SAMHSA RFA on this same project.
 We were not aware for some time of the potential
restrictions regarding the target population or the
restrictions regarding interventions for youth with
“prodromal symptoms.” We believe that both youth, with
first episodes, and youth with prodromal symptoms should
be engaged in care/treatment. As such we have figured out
a way to use GF to pay for the younger, latter population
and track that work separately.
CORE Project Goals
 DE expects to be able to achieve our goals in less than five
years. We are small and only have 3 counties in which to
implement this work.
 Phase One will include the northern most county, New
Castle, that holds about half of DE’s population.
 Phase Two will broaden these efforts to include the two
southern counties who, together, have population
numbers that match NC but that are much more rural.
 In Phase Two, we anticipate starting in the southernmost
county and then moving to Kent County with a shared
intervention team.
CORE Project
Measureable Outcomes
1. Statewide policy changes in DSAMH and the Kids Dept.
including MOU.
2. Stakeholder organizations entering into performance based
agreements with DSAMH and Kids.
3. Number of youth and families referred,
4. Number of youth and families engaged,
5. Treatment retention with a goal of 2 years,
6. Conversion rates of psychosis in at risk youth,
7. Formalization of training and intervention documents and
8. Number of high risk youth that do not convert to psychosis
DE CORE Project
Five Year Work Proposal
 We expect to Refer over 692 transitional age
youth/families for assessment,
 We expect to Assess 198 youth/families for services,
 And we expect to Treat 155+ youth/families for
engagement into these services.
 DE is the perfect statewide microscope to see how these
interventions work in a state that is urban, suburban and
 The current USDOJ Settlement Agreement also supports
this work.
CORE Project
 DE is one of only four states in the US that maintain
separate mental health systems of care for children and
adults. There are advantages and disadvantages to this
model. The most troubling is the interruption in care for a
youth and their family when they turn 18.
 Another issue is the fact that the adult MH system in DE is
not prepared to accept young people age 18-25 as the
population we serve are mostly older and young people
do not find our services age appropriate.
 As such, many of these youth disappear at 18, only to
resurface, often much more ill, at age 23-25.
CORE Project
 The DE Adult and Kids System’s hope that this project will
draw together these gaps in service and encourage a
better partnership going forward and targeting youth age
16-20 to stay in care.
 This project will use two Family ACT teams to provide the
assessment and interventions required under the RAISE
and PIER Program models.
 DE DSAMH and Kids plan to spend a great deal of time in
training our communities, including parents, on signs and
symptoms. We have also partnered with DE NAMI and DE
MHA in this proposed work.
Early Detection, Screening and
Intervention to Prevent Psychosis
 Regardless of the bureaucratic challenges the fact remains
that the ten years of work done, by RAISE and PIER, have
clearly demonstrated some really exciting outcomes.
 I personally believe that every state needs to get informed
on these interventions and implement these strategies
ASAP. Even one successful intervention that prevents
psychosis is worth an estimated 10 million dollars.
(McFarlane, 2014).
 Kevin Ann Huckshorn PhD, MSN, RN, CADC
[email protected]
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