Table 2.
Importance attached by senior early psychosis staff members to each component of the coordinated specialty care model
| Item | Level of evidence-base † | Level of importance (n=25)
|
||||
|---|---|---|---|---|---|---|
| Extremely Important | Important | Equivocal | Less important | Un-important | ||
|
|
||||||
| Population-level interventions and access | ||||||
| * First appointment within 2 weeks | D | 84% | 16% | - | - | - |
| Targeted education to “first contact” services in the community | B | 64% | 36% | - | - | - |
| communication between FEP & inpatient services | D | 64% | 32% | - | 4% | - |
| Comprehensive assessments and care plan | ||||||
| * comprehensive clinical assessment at intake | C | 92% | 8% | - | - | - |
| * Create individual treatment plan following assessment | C | 88% | 12% | - | - | - |
| Psychosocial needs are incorporated into care plan | C | 72% | 24% | 4% | - | - |
| Seek collateral information from family | C | 76% | 24% | - | - | - |
| Pharmacotherapy | ||||||
| Antipsychotic medication provided | A | 52% | 32% | 16% | - | - |
| Medication decision based on standardized algorithm | - | 40% | 32% | 16% | 4% | 8% |
| Clozapine offered after two unsuccessful trials of APs | A | 24% | 32% | 16% | 16% | 12% |
| Guided AP dose reduction after 1 year of remission | - | 20% | 48% | 16% | 8% | 8% |
| Structured intervention to prevent weight gain | B | 4% | 48% | 24% | 16% | 8% |
| Psychoeducation & Psychotherapy | ||||||
| Client-focused psyched or illness management training | B | 60% | 24% | 16% | - | - |
| CBT for symptoms of psychosis, anxiety or depression | B | 60% | 36% | - | - | 4% |
| Caregiver education and support | A/B | 60% | 28% | 8% | 4% | - |
| Social & community skills training | B | 48% | 40% | 8% | 4% | - |
| Addictions treatment | ||||||
| MET or CBT for co-morbid substance use | C | 48% | 40% | 8% | 4% | - |
| Vocational and Educational support | ||||||
| Supported employment services | A | 56% | 32% | 8% | - | 4% |
| Service system and models of intervention | ||||||
| * At least Masters level Team Leader | - | 88% | 11% | - | - | - |
| * Providing crisis intervention or linkage to crisis services | C | 88% | 8% | 4% | - | - |
| * Regular multidisciplinary team meetings | B | 88% | 8% | - | 4% | - |
| Multidisciplinary team of qualified professionals | - | 80% | 16% | - | 4% | - |
| Case manager assigned for ongoing care | C | 80% | 16% | - | 4% | - |
| Psychiatrists assigned to specific clients | C | 76% | 24% | - | - | - |
| Psychiatrist integrated into the team | C | 68% | 24% | - | 4% | 4% |
| Proactive outreach and engagement for clients | C | 60% | 24% | 12% | - | 4% |
| Explicit admission criteria | B | 56% | 24% | 20% | - | - |
| ratio of active FEP clients to clinicians 20:1 | C‡ | 48% | 44% | 4% | 4% | - |
| Clearly identified population served | - | 48% | 40% | 8% | - | 4% |
| Mandate to provide services for specified time | B | 36% | 36% | 20% | - | 8% |
| Evaluation and quality improvement | ||||||
| Formal annual assessment conducted | C | 64% | 24% | 12% | - | - |
Key: AP: Antipsychotic; CBT: Cognitive Behavioral Therapy; FEP: First Episode Psychosis; MET: Motivational Enhancement Therapy.
†
Level of evidence base as determined in the Addington et al., 2013 review of essential EP program components. A= strong evidence, B= Supportive evidence, C=opinion, D= No evidence of benefit or harm.
‡
Defined as ratio of 1:25 in Addington et al., 2013 study.
*
Denotes components that were deemed as “extremely important” by at over 80% of participants.