1 Getting Started
2 Building Your Program
3 Training Frontline Staff
4 Elements for Stress Reduction
This meditation guide uses the four elements (earth, water, air, and fire) to help form calming mentality as a way to deal with stress.
4 Evaluating Your Program
6 Using Multimedia
A Community Outreach and Education Model for Early Identification of Mental Illness in Young People
Objective: The Portland [Maine] Identification and Early Referral (PIER) program was established in 2000 as a prevention system for identifying and treating adolescents and young adults at high risk of an initial psychotic episode. Community outreach and education to targeted groups was the primary method for identification.
Methods: Community outreach and education is defined as any activity designed to inform key audiences about the importance of and methods for early detection and intervention of psychosis in adolescents and young adults. PIER program staff presented information on the early warning signs of psychosis and how to make a referral to target audiences within a young person’s social network.
Results: Community outreach resulted in the referral of 780 youths who met demographic criteria, yielding 404 cases that were deemed sufficiently at risk to be eligible for formal assessment. After screening and assessment by PIER staff, 37% of community referrals were found to be at high risk for psychosis, and another 20% had untreated psychosis, yielding a correct-referral efficiency ratio of 57%. In addition, community educational presentations were significantly associated with referrals six months later.
Conclusions: In its efforts to create a system of early identifiers for young people at the beginning stages of mental illness, the PIER program has developed a new model for community health education that has shown that it is possible to engage community members in the identification of adolescents and young adults who are experiencing the early symptoms of a psychotic disorder.
A Fidelity Coding Guide for a Group Cognitive Behavioral Therapy for Depression
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This report describes the development of the fidelity rating tools for the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) and BRIGHT-2 interventions — cognitive behavioral therapy interventions for clients with co-occurring depression and substance use problems. The tools, which assess adherence to and competence in administering the BRIGHT treatments, and their interrater reliability are discussed, and a recommended training plan for fidelity coders in research settings is presented. The training plan includes coder selection, initial training, and ongoing training. Finally, specific guidance is provided on how to apply the fidelity tools. This guidance is based on experience using the tools within a research context, but it should be helpful for supervisors in clinical settings as well.
A Guide to Oregon’s Declaration for Mental Health Treatment
This guide offers a series of questions and answers about creating a declaration of mental health treatment.
A Literature Review of Early Interventions for Psychosis
This paper, incorporating a comprehensive review of the research literature as of spring 2007, describes the principles and evidence of the prospective detention, engagement and treatment of young people at risk for psychosis, and young people experiencing the first onset of psychosis.
A Practical Guide for People with Disabilities Who Want to Go to College
This guide will help you at every turn. You will learn how to plan for picking the right school for you. You will learn how to plan for the type of degree you should pursue to get the jobs you want. You will learn how to pay for school and secure additional
funding if necessary, and plan for paying back loans for tuition. Everything you need to
know, from planning on how to manage your disability on campus to planning on what to
do with your degree once it’s in your hands, will be addressed in this guide, with additional resources in the back.
A Prospective Study of PTSD Following Recovery From First-Episode Psychosis: The Threat from Persecutors, Voices, and Patienthood
Approximately one third of people with early psychosis report post-traumatic symptoms, some of which are thought to arise from traumatic experiences associated with psychosis itself. This prospective study tested hypotheses based on retrospective findings that threat appraisals of voices, persecutors, or the new label of 'mental health patient' predict symptoms of post-traumatic stress disorder (PTSD).
Appraisals of power and threat from voices and other persecutors and appraisals of the threat posed to identity by the diagnosis were assessed during the first acute phase of psychosis. Eighteen months later, PTSD symptom levels and diagnosis were established.
Of 39 participants who completed the follow-up phase, 12 (31%) met criteria for PTSD diagnosis. Nineteen (49%) of the participants were still distressed by memories of their psychosis or the associated treatment. During the acute phase of psychosis, appraisals of threat from voices and persecutors were strongly associated with distress. With the exception of the perceived ability to cope with threat, none of these appraisals were predictive of subsequent post-traumatic stress however. Similarly, only one appraisal of the diagnosis (loss of control) was predictive of PTSD.
It may be that retrospective studies have overestimated the influence of candidate appraisals in predicting PTSD. It might also be that assessments made during the acute phase of psychosis preceded a key phase of psychological processing that takes place during the immediate aftermath of the psychotic episode. A staged prospective design is required to uncover the true impact of psychosis on PTSD.
Accommodation and Compliance Series Higher Education Accommodations: Students with Mental Health Impairments
JAN’s Accommodation and Compliance Series is designed to help employers and educators determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information. The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each student’s individual limitations and accommodation needs.
ACT Fidelity Scale
ACT Fidelity Scale
Additional Resources on Adolescent Development
Adolescent Substance Use Checklist
Age of Onset of Mental Disorders: A Review of Recent Literature
First onset of mental disorders usually occur in childhood or adolescence, although treatment typically does not occur until a number of years later. Although interventions with early incipient disorders might help reduce severity-persistence of primary disorders and prevent secondary disorders, additional research is needed on appropriate treatments for early incipient cases and on long-term evaluation of the effects of early intervention on secondary prevention.
Agency Cultural Competency Readiness
This checklist is designed for staff to indicate the extent to which they believe
their residential programs demonstrate an environment that values cultural
diversity and supports cultural and linguistic competence. Concrete examples
of the kinds of values, practices, and resources that foster such an environment
are included in checklist items.
This checklist can be completed by program administrators, staff, providers,
and other personnel. Respondent feedback can provide information about the
extent to which program staff perceive that practices which support cultural
diversity and cultural and linguistic competence are incorporated in many daily
Applying for a Job: The Young Adult’s Guide
This tip sheet may help you plan and carry out applying for jobs.
Assessing Self-determination in Your Life
This self-assessment is designed to help you discover how much self-determination you have in your life. You are the person in charge of this assessment. To complete it, you’ll read a series of statements and think about whether they describe your life. This will help you identify life areas (such as money or relationships) where you’d like to increase your level of self-determination and other areas where you’re already satisfied.
The simple act of thinking about these things will increase your awareness of the presence of self-determination in your life.
At the Heart of an Early Psychosis Centre: The Core Components of the 2014 Early Psychosis Prevention and Intervention Centre (EPPIC) Model for Australian Communities
To describe the core components of the Early Psychosis Prevention and Intervention Centre service model as the template agreed with the Australian Federal Government for national upscaling. The Early Psychosis Prevention and Intervention Centre model of early intervention has two main goals: to reduce the period of time between the onset of psychosis and the commencement of treatment and to bring about symptomatic recovery and restore the normal developmental trajectory as early as possible.
The Early Psychosis Prevention and Intervention Centre comprises three elements of service provision for young people experiencing a first episode of psychosis: (i) early detection; (ii) acute care during and immediately following a crisis; (iii) recovery-focused continuing care, featuring multimodal interventions to enable the young person to maintain or regain their social, academic and/or career trajectory during the critical first 2–5 years following the onset of a psychotic illness. It does this via a combination of 16 core components, which provide a flexible, comprehensive, integrated service that is able to respond quickly, appropriately and consistently to the individual needs of the young person and their family. Innovative service reforms, such as Early Psychosis Prevention and Intervention Centre, that recognise the value of early intervention are crucial to reducing the impact of serious mental illness on young people and their families and, ultimately, on our society.
Back to School: Toolkits to Support the Full Inclusion of Students with Early Psychosis in Higher Education (Staff & Administrator Version)
This Toolkit is one of a two-part series. The companion Toolkit is geared towards students and families.
Depending on your role and responsibilities, you might be wondering why guidance materials aimed at supporting students with early psychosis have been created or, conversely, why it’s taken the field so long to recognize the need for guidance. The number of students perceived as having more serious psychiatric challenges and diagnoses has been steadily increasing for the past decade and a half, although no one is sure exactly why. Recent federal initiatives aimed at providing effective, high quality wraparound early intervention services to young people experiencing a first episode of psychosis are likely to further contribute to the number of postsecondary students with psychosis. In fact, increasing the college attainment of clients is an explicit goal of most early intervention programs.
Back to School: Toolkits to Support the Full Inclusion of Students with Early Psychosis in Higher Education (Students and Family Version)
This Toolkit is one of a two-part series. The companion Toolkit is geared towards campus
staff and administrators.
Depending on who you are, returning to school after hospitalization(s) or intensive
treatment for psychosis might seem: completely overwhelming; difficult but doable; or
no big deal. Regardless of your initial feelings, the complex array of campus services, policies, supports and procedures can be confusing and difficult to navigate. Returning to campus with psychosis is also likely to raise multiple new questions and decision points: Will you disclose to faculty? To other students? Are there academic accommodations that would help? Who will you turn to if things go wrong?
Becoming Dialogical: Psychotherapy or a Way of Life?
After birth the first thing we learn is becoming a participant in dialogue. We are
born in relations and those relations become our structure. Intersubjectivity is the
basis of human experience and dialogue the way we live it. In this paper the
dilemma of looking at dialogue as either a way of life or a therapeutic method is
described. The background is the open dialogue psychiatric system that was initiated
in Finnish Western Lapland. The author was part of the team re-organizing
psychiatry and afterwards became involved in many different types of projects in
dialogical practices. Lately the focus has shifted from looking at speech to seeing
the entire embodied human being in the present moment, especially in multifarious
settings. Referring to studies on good outcomes in acute psychosis, the contribution
of dialogical practice as a psychological resource will be clarified.
Best Practices in Clinical Supervision
The Task Force that created this document held open meetings at the ACES conference in October 2009 and at the Southern ACES conference in October 2010 to discuss the most recent drafts of the guidelines for best practices. Feedback from those discussions has been incorporated into this final draft. In addition, Task Force members also elicited comments from supervisors who work in different settings, including community agencies and schools. After receiving comments, they revised the best practices guidelines as appropriate and now present the document to the ACES Executive Council for endorsement. It is important to note that these are best practices rather than minimal acceptable practices. The best practices guidelines are intended to support supervisors in their work. They are intended to be relevant and practical, and are offered to augment the judgment of supervisors as they strive to do the following: (a) offer ethical and legal protection of the rights of supervisors, supervisees, and clients; and (b) meet the professional development needs of supervisees while protecting client welfare. The guidelines also provide a framework for those seeking to develop supervisor training programs. Importantly, the guidelines are meant to supplement, not replace, the ACA Code of Ethics. In fact, ACES is not in a position to hear complaints about alleged non-compliance with these guidelines. Any complaints about the ethical behavior of any ACA member should be lodged with ACA in accordance with its procedures for doing so. Finally, this is meant to be a living document and as such will require review and revision approximately every 8-10 years.
Biopolar Disorder in Children and Adolescents
This booklet discusses bipolar disorder in children and teens.
This write up promotes BoosterBuddy, an app to help young people with mental illness self-manage their symptoms. But this is an app with a difference. Designed by youth for youth, BoosterBuddy uses the power of video game design elements and applies them to everyday life to encourage healthy behaviors while keeping users engaged.
Build a Healthy Meal
This tipsheet gives easy guidelines for healthy eating habits.
Building Upon Existing Programs and Services to Meet the Needs of Persons Experiencing A First Episode of Psychosis
This fact sheet offers strategies to increase access to recovery-oriented, evidence-based, integrated care services for individuals experiencing a first episode of a psychotic illness (FEP) and practical suggestions for starting FEP programs or building on existing programs to enhance the quality of life for individuals affected by early-course psychotic illness.
Building Your Program
Building Your Program is intended to help mental health authorities, agency administrators, and program leaders think through and develop Medication Treatment, Evaluation and Management (MedTEAM). The first part of this booklet gives you background information about the MedTEAM model. Specific information about your role in implementing and sustaining MedTEAM follows.
Building Your Program
Building Your Program is intended to help mental health and substance abuse authorities, agency administrators, and program leaders think through and develop the structure of Integrated Treatment for Co-Occurring Disorders.
Cannabis & Psychosis: A Brief Review
This outline acts as a brief academic orientation to cannabis and its relationship with psychosis in young adults.
Cannabis & Psychosis: a brief review
This is a study guide on cannabis and psychosis.
Cannabis and Psychosis Awareness Project: A Pan-Canadian Study of Youth Experiences
We know very little about the impact of cannabis on young adults with psychosis or at risk for psychosis from the perspectives of youth who have experienced a first episode of psychosis. As a result, this project’s aim was to conduct interviews and hold focus groups with youth in first episode psychosis clinics across Canada to gain their experiences of cannabis use and its potential link with psychosis.
Cannabis and Psychosis: List of Webpages
This living document lists helpful webpages to learn about cannabis and its relationship to young adults with psychosis. Check back for updates or surf the web from these starting points for more information.
Cannabis Use and Youth: A Parent's Guide
The aim of this guide is to help parents weigh the risks (and benefits) of cannabis use and put them in perspective within their individual situation. The goal is to offer an honest and thoughtful discussion on cannabis so parents can make better decisions about cannabis use—or non-use—in the context of their family.
Chapter 3- Culture and Mental Illness: Social Context and Explanatory Models
In this chapter, the authors provide some examples of how social context and explanatory models influence common psychiatric conditions.
Charting a Meaningful Life: Planning Ownership in Person/Family-Centered Planning
Person-centered planning puts the focus on the adult or child and his/her future, rather than on a set of services, programs, or treatments that can be offered to meet various needs and goals. This paper aims to answer the question, "Who owns the plan?" Or instead, "Who owns the person's life?"
Childhood Trauma, Psychosis, and Schizophrenia: A Literature Review with Theoretical and Clinical Implications
OBJECTIVE: To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications.
METHOD: Relevant studies and previous review papers were identified via computer literature searches.
RESULTS: Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large-scale general population studies indicate the relationship is a causal one, with a dose-effect.
CONCLUSION: Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.
Choose My Plate
choosemyplate.gov is a USDA interactive online tool which provides information about healthy diet
Clinical and Functional Outcomes After 2 Years in the Early Detection and Intervention for the Prevention of Psychosis Multisite Effectiveness Trial
Objective: To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth.
Clinical Staging Model for Psychosis
Diagnosis in psychiatry increasingly struggles to fulfil its key purposes, namely, to guide treatment and to predict outcome. The clinical staging model, widely used in clinical medicine yet virtually ignored in psychiatry, is proposed as a more refined form of diagnosis which could restore the utility of diagnosis, promote early intervention and also make more sense of the confusing array of biological research findings in psychiatry by organizing data into a coherent clinicopathological framework. A selective review of key papers in clinical medicine and psychiatry which describe clinical and clinicopathological staging, and a range of related issues. Clinical staging has immediate potential to improve the logic and timing of interventions in psychiatry just as it does in many complex and potentially serious medical disorders. Interventions could be evaluated in terms of their ability to prevent or delay progression from earlier to later stages of disorder, and they could be selected on clear-cut risk/benefit criteria. Biological variables and a range of candidate risk factors could be studied within and across stages, and their role, specificity and centrality in risk, onset and progression of disorder could be greatly clarified. A clinicopathological framework could be progressively constructed. Clinical staging with a restructure across and within diagnostic boundaries with the explicit operationalization of criteria for extent and progression of disorder should be actively explored in psychiatry as a heuristic strategy for the development and evaluation of earlier, safer, and more effective clinical interventions, and for clarifying the biological basis of psychiatric disorders.
Clinicians’ Treatment Manual for Family-Focused Therapy for Early-Onset Youth and Young Adults
The purpose of this manual is to explain an early intervention treatment for
adolescents and young adults who may already have, or may be at risk for
developing bipolar disorder (BD) or psychosis (hereafter referred to as EarlyOnset
Youth, or EOY). Family Focused Treatment for EOY and their families
(FFT-EOY) consists of 8 weekly and 4 biweekly sessions (12 sessions over 4
Cognitive Behavioral Therapy for Psychosis In Practice
Cognitive Behavioral Therapy for Psychotic Symptoms: A Therapist's Manual
This treatment protocol provides the therapist with a comprehensive, detailed and systematic approach to treatment delivery.
Cognitive Therapy Scale
A client-therapist feedback scale rating therapist's adherence to various program treatments.
Common Experience Versus Intended Result
This table outlines the common experiences of individuals with psychosis "with" and "without" early intervention services.
Comorbid Depressive and Anxiety Disorders in 509 Individuals with an At-risk Mental State: Impact on Psychopathology and Transition to Psychosis
The current diagnostic system for subjects at enhanced clinical risk of psychosis allows concurrent comorbid diagnoses of anxiety and depressive disorders. Their impact on the presenting high-risk psychopathology, functioning, and transition outcomes has not been widely researched.
In a large sample of subjects with an At-Risk Mental State (ARMS, n = 509), we estimated the prevalence of DSM/SCID anxiety or depressive disorders and their impact on psychopathology, functioning, and psychosis transition. A meta-analytical review of the literature complemented the analysis.
About 73% of ARMS subjects had a comorbid axis I diagnosis in addition to the "at-risk" signs and symptoms. About 40% of ARMS subjects had a comorbid diagnosis of depressive disorder while anxiety disorders were less frequent (8%). The meta-analysis conducted in 1683 high-risk subjects confirmed that baseline prevalence of comorbid depressive and anxiety disorders is respectively 41% and 15%. At a psychopathological level, comorbid diagnoses of anxiety or depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, and avolition/apathy. Comorbid anxiety and depressive diagnoses were also associated with impaired global functioning but had no effect on risk of transition to frank psychosis. Meta-regression analyses confirmed no effect of baseline anxiety and/or depressive comorbid diagnoses on transition to psychosis.
The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms. These symptoms may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis. Anxiety and depressive symptoms are likely to impact the ongoing psychopathology, the global functioning, and the overall longitudinal outcome of these patients.
Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes from the NIMH RAISE Early Treatment Program
The primary aim of this study was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first-episode psychosis designed for implementation in the U.S. health care system, with community care on quality of life.
Thirty-four clinics in 21 states were randomly assigned to NAVIGATE or community care. Diagnosis, duration of untreated psychosis, and clinical outcomes were assessed via live, two-way video by remote, centralized raters masked to study design and treatment. Participants (mean age, 23) with schizophrenia and related disorders and ≤6 months of antipsychotic treatment (N=404) were enrolled and followed for ≥2 years. The primary outcome was the total score of the Heinrichs-Carpenter Quality of Life Scale, a measure that includes sense of purpose, motivation, emotional and social interactions, role functioning, and engagement in regular activities.
The 223 recipients of NAVIGATE remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school compared with 181 participants in community care. The median duration of untreated psychosis was 74 weeks. NAVIGATE participants with duration of untreated psychosis of <74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care. Rates of hospitalization were relatively low compared with other first-episode psychosis clinical trials and did not differ between groups.
Comprehensive care for first-episode psychosis can be implemented in U.S. community clinics and improves functional and clinical outcomes. Effects are more pronounced for those with shorter duration of untreated psychosis.
Coordinated Specialty Care for First Episode Psychosis
This manual is designed to guide implementation of a team-based program to serve individuals who are experiencing emerging psychosis within an existing mental health clinic (MHC). It provides information on administrative issues that must be discussed and resolved between the team and the clinic, such as hiring team members, managing team caseloads, providing services outside of the clinic setting, using the clinic’s support staff for smooth team functioning, and sharing space and resources. Other critical implementation issues involve training and ongoing supervision of team members, ways to measure fidelity to the team model, and how to build supervision and fidelity assessment into ongoing practice within the clinic.
Coordinated Specialty Care for First Episode Psychosis Manual I: Outreach and Recuitment
When developing an early intervention specialty clinic, it is essential to develop a structure that systematically disseminates information about the program and can facilitate a successful referral and enrollment process. This manual describes methods for outreach, steps to establishing a referral network, and guidance on evaluating and admitting individuals to a specialty clinic.
Cost-effectiveness of Treating First-Episode Psychosis: Five Year Follow-up Results from an Italian Early Intervention Programme
Early intervention programmes are expected to result in the reduction of illness severity in patients with schizophrenia, and contain health-care costs by reducing hospital admissions and improving the social functioning of patients. This study aimed to investigate the cost-effectiveness of treatment in an early intervention programme in comparison to standard care.
Retrospective analysis of data prospectively recorded in an urban area (Milan, Italy). Twenty-three patients from an early intervention programme and 23 patients from standard care with first-episode psychosis were evaluated on their use of services over a 5-year period. The Health of the Nation Outcome Scale was used to measure clinical status.
Significant changes with respect to initial assessment were recorded on the Health of the Nation Outcome Scale, with larger effect sizes in the early intervention programme than in the standard care group. Consequently, the cost-effectiveness ratio per reduced score of severity was lower in the early intervention programme than in standard care (€ 4802 vs. € 9871), with an incremental cost-effectiveness ratio, or net saving of €-1204 for every incremental reduced score of severity. Over time, greater recourse to hospital and residential facilities to obtain comparable improvement in symptoms resulted in a steady cost increase for the patients in standard care.
Allocation of funds to specialized early intervention programmes is the best alternative, as it can save costs by reducing the use of hospitals and residential facilities, and may produce net savings of costs in the long term.
Coverage of Early Intervention Services for First Episode Psychosis
This informational bulletin is intended to assist states in designing a benefit package to guide early treatment intervention options that will meet the needs of youth and young adults experiencing first episode psychosis.
Creating a Healthy You
Cultural Competency in Mental Health Peer Run Programs and Self-Help Groups: A Tool to Assess and Enhance Your Services
This tool was created to help mental health, consumer operated programs and self-help groups assess their own cultural competency. By using it, you’ll identify the ways in
which your activities are already responsive to culturally diverse peers and areas where you could use some improvement. You’ll also create specific action plans to
enhance your cultural competency in five important areas.
This handout includes definitions of culture, examples of cultural identifiers, and exploration of cultural humility to be used in building cultural competency.
Cultural Conversation Starters
A person’s cultural beliefs, values, and practices can play an important role in his or her decision making. The shared decision making process can provide opportunities to
explore and discuss cultural aspects of health and healing. Provider awareness of these beliefs can help bridge differences that influence relationships and decision making. Here are conversation starters for addressing culture in shared decision making.
Cultural Formulation Interview (CFI)
This measure aims to clarify key aspects of the presenting clinical problem from the point of view of the individual and other members of the individual’s social network (i.e., family, friends, or others involved in current problem). This includes the problem’s meaning, potential sources of help, and expectations for services.
Cultural Formulation Interview (CFI)—Informant Version
The following questions aim to clarify key aspects of the presenting clinical problem from the informant’s point of view. This includes the problem’s meaning, potential sources of help, and expectations for services.
Dealing with Psychosis
This toolkit is meant to help you learn skills you can use to:
1. Manage symptoms of psychosis
2. Move forward and enjoy your life
Learning new skills is not easy. It's important that you have somebody who can support you in the learning process. This is your support person.
Depression and College Students: Answers to College Students' FAQs about Depression
Booklet of Q&As about depression.
Depression in Youths: Strategies for Improving Treatment & Patient Outcomes
A PowerPoint Presentation that outlines knowledge about depression in youths and evidence-based treatments and strategies.
Depression: What you need to know
This booklet contains information on the signs and symptoms of
depression, treatment and support options, and a listing of additional
Dialogical Recovery of Life
Disclosing to Employers
This guide may help you decide whether or not to disclose your disability status with your employer.
Do I Tell My Boss?: Disclosing My Mental Health Condition at Work
Every young adult with a mental health condition will face the decision of whether or not to tell others about, or “disclose” their condition at work. Typically the reason for disclosure is to ask for an accommodation in order to perform better at your present job. An accommodation is modifying a job, the job site, or the way things are done in order to enable a qualified individual with a disability to have an equal opportunity for employment.1 The following information can provide some guidance in helping you make an informed decision.
Early Detection and Intervention for the Prevention of Psychosis: Outreach Evaluation Report Year 3
This report evaluates the education and community outreach efforts of EDIPPP over four years. It assesses three major areas: (1) implementation of the PEI education and community outreach strategies, (2) contextual factors that may influence the implementation and impact of this initiative, and (3) specific outcomes related to the PEI education and outreach efforts.
Early Detection, Intervention, and Prevention of Psychosis Program: Rationale, Design, and Sample Description
Objective: To describe the rationale, design, intervention, and sample characteristics of the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP), a multi-site study of the effectiveness of Family-Aided Assertive Community Treatment (FACT) in preventing the onset of psychosis in a nationally representative sample of at-risk young people.
Methods: Young people (age 12 - 25) and their families are assigned to a clinical high risk (CHR) group or a low risk group based on severity of positive symptoms of psychosis. Treatment families (CHR group) receive minimally 1 year of FACT and comparison families (low risk group) receive community care and monthly assessments. Initial between-groups differences on key variables are statistically controlled according to procedures of the regression discontinuity design (RDD), so any emerging between-group differences in outcomes can be attributed to treatments.
Results: 337 young people (mean age 16.6) were assigned to the treatment group (n = 250) or comparison group (n = 87). 86% of the CHR sample met DSM-IV criteria for an Axis I disorder. The RDD procedure successfully removed between-group differences in baseline scores on all but one of the key outcome variables.
Conclusion: Six sites located in 4 distinct regions of the U. S. have successfully collaborated in the initial phase of a large sample test of FACT in preventing the onset of psychosis. Treatment outcome findings and other research initiated at individual sites will significantly increase our knowledge of the early phases of psychotic illness and the factors that may prevent it.
Early Intervention in Psychosis: Obvious, Effective, Overdue
Early intervention for potentially serious disorder is a fundamental feature of healthcare across the spectrum of physical illness. It has been a major factor in the reductions in morbidity and mortality that have been achieved in some of the non-communicable diseases, notably cancer and cardiovascular disease.
Over the past two decades, an international collaborative effort has been mounted to build the evidence and the capacity for early intervention in the psychotic disorders, notably schizophrenia, where for so long deep pessimism had reigned. The origins and rapid development of early intervention in psychosis are described from a personal and Australian perspective. This uniquely evidence-informed, evidence-building and cost-effective reform provides a blueprint and launch pad to radically change the wider landscape of mental health care and dissolve many of the barriers that have constrained progress for so long.
Early Psychosis Guide for Mental Health Clinicians
This booklet was produced by Mheccu as a supporting document for the Early Psychosis Initiative (EPI) of British Columbia. A major goal of EPI is to enhance recognition of early signs and symptoms of psychosis so that effective treatment can be started promptly.
EASA & EASA Center for Excellence Information Flyer
This 2-sided flyer gives a brief description of the Oregon statewide Early Assessment & Support Alliance (EASA) and its central administration and research Center for Excellence in Portland, OR.
EASA Cultural Competency Readiness
Bullet point list of cultural competence readiness considerations.
EASA Family Guidelines
This list of motivational phrases/reminders for families of individuals experiencing psychosis.
EASA Family Guidelines (Spanish)
Spanish version of the EASA Family Guidelines
EASA Family Handbook
This booklet is given to families of individuals experiencing psychosis in the Multnomah County (Oregon) EASA program. It aims to answer questions and offer advice about supporting someone experiencing psychosis.
EASA Family Input Form
EASA General Health Questionnaire
EASA Nurse Monitoring Form
EASA Occupational Therapy Brochure
EASA Peer Support Welcome Letter
EASA Practice Guidelines
The core program model and fidelity tool for Early Assessment & Support Alliance (EASA) programs.
EASA Risk Assessment
This is a short risk assessment developed by EASA.
EASA Screening Assessment
This form covers the key screening areas to determine if an individual is a good fit for EASA. It can also be integrated into MHA.
EASA Strengths Assessment
The assessment you can use to determine participant strengths and to guide the treatment plan.
EASA Young Adult Leadership Council Housing Recommendations
The EASA Young Adult Leadership Council has created the following overview and recommendations for policy makers and state and local program developers, focused on how best to support the experiences of young adults transitioning into independent housing situations.
EASA Young Adult Leadership Council National Policy Platform
The EASA Young Adult Leadership Council outlines ideal policy for mental health and early psychosis intervention at the national level, by drawing on members' lived experiences.
EASA Young Adult Leadership Council New Applicants Policy
The EASA Young Adult Leadership Council's official policy for adding new members to the group.
EASA Young Adult Leadership Council Overview
An overview of what the EASA Young Adult Leadership Council is and its mission.
EASA Young Adult Leadership Council Welcome Letter
Welcome and privacy contract for the EASA Young Adult Leadership Council.
Economic Impact of Early Intervention in People at High Risk of Psychosis
Despite the increasing development of early intervention services for psychosis, little is known about their cost-effectiveness. We assessed the cost-effectiveness of Outreach and Support in South London (OASIS), a service for people with an at-risk mental state (ARMS) for psychosis.
The costs of OASIS compared to care as usual (CAU) were entered in a decision model and examined for 12- and 24-month periods, using the duration of untreated psychosis (DUP) and rate of transition to psychosis as key parameters. The costs were calculated on the basis of services used following referral and the impact on employment. Sensitivity analysis was used to test the robustness of all the assumptions made in the model.
Over the initial 12 months from presentation, the costs of the OASIS intervention were pound1872 higher than CAU. However, after 24 months they were pound961 less than CAU.
This model suggests that services that permit early detection of people at high risk of psychosis may be cost saving.
EDIPP Booklet: Recognizing and Helping Young People at Risk for Psychosis
Professionals play a central role in identifying young people at risk for psychotic illness and referring them to appropriate services. This booklet is designed to help you do just that. You may refer to specific sections depending on your questions and on your clinical training, but we encourage you to read the entire booklet. This guide is also a useful resource for families.
Effect of Omega-3 Fatty Acids for Indicated Prevention of Young Patients At Risk for Psychosis: When Do They Begin to Be Effective?
The results of a recent double-blind, randomized, placebo-controlled trial performed in 81 young patients at ultra-high risk for psychosis indicated that a 12-week intervention of 1.2g/day of ω-3 polyunsaturated fatty acids (PUFA) significantly reduced the risk of transition to psychosis and improved positive, negative and general symptoms as well as functioning. The aim of this post-hoc analysis was to determine at which time point ω-3 PUFAs start to significantly differ from placebo in improving psychopathology and functioning in young people at risk of developing psychosis. Analyses were performed using the mixed model repeated-measures analysis of variance. Compared to placebo, ω-3 PUFAs' significant effects on the amplitude of the reduction in General and Total PANSS scores are evident after the first four weeks of treatment; a reduction of positive symptoms and a lower mean PANSS positive score were apparent after eight weeks, whereas the significant drop in negative symptoms and the significant change and higher mean scores in global functioning occur later at 12weeks. The delay of onset of ω -3 PUFAs seems comparable to that of antipsychotics and antidepressants.
Effective Ways to Address a Legal History Background When Seeking Employment
If you have been involved with the criminal justice system at some point in your life, it is important to plan for how to address this part of your history during your employment search. Thoughtful planning about how to address this can substantially limit the negative impact legal involvement will have on your search.
Emerging Adults and Psychosis: What Supporters can do to Prevent and Navigate Criminal Justice Involvement
Legal involvement is common among emerging adults with psychosis. Psychosis in its acute phase prevents individuals from being able to discern what is real from what is not. As a result, their behavior frequently results in early law enforcement contact. The police are often the first professionals called in to respond to a mental health crisis, and how they respond can have a lasting impact on the young person’s life. A well-informed team can prevent legal involvement and advocate more effectively when needed.
Employment Programming: Addressing Prevailing Barriers to Competitive Work
Employment prospects are grim for people with psychiatric disabilities returning to community life from jail or prison. On the one hand, there are very few employment programs, either pre- or post-release, to help this dually disadvantaged group into the competitive labor market. On the other hand, the programs that do offer assistance with finding jobs report only modest outcomes. The unavailability and ineffectiveness of work-oriented programs is particularly discouraging because stable jobs have been demonstrated to increase emotional stability and decrease reliance on criminal activity for income. There is compelling evidence that people who work are less likely either to return to psychiatric institutions or to be reincarcerated.
Employment Resource Book
This action-oriented resource book is designed for you if you have had mental health problems and you are now considering finding a job, you have already decided to find a job, or you already have a job in the general workforce. Finding a part-time or full-time job in the general workforce—a job not set aside for people with disabilities—is known as competitive employment. This resource book is designed to help you think about working and guide you before, during and/or after your competitive employment job search. It will also help you move your life in a meaningful direction.
EPI Family Coping Booklet
This handbook serves as a guide to coping with a family member's experience of psychosis.
Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams
This review is an initial exploration of team development within effective integrated primary and behavioral healthcare teams. Six integrated teams in safety net primary care settings were interviewed on the development of the clinical team. The study identifies four essential elements for effective integrated behavioral health and primary care teams and provides a roadmap for organizations designing their own teams, using examples from these best practices.
Essential Evidence-Based Components of First-Episode Psychosis (FEP) Services
Objective: The purpose of this study was to identify essential evidence-based components of first-episode psychosis services. Methods: The study was conducted in two stages. In the first stage a systematic review of both peer-reviewed and gray literature (January 1980 to April 2010) was conducted. Databases searched included MEDLINE, PsycINFO, and EMBASE. In the second stage, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential.
Results: The review identified 1,020 citations; abstracts were reviewed for relevance. A total of 280 peer-reviewed articles met criteria for relevance. Two
researchers independently reviewed these articles and identified 75 unique service components. Each component was assigned a level of supporting evidence. Twenty-seven experts completed the first Delphi round, of whom 23 participated in the second. Consensus was achieved in two rounds, with 32 components rated as essential. Conclusions: The two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form
a foundation for developing a fidelity scale for such services. It may also be
helpful to funders and providers as a summary of essential services.
Essential Evidence-Based Components of First-Episode Psychosis Services
The purpose of this study was to identify essential evidence-based components of first-episode psychosis services.
The study was conducted in two stages. In the first stage a systematic review of both peer-reviewed and gray literature (January 1980 to April 2010) was conducted. Databases searched included MEDLINE, PsycINFO, and EMBASE. In the second stage, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential.
The review identified 1,020 citations; abstracts were reviewed for relevance. A total of 280 peer-reviewed articles met criteria for relevance. Two researchers independently reviewed these articles and identified 75 unique service components. Each component was assigned a level of supporting evidence. Twenty-seven experts completed the first Delphi round, of whom 23 participated in the second. Consensus was achieved in two rounds, with 32 components rated as essential.
The two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form a foundation for developing a fidelity scale for such services. It may also be helpful to funders and providers as a summary of essential services.
Evaluating Community Outreach Efforts: A Framework and Approach Based on a National Mental Health Demonstration Project
Background: Community health efforts often include outreach activities designed to increase awareness and ensure uptake of services or programs. Yet, few comprehensive outreach evaluations exist, particularly those designed to improve access to and use of mental health services. Purpose: This article summarizes the use of two established evaluation frameworks and details an approach to assessing outreach that may have broad appeal to administrators, social workers, health educators, community organizers, and others interested in exploring the results of their efforts. Setting: Multi-site national study conducted in five states Intervention: Community outreach Research Design: Two existing published frameworks are applied to assess community outreach. The evaluation design included three components: 1) process, 2) outcomes and 3) context. Data Collection and Analysis: Qualitative data were based on focus groups and key informant interviews. Quantitative data were gathered through evaluation surveys, tracking forms and other outreach protocols. The findings focus on lessons learned that may have applicability to others interested in evaluating community outreach efforts in areas beyond mental health.
Evaluating Your Program
Evaluating Your Program shows quality assurance team members how to evaluate the effectiveness of your Integrated Treatment for Co-Occurring Disorders program.
Factors Contributing to Engagement During the Initial Stages of Treatment for Psychosis
There is a growing international effort to improve the rate of engagement with young people needing early treatment for psychosis. In this article I describe how a sample of 30 young people, who successfully engaged in treatment for a first episode of psychosis, experienced the process of engagement during the initial stages of care. Using a grounded theory approach and purposive sampling, I found that the nature of relationships among young patients and care providers is a factor that influences engagement. I also found that the transition between initial treatment and community care is a critical time for engagement. The success of this transition is marked by contact with client-centered-care providers and a supportive peer group culture.
Families Are Part of the Solution: A Strategic Direction for Family Support & Inclusion
Recommendations for families supporting individuals experiencing psychosis.
Family and Network Therapy Training for a System of Care: A Pedagogy of Hope
This curriculum has been used successfully in a variety of settings and with trainees from a variety of clinical disciplines including social work, psychology, psychiatry, nursing, and family medicine.
Family Involvement Decisional Balance Form
This sheet can be used to determine whether or not you want your family involved in you treatment planning.
Family Psychoeducation Implementation Resource Kit User's Guide
The User's Guide begins by providing general information about the Implementing
Evidence-Based Practices Project, including the project philosophy and values. This is followed by descriptions of the materials contained in the resource kit and their
proposed role in the implementation process. The basic structure of an implementation
plan is outlined. Specific suggestions for implementing the practice of family
psychoeducation are presented in the Implementation Tips documents. This guide also
contains a list of readings and other resources and a special populations appendix
which provides a review of the literature addressing the range of populations for which this practice has demonstrated efficacy or effectiveness.
Federal Financing Report on Employment Services
This report identifies strategies for improved access to federal financing of IPS supported employment and customized employment through case studies of current state and local practices.
Finding Personal Motivation to Use Medication
Our family may urge us to take medication to help our mental health. Our team may encourage us to try medication. A judge may want us to take mental health medication. This can feel annoying until we discover our own personal motivation to use medication to help support our recovery. Why do you (or don’t you) use medication to support your mental health? This worksheet will help you explore what might motivate you to
use mental health medication.
First Episode Psychosis: Support for States and Programs
The Center for Practice Innovations (CPI) at Columbia Psychiatry, New York State Psychiatric Institute, offers consultation and training for States and programs considering implementing Coordinated Specialty Care (CSC), an evidence-based, team-based intervention for individuals experiencing early psychosis. CSC components include:
• Individual and group psychotherapy
• Supported employment and education services
• Family education and support
• Low doses of select antipsychotic agents
• Care coordination and management
First Episode: Psychosis (Results from a 2011 NAMI Survey)
In July 2011, NAMI (National Alliance on Mental Illness) conducted an online survey of individuals who have experienced psychosis firsthand or directly witnessed the experience of a family member or friend.
From the Couch to the Bus Depot to the Mall to Work: Understanding the Relationship of the Post-Psychotic Adjustment Process to Recovery
The post-psychotic adjustment process is described in the Milestones of Recovery Post-Psychotic Recovery Model (MAPP). MAPP defines a non-linear, 4-phase process (cognitive dissonance, insight, cognitive constancy, and ordinariness), based on Festinger’s Cognitive Dissonance theory includes cognitive, emotional, interpersonal, and physiological milestones within each phase.
This easy-to-use self-administered patient questionnaire is used as a screening tool and severity measure for generalized anxiety disorder (GAD).
Gaining Employment: A Collection of Resources
This collection was designed to be used by individuals seeking assistance in joining or re-joining the workforce, and their supporters.
Getting Started with Evidence-based Practices
Getting Started with Evidence-Based Practices gives you an overview of the activities that are generally involved in implementing evidence-based practices (EBPs) and tells you how to make EBPs culturally competent. This booklet is particularly relevant to mental health authorities and agency staff who develop and manage EBP programs.
Help for People with Mental Health and Substance Use Problems
This is an example of a brochure for integrated DD services.
Helping Others Make Important Decisions: A Step-by-Step Approach
Often, people want or need support to make a difficult decision. This workbook
is designed to help you support someone in making difficult decision, not just
decisions about treatment or services.
You can use this workbook in several ways:
• To prepare yourself to hold a decision making conversation
• As a guide to help someone work through the steps of decision
making on paper or using the worksheet included at the back
of the workbook;
• As an aid for making a shared decision together with someone;
• As a way to help someone prepare for a planning or decision
Helping your Family Member
This booklet is dedicated to all families who have experienced the onset of psychosis in a young person.
How I Perceive and Manage My Illness
The article describes some of the ongoing problems psychiatric patients encounter on a daily basis as perceived” by an individual who has lived with schizophrenia for more than 25 years. Specific carefully planned coping strategies which are seen as critical to the
recovery process are presented.
How Medications Can Help Teenagers with Depression
This pamphlet describes how using antidepressant medications can help you feel better and ready to make small changes that may improve the quality of your life.
How to Keep a Job: The Young Adult’s Guide
This tip sheet may help you keep your jobs.
IDDT Affiliation Code
Many service organizations and county boards have witnessed first-hand the positive effects of IDDT upon outcomes for consumers, service organizations, and service systems. Yet, there has not been an established method to conduct local and statewide evaluation on a consistent basis. The IDDT Affiliation Code Initiative gives us the
capacity to collect data and to examine indicators and outcomes systematically for IDDT consumers and to use this knowledge to inform and advance public policy, community service plans, and day-today service delivery locally and across the state.
IDDT Clinical Guide: Integrated Dual Disorder Treatment
This booklet is part of an evolving consulting and training process from the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University. For more information about the Center, see the back cover of this booklet. For more information about Integrated Dual Disorder Treatment (IDDT), the evidence-based practice, consult these resources from our website.
IDDT Fidelity Scale
IDDT Fidelity Scale.
This booklet outlines the stages-of-change technology that the Ohio SAMI CCOE utilizes with policy makers, administrators, team leaders, service providers, community stakeholders, and steering committees to guide them through the process of implementing the Integrated Dual Disorder Treatment (IDDT) model. IDDT is an evidence-based practice (EBP) for people with co-occurring mental and substance use disorders (see Drake 1998, 2001 in Sources on page 38).
If you are experiencing difficulty with concentration, you are not alone. Below are some tips from people who have taken steps to improve their concentration. You might want to try these suggestions to see if one or more helps you.
Improving Cultural Competence
This Treatment Improvement Protocol (TIP)
uses Sue’s (2001) multidimensional model for
developing cultural competence. Adapted to
address cultural competence across behavioral
health settings, this model serves as a framework
for targeting three organizational levels
of treatment: individual counselor and staff,
clinical and programmatic, and organizational
Inner and outer voices in the present moment of family and network therapy
In this paper three main themes are considered. First, I analyse the importance of the present moment in family therapy. Second, I explore the polyphony of voices as the main aspect of human psychology and its meaning for family therapy dialogue. Third, the
effectiveness of dialogism in the treatment of psychotic problems will be illustrated in the province of Western Lapland in Finland.
Integrated Dual Disorder Treatment
Poster depicting key elements of IDDT.
Introduction to Counseling Young People Experiencing Psychosis
Involuntary Medication Hearing Handbook
The purpose of this Handbook is to provide general information about the involuntary medication hearing process to individuals at any Oregon State Hospital campus for treatment of a mental health condition. Your doctor may believe you need a certain type of medication, know as a psychotropic. A psychotropic medication can affect your thought process, emotions, or behaviors. This Handbook will give you information about what you can do if your doctor believes you need one or more psychotropic medications.
IPS Data and Record Keeping
IPS Data and Record Keeping fidelity chart.
IPS Fidelity Review Model
IPS Supported Employment Manual.
IPS Fidelity Scale
IPS Supported Employment Fidelity Review Scale
IRIS Guideline 1
A strategy for early detection and assessment of frank psychosis is an essential component of early intervention.
IRIS Guideline 10
A strategy to promote a positive image of people with psychosis needs to be developed locally.
IRIS Guideline 2
A key worker should be allocated early following referral of the case in order to develop engagement and rapport and to 'stay with' the client and family/friends through the first 3 years (the 'critical period') preferably within an assertive outreach model.
IRIS Guideline 3
An assessment plan and collaborative assessment of needs should be drawn up which is both comprehensive and collaborative, and driven by the needs and preferences of the client and their relatives and friends.
IRIS Guideline 5
Family and friends should be actively involved in the engagement, assessment, treatment and recovery process.
IRIS Guideline 6
A strategy for relapse prevention and treatment resistance should be implemented.
IRIS Guideline 8
Ensuring that basic needs of everyday living--housing, money, practical support--are met.
IRIS Guideline 9
Assessment and treatment of "comorbidity" should be undertaken in conjunction with that for psychosis.
IRIS Guidelines Glossary
A glossary of terms to accompany the IRIS Guidelines.
IRIS Guidelines Introduction
These guidelines are for service providers and commissioners of mental health services to help them to ensure high quality and cost effective delivery of care and support for people experiencing a first episode of psychosis. Anticipating a new era of practice and policy development, these 2012 guidelines describe the key elements of service design for the delivery of Early Intervention in Psychosis (EIP). In doing so it is important to emphasize that Early Intervention in Psychosis does not describe an intervention but rather a distinctive model of service and ethos/philosophy of care, with an evidence base of clinical and cost-effectiveness
and positive service user evaluation. These guidelines lay out the service principles and the key elements of provision.
IRIS Medication Guidelines
Outlines things to consider when prescribing medication to first episode psychosis clients.
IRIS Recovery Guide
This short guide intends to simply explain what recovery-focused practice looks like.
The references list to accompany the IRIS Guidelines
IRIS Suicide Risk Management in Early Intervention
This publication focuses specifically on managing suicide risk in the context of a first episode of psychosis. It draws on current evidence for best practice in suicide risk management and provides practical guidance for practitioners, managers and
clinical leads. It acknowledges the difficulties we face in identifying those who pose the greatest risk but promotes an optimistic, practical and purposeful approach to management.
IRIS Talking to Families About Emerging Psychosis
This article explains empowering and non-stigmatizing ways for doctors to orient clients and families to a psychosis diagnosis, and foster a feeling of hope and recovery.
LEAP Model: Engagement Tips
LEAP (“Listen-Empathize-Agree-Partner”) shows you how to quickly gain the trust of someone you are at odds with. When you Listen–Empathize–Agree–Partner, you stop trying to convince the other person he is wrong, or simply misguided and instead listen in a new way that conveys respect for the person’s point of view and complete lack of judgment.
Leeds Alliance in Supervision Scale (LASS)
The LASS is a reliable and valid measure of the supervisory alliance that is sensitive to change and has the clinical utility to be used on a sessional basis.
Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population
CONTEXT: Recent general population surveys of psychotic disorders have found low lifetime prevalences. However, this may be owing to methodological problems. Few studies have reported the prevalences of all specific psychotic disorders.
OBJECTIVE: To provide reliable estimates of the lifetime prevalences of specific psychotic disorders.
DESIGN: General population survey.
SETTING AND PARTICIPANTS: A nationally representative sample of 8028 persons 30 years or older was screened for psychotic and bipolar I disorders using the Composite International Diagnostic Interview, self-reported diagnoses, medical examination, and national registers. Those selected by the screens were then re-interviewed with the Structured Clinical Interview for DSM-IV. Best-estimate DSM-IV diagnoses were formed by combining the interview and case note data. Register diagnoses were used to estimate the effect of the nonresponders.
MAIN OUTCOME MEASURES: Diagnosis of any psychotic or bipolar I disorder according to the DSM-IV criteria.
RESULTS: The lifetime prevalence of all psychotic disorders was 3.06% and rose to 3.48% when register diagnoses of the nonresponder group were included. Lifetime prevalences were as follows: 0.87% for schizophrenia, 0.32% for schizoaffective disorder, 0.07% for schizophreniform disorder, 0.18% for delusional disorder, 0.24% for bipolar I disorder, 0.35% for major depressive disorder with psychotic features, 0.42% for substance-induced psychotic disorders, and 0.21% for psychotic disorders due to a general medical condition. The National Hospital Discharge Register was the most reliable of the screens (kappa = 0.80). Case notes supplementing the interviews were essential for specific diagnoses of psychotic disorders.
CONCLUSIONS: Multiple sources of information are essential for accurate estimation of lifetime prevalences of psychotic disorders. The use of comprehensive methods reveals that their lifetime prevalence exceeds 3%.
Linehan Risk Assessment and Management Protocol (LRAMP)
This is a tool to assess suicide risk and how to manage it.
Locus of Control Scale
The Locus of Control Scale is a 13 item questionnaire developed by Rotter (1966). It measures generalized expectancies for internal versus external control of reinforcement. People with an internal locus of control believe that their own actions determine the rewards that they obtain, while those with an external locus of control believe that their own behavior doesn't matter much and that rewards in life are generally outside of their control. Scores range from 0 to 13. A low score indicates an internal locus of control while a high score indicates external control.
Medication Adherence Scale
This document describes some features of the more widely used of the currently available adherence rating scales. The objective of some of the earlier tools was primarily to allow the patient’s subjective experience of treatment with antipsychotic drugs to be quantified.
Medication Side Effects Profile
This sheet can help you reflect on your experiences with certain medications.
Medication, Treatment, Evaluation, and Management
MedTEAM is a systematic, evidence-based approach for offering medication management to people with mental illnesses. It helps those who prescribe medications to integrate the best current research evidence, clinical expertise, and consumer experience.
Medications and My Life
This tool can help you prepare for a conversation with a provider about medications. Fill it out before your appointment then take a copy with you to the appointment. You may also want to give your provider a copy.
Mental Health Consumer Providers: A Guide for Clinical Staff
The purpose of this booklet is to provide mental health clinic staff with a brief guide to implementing and sustaining a consumer provider (peer support)program.
Mental Health Law in Oregon
This Guide was written to provide information about the rights and protections that individuals with mental illness have under the law in Oregon, and includes citations to Oregon Revised Statutes (ORS) and Oregon Administrative Rules (OAR).
Mental Illness and Exercise
This tipsheet offers a starting point for simple exercise habits to combat heart disease and other risks associated with mental health.
Mindfulness for psychosis
Mindfulness treatments and research have burgeoned over the past decade. With psychosis, progress has been slow and likely held back by clinicians’ belief that mindfulness may be harmful for this client group. There is emerging evidence that mindfulness for
psychosis – when used in an adapted form – is safe and therapeutic.
Mood Disorder Questionnaire (MDQ)
The MDQ was developed by a team of psychiatrists, researchers and consumer advocates to address a critical need for timely and accurate diagnosis of bipolar disorder, which can be fatal if left untreated. The questionnaire takes about five minutes to complete, and can provide important insights into diagnosis and treatment. Clinical trials have indicated that the MDQ has a high rate of accuracy; it is also able to identify seven out of ten people who have bipolar disorder and screen out nine out of ten people who do not.
A recent National DMDA survey revealed that nearly 70% of people with bipolar disorder had received at least one misdiagnosis and many had waited more than 10 years from the onset of their symptoms before receiving a correct diagnosis. National DMDA hopes that the MDQ will shorten this delay and help more people to get the treatment they need, when they need it.
The MDQ screens for Bipolar Spectrum Disorder, (which includes Bipolar I, Bipolar II and Bipolar NOS).
My Designated Observer
Why a Designated Observer? Sometimes it’s helpful to have another person tell us if we seem different than we usually do, especially if we’re trying a new medication, stopping a
medication, or making changes to our medication.
NAMI First Episode Psychosis Survey
Results from a 2011 NAMI survey on national FEP access.
National Practice Guidelines for Peer Supporters
In addition to the SAMHSA Working Definition and Guiding Principles of Recovery, these core values have been ratified by peer supporters across the country as the core ethical guidelines for peer support practice.
National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities (HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the United States.
NAVIGATE Family Education Program (FEP)
Relatives typically respond with a variety of emotions when their loved one develops a psychotic illness—they want to help improve the situation, but they are usually bewildered, confused, and frightened. Many may feel angry or disbelieving about the situation. A small, but not insubstantial number, may have prior experience of
psychotic illness with other family members, and may feel hopeless or discouraged
about the illness in another loved one. Regardless of the relative’s response, the family clinician always has two objectives in every interaction—1) to reduce relative burden
and 2) help the relatives build on their strengths to create and maintain an environment to support the client’s recovery. To meet these objectives, the family clinician must help the relatives cultivate the necessary knowledge base, attitudes, and skills to cope effectively with the situation and support the client’s progress; this is the work of the family services component of the NAVIGATE program.
NAVIGATE Supported Employment and Education (SEE) Manual
This manual describes the NAVIGATE Supported Employment and Education and how to implement it.
Neurocognitive Development in First-Episode Psychosis 5 Years Follow-up: Associations Between Illness Severity and Cognitive Course
Cognitive deficits are documented in first-episode psychosis (FEP), but the continuing course is not fully understood. The present study examines the longitudinal development of neurocognitive function in a five year follow-up of FEP-patients, focusing on the relation to illness severity, as measured by relapses and diagnostic subgroups. The study is an extension of previous findings from the TIPS-project, reporting stability over the first two years. Sixty-two FEP patients (53% male, age 28 ± 9 years) were neuropsychologically examined at baseline and at 1, 2, and 5 year follow-ups. The test battery was divided into five indices; Verbal Learning, Executive Function, Impulsivity, Motor Speed, and Working Memory. To investigate the effect of illness severity, the sample was divided in groups based on number of relapses, and diagnostic subgroups, respectively. Impulsivity and Working Memory improved significantly in the first two years, followed by no change over the next three years. Motor Speed decreased significantly from 2 to 5 years. Number of relapses was significantly related to Verbal Learning and Working Memory, showing a small decrease and less improvement, respectively, in patients with two or more episodes. No significant association was found with diagnostic group. Neurocognitive stability as well as change was found in a sample of FEP-patients examined repeatedly over 5 years. Of potential greater importance for understanding how psychotic illnesses progress, is the finding of significant associations between neurocognition and number of relapses but not diagnostic group, indicating that neurocognition is more related to recurring psychotic episodes than to the descriptive diagnosis per se.
OARS: Four Basic Skills of Motivational Interviewing
The goal of motivational interviewing is to get individuals to resolve their ambivalence about changing their behavior, without evoking resistance to change. It is based on stages of change and assumes motivation is fluid and can be influenced.
Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial
The focus for this study was the effectiveness of the established practice of occupational therapy. Although evidence based practice generally validates novel treatments as more effective than older therapies, established therapies that are routinely delivered do merit investigation. Occupational therapy draws on the emerging discipline of occupational science, which asserts that engagement in meaningful and satisfying occupations contributes towards health and wellbeing, social inclusion, improved functioning and self respect.
Occupational Therapy for Psychosis: Tips and Strategies
At EASA, OTs collaborate with the young people and their family/support systems to
provide individualized assessment and intervention. As a key part of multi-disciplinary clinical teams, they often provide consultation for other members (such as advising on educational and vocational supports). They place special emphasis on sensory processing and sensory modulation techniques to alleviate distress caused by psychosis-related sensory sensitivity.
Occupational Therapy Manual for the EASA Model
This manual was developed after several EASA teams identified the need for more formal guidelines and information regarding the role of occupational therapy in EASA programs. It is intended for use by all EASA programs and provides information relevant to occupational therapists, administrators, and teams. This document describes the occupational therapy profession and its connection to mental health practice, the roles and services that can be provided on EASA teams, information related to billing and reimbursement, the hiring and supervising process, as well as many resources.
Occupational Therapy’s Role in Community Mental Health
The origins of occupational therapy are rooted in mental health, as the creation of the profession dovetailed with the early 20th century’s mental hygiene movement. With the call for deinstitutionalization of individuals with mental illness, which culminated in the 1963 Community Mental Health Act, occupational therapists and occupational therapy assistants began working in community mental health.
Occupational Therapy’s Role in Mental Health Recovery
Occupational therapy practitioners work collaboratively with people in a manner that helps to foster hope, motivation, and empowerment, as well as system change. Educated in the scientific understanding of neurophysiology, psychosocial development, activity and environmental analysis, and group dynamics, occupational therapy practitioners work to
empower each individual to fully participate and be successful and satisfied in his or her self-selected occupations. Occupational therapy practitioners assume a variety of roles such as direct care therapists, consultants, academic educators, managers, and administrators. They may also work in state and national mental health organizations to help assist in local, state, and national transformation efforts.
Omega-3 Fatty Acids and Brain Health
Research suggests intake of certain omega-3 fatty acids can improve psychosis and negative symptoms in schizophrenia, among other health benefits.
OnTrack NY Medical Manual
This manual is designed to be a reference for psychiatrist and nurse prescribers, and for other nurses providing care through OnTrackNY. It summarizes our approach to the safe and effective use of antipsychotic medication and to supporting individuals’ general health and wellbeing as they strive to achieve their goals. It includes guidelines for discussing and selecting antipsychotic medication, monitoring efficacy and side effects, managing related medical issues and promoting overall wellness.
OnTrack Outreach and Recruitment Manual
This manual provides and overview and methods that can be used to conduct strategic outreach and recruitment to an Early Psychosis program.
Opening the Door: Starting difficult conversations with your mental health service provider
Starting difficult conversations with your mental health service provider
It can be hard to talk to others about difficult or sensitive issues. Sometimes the hardest part is figuring out how to start. This document offers some ways to start conversations about three topics:
1. Partnering and decision making;
2. Medications; and
Orygen Clinical Guidelines
This practitioner guide is a summary of the second edition of the Australian Clinical Guidelines for Early Psychosis, developed at EPPIC Statewide for the Orygen Youth Health Research Centre. We strongly encourage readers to refer to the full guidelines if possible; they are available via the Orygen, The National Centre of Excellence in Youth Mental Health Website at www.orygen.org.au.
Orygen General Practitioner Guide
This booklet was produced by ORYGEN Youth Health to promote awareness of the benefits of early intervention on the long and short term health of young people with a mental illness.
Overview of Integrated Dual Diagnosis Treatment (IDDT)
This booklet is part of an evolving consulting and training process from the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University. For more information about the Center, see the back cover of this booklet. For more information about Integrated Dual Disorder Treatment (IDDT), the evidence-based practice, consult these resources from our website.
Patient Health Questionnaire
Recognizing signs of mental health disorders is not always easy. The Patient Health Questionnaire (PHQ) is a diagnostic tool for mental health disorders used by health care professionals that is quick and easy for patients to complete.
Peer Involvement and Leadership in Early Intervention in Psychosis Services: From Planning to Peer Support and Evaluation
The goal of this guide is to provide a range of different stakeholders with information and best practices for peer support and leadership in early intervention for psychosis (EIP) services. Audiences that may find this manual to be useful include state-level administrators, clinical directors, peer and family advocates, young people, and early intervention planning committee members, as well as researchers and others with an interest in youth and peer involvement. This document includes many concrete examples of exemplary or innovative services, projects and individuals (see “spotlights”), and a comprehensive appendix of resources is offered at the end of the guide. Unlike many other U.S. peer support manuals, the aim of this guide is to provide coverage of a broad range of domains in which peers might assume leadership or advisory roles. These include program development and planning, direct service delivery (including peer support), public outreach and engagement, clinician education, and quality improvement and evaluation.
Peer Support Specialist Job Description
Sample Peer Support Specialist job description from Yamhill County Adult Mental Health in Oregon.
PEPP Treatment Manual
The model involves a comprehensive approach with intensive medical and psychosocial
management being provided by a nurse case manager (or social worker). In essence, a case manager walks the client through the mental health system, though whenever possible, relying on generic community services to reintegrate the young adult to his/her full potential over a two-year follow-up period. This model includes a close partnership with families.
PLANNING TO FEEL BETTER: A GUIDE FOR DEPRESSED ADOLESCENTS
This booklet helps teens learn about depression and simple coping strategies.
Portland Identification and Early Referral: A Community-Based System for Identifying and Treating Youths at High Risk of Psychosis
The Portland [Maine] Identification and Early Referral (PIER) program was established in 2000 as a prevention system for identifying and treating youths at high risk of an initial psychotic episode.
During six years, 7,270 professionals from the educational, medical, and mental health sectors were provided information on prodromal symptoms and means for rapid referral of at-risk youths, which resulted in referral of 780 youths who met eligibility criteria.
After screening, 37% of the community referrals were found to be at high risk of psychosis, and another 20% had untreated or early psychosis, yielding an efficiency ratio of 57%. Prodromal cases identified were 46% of the expected incidence of psychosis in the catchment area. Community educational presentations were significantly associated with referrals about six months later; half of referrals were from outside the mental health system.
Community-based identification is an efficient public health strategy, offering the opportunity for preventive intervention.
Practitioner's Guide to Ethical Decision Making
Practitioners are often faced with situations that require sound ethical decision-making ability. Determining the appropriate course to take when faced with a difficult ethical dilemma can be a challenge. To assist American Counseling Association (ACA) members in meeting this challenge, the authors have developed the Practitioner’s Guide to Ethical Decision Making as a framework for sound ethical decision making. This document addresses the guiding principles that are globally valuable in ethical decision making and presents a model that professionals can use as they address ethical questions and dilemmas in their work.
Prediction of Psychosis in Youth at High Clinical Risk: A Multisite Longitudinal Study in North America
Early detection and prospective evaluation of individuals who will develop schizophrenia or other psychotic disorders are critical to efforts to isolate mechanisms underlying psychosis onset and to the testing of preventive interventions, but existing risk prediction approaches have achieved only modest predictive accuracy.
To determine the risk of conversion to psychosis and to evaluate a set of prediction algorithms maximizing positive predictive power in a clinical high-risk sample.
DESIGN, SETTING, AND PARTICIPANTS:
Longitudinal study with a 2 1/2-year follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes criteria. The patients were recruited and underwent evaluation across 8 clinical research centers as part of the North American Prodrome Longitudinal Study.
MAIN OUTCOME MEASURE:
Time to conversion to a fully psychotic form of mental illness.
The risk of conversion to psychosis was 35%, with a decelerating rate of transition during the 2 1/2-year follow-up. Five features assessed at baseline contributed uniquely to the prediction of psychosis: a genetic risk for schizophrenia with recent deterioration in functioning, higher levels of unusual thought content, higher levels of suspicion/paranoia, greater social impairment, and a history of substance abuse. Prediction algorithms combining 2 or 3 of these variables resulted in dramatic increases in positive predictive power (ie, 68%-80%) compared with the prodromal criteria alone.
These findings demonstrate that prospective ascertainment of individuals at risk for psychosis is feasible, with a level of predictive accuracy comparable to that in other areas of preventive medicine. They provide a benchmark for the rate and shape of the psychosis risk function against which standardized preventive intervention programs can be compared.
PREP Clinician Brochure
This is an example of an outreach brochure for clinicians.
PREP Provider Brochure
This is an example of an outreach brochure for providers.
Preparing to Talk about Symptoms
We can’t always get all the time we want with our doctor, therapist or other team members. Use this form to help prepare for the things you want to discuss with your team.
Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study
Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients.
Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project’s Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry.
The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects.
Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.
Preventing a First Episode of Psychosis: Meta-analysis of Randomized Controlled Prevention Trials of 12 month and Longer-term Follow-ups
Over the last decade many studies were conducted to assess the feasibility of early detection of people at risk of developing psychosis and intervention to prevent or delay a first psychotic episode. Most of these studies were small and underpowered. A meta-analysis can demonstrate the effectiveness of the efforts to prevent or postpone a first episode of psychosis. A search conducted according the PRISMA guideline identified 10 studies reporting 12-month follow-up data on transition to psychosis, and 5 studies with follow-ups varying from 24 to 48 months. Both random and fixed effects meta-analyses were conducted. The quality of the studies varied from poor to excellent. Overall the risk reduction at 12 months was 54% (RR=0.463; 95% CI=0.33-0.64) with a Number Needed to Treat (NNT) of 9 (95% CI=6-15). Although the interventions differed, there was only mild heterogeneity and publication bias was small. All sub-analyses demonstrated effectiveness. Also 24 to 48-month follow-ups were associated with a risk reduction of 37% (RR=.635; 95% CI=0.44-0.92) and a NNT of 12 (95% CI=7-59). Sensitivity analysis excluding the methodologically weakest study showed that the findings were robust. Early detection and intervention in people at ultra-high risk of developing psychosis can be successful to prevent or delay a first psychosis. Antipsychotic medication showed efficacy, but more trials are needed. Omega-3 fatty acid needs replication. Integrated psychological interventions need replication with more methodologically sound studies. The findings regarding CBT appear robust, but the 95% confidence interval is still wide.
Preventing Progression to First-Episode Psychosis in Early Initial Prodromal States
Young people with self-experienced cognitive thought and perception deficits (basic symptoms) may present with an early initial prodromal state (EIPS) of psychosis in which most of the disability and neurobiological deficits of schizophrenia have not yet occurred.
To investigate the effects of an integrated psychological intervention (IPI), combining individual cognitive-behavioural therapy, group skills training, cognitive remediation and multifamily psychoeducation, on the prevention of psychosis in the EIPS.
A randomised controlled, multicentre, parallel group trial of 12 months of IPI v. supportive counselling (trial registration number: NCT00204087). Primary outcome was progression to psychosis at 12- and 24-month follow-up.
A total of 128 help-seeking out-patients in an EIPS were randomised. Integrated psychological intervention was superior to supportive counselling in preventing progression to psychosis at 12-month follow-up (3.2% v. 16.9%; P = 0.008) and at 24-month follow-up (6.3% v. 20.0%; P = 0.019).
Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people in an EIPS.
Prevention and Early Intervention Program for Psychoses (PEPP) Assessment Manual
Here we will provide the reader with a detailed description of a new early intervention program (PEPP). We have attempted to provide practical guidelines for setting up an early intervention program/service for psychotic disorders with special emphasis on assessment procedures and integrated phase specific treatment. While we have attempted to provide sufficient detail these modules cannot be considered training manuals. The latter may be obtained from the program on direct request. It must be emphasized that in order to provide optimum assessment and treatment as outlined in this package clinicians are advised to obtain specific training.
Processing the Psychotic Episode
This module focuses on helping clients recount and “process” the details of their
episode, sorting out aspects of their experience that may have been confusing or
particularly upsetting, and challenging inaccurate and self-defeating beliefs about the
experience. The module is divided into two topics: Telling Your Story, and Challenging
Self-Defeating Thoughts and Beliefs. In the Telling Your Story topic, the clinician begins by exploring upsetting aspects of the client’s psychotic episode, and using two
standardized scales to understand how it has affected him or her (the Post-Psychotic
Episode Checklist and the Self-Stigmatizing Beliefs Checklist). Next, a rationale is
provided for how “telling one’s story” about any very upsetting experience, including a
psychotic episode, can help people overcome distress related to their experience. You
and the client then review the “story” of a young man who had a psychotic episode.
Next, you and the client work together to develop a cohesive narrative of the client’s
own personal experience.
Prodromal Questionnaire- Brief Version: Instructions for Clinicians
The Prodromal Questionnaire – Brief Version (PQ-B) is a self-report measure designed to identify help-seeking adolescents and young adults who may be experiencing attenuated psychotic symptoms that characterize the schizophrenia prodrome. This tool is not diagnostic; rather, it is meant to identify young people in need of further assessment for a psychosis risk syndrome as assessed by established clinical interview.
Program Directory of Early Psychosis Intervention Programs
This directory is undergoing continuing development in order to always have the most recent directory information for all early psychosis intervention programs in the United States.
Reflecting the growing national collaboration, this version of the directory features expanded national, state, and program information. This includes a new section on national resources, state contact people for early psychosis section, and program criteria (e.g., accepted age ranges, types of insurance accepted).
Promoting Early Detection of Psychosis: The Role of Community Outreach
Purpose – The purpose of this paper is to determine the effectiveness of community outreach efforts in promoting public education on the early warning signs of psychosis and in generating referrals for treatment during the prodromal stage of illness.
Design/methodology/approach - Five mental health centres across the United States implemented a community outreach model known as the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). A multi‐site evaluation was conducted to assess whether the model's outreach objectives could be achieved among replication sites in geographically and demographically diverse locations. The assessment included the analysis of data from three main sources: administrative data, structured qualitative interviews, and participant self‐report surveys.
Findings – Results demonstrated that the outreach activities in all five sites resulted in increased awareness of participants about the early warning signs of psychosis, the availability of local treatment options and increased knowledge of the referral process. There were benefits of outreach participation regardless of whether the participant was a professional or non‐professional in the community. Additionally, outreach participants showed a significant increase in their likelihood to refer a young adult for a mental health evaluation.
Originality/value – Community outreach can be an effective tool for mental health centres in developing a local network that can generate timely referrals for early intervention programmes and clinical research. Results also show that relatively brief community engagement efforts can significantly increase the knowledge and awareness of the public on complex mental health conditions where early detection may be integral to effective treatment.
Psychoeducation as Evidence-Based Practice: Considerations for Practice, Research, and Policy
This paper describes psychoeducation and its applications for mental health and health professions across system levels and in different contexts by reviewing the range of applications that have appeared in the recent literature. The theoretical foundations of clinically based psychoeducation are reviewed and the common elements of practice are identified. Examples of well-defined psychoeducational interventions are presented that meet criteria for empirically supported psychological interventions. In conclusion, the broad applications of psychoeducation for health care and mental health practice and policy at both the clinical and community levels are discussed, and the need for further evaluation and research is considered.
Psychopathological Mechanisms Linking Childhood Traumatic Experiences to Risk of Psychotic Symptoms: Analysis of a Large, Representative Population-Based Sample
Background: Different psychological models of traumainduced psychosis have been postulated, often based on the observation of “specific” associations between particular types of childhood trauma (CT) and particular psychotic symptoms or the co-occurrence of delusions and hallucinations. However, the actual specificity of these associations remains to be tested. Methods: In 2 population-based studies with comparable methodology (Netherlands Mental Health Survey and Incidence Study-1 [NEMESIS-1] and NEMESIS-2, N = 13 722), trained interviewers assessed CT, psychotic symptoms, and other psychopathology. Specificity of associations was assessed with mixed-effects regression models with multiple outcomes, a statistical method suitable to examine specificity of associations in case of multiple correlated outcomes. Results: Associations with CT were strong and significant across the entire range of psychotic symptoms, without evidence for specificity in the relationship between particular trauma variables and particular psychotic experiences (PEs). Abuse and neglect were both associated with PEs (ORabuse: 2.12, P < .001; ORneglect: 1.96, P < .001), with no large or significant difference in effect size. Intention-to-harm experiences showed stronger associations with psychosis than CT without intent (χ2 = 58.62, P < .001). Most trauma variables increased the likelihood of co-occurrence of delusions and hallucinations rather than either symptom in isolation. Discussion: Intention to harm is the key component linking childhood traumatic experiences to psychosis, most likely characterized by co-occurrence of hallucinations and delusions, indicating buildup of psychotic intensification, rather than specific psychotic symptoms in isolation. No evidence was found to support psychological theories regarding specific associations between particular types of CT and particular psychotic symptoms.
Psychophenomenology of the Postpsychotic Adjustment Process
The post-psychotic adjustment process is described in the Milestones of Recovery Post-Psychotic Recovery Model (MAPP). MAPP defines a non-linear, 4-phase process (cognitive dissonance, insight, cognitive constancy, and ordinariness), based on Festinger’s Cognitive Dissonance theory includes cognitive, emotional, interpersonal, and physiological milestones within each phase.
Psychosis Risk Screening with the Prodromal Questionnaire: Brief Version (PQ-B)
In this study, we examined the preliminary concurrent validity of a brief version of the Prodromal Questionnaire (PQ-B), a self-report screening measure for psychosis risk syndromes. Adolescents and young adults (N=141) who presented consecutively for clinical assessment to one of two early psychosis research clinics at the University of California, San Francisco and UC Los Angeles completed the PQ-B and the Structured Interview for Prodromal Syndromes (SIPS) at intake. Endorsement of three or more positive symptoms on the PQ-B differentiated between those with prodromal syndrome and psychotic syndrome diagnoses on the SIPS versus those with no SIPS diagnoses with 89% sensitivity, 58% specificity, and a positive Likelihood Ratio of 2.12. A Distress Score measuring the distress or impairment associated with endorsed positive symptoms increased the specificity to 68%, while retaining similar sensitivity of 88%. Agreement was very similar when participants with psychotic syndromes were excluded from the analyses. These results suggest that the PQ-B may be used as an effective, efficient self-report screen for prodromal psychosis syndromes when followed by diagnostic interview, in a two-stage evaluation process in help-seeking populations.
Psychosis with coexisting substance misuse: Assessment and management in adults and young people
This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.
Questions to Ask about Complementary and Alternative Medicine
Medications are one option for dealing with mental health problems. Some people find it helpful to use other approaches in addition to or instead of prescribed drug treatments. These are often called Complementary and Alternative Medicine (CAM). CAM approaches may include diet changes and exercise, spiritual practices, vitamins, supplements and herbal preparations, special treatment, or activities.
Questions to Ask About Medications
This sheet offers examples of questions to ask if a doctor recommends or prescribes a medication for you.
Quick Scale for Assessment of Negative Symptoms
Negative symptoms, such as anhedonia, asociality, avolition, affective flattening, and alogia, are a critical unmet need in the treatment of schizophrenia. Bobes et al1 found that almost 60% of treated patients with schizophrenia had 1 or more negative symptoms, of whom 13% had primary negative symptoms. Because of the proven impact of negative symptoms on patient functioning, clinicians need to be able to assess, diagnose, and address these symptoms. Unfortunately, antipsychotic agents are more effective in treating positive rather than negative symptoms. The lack of treatment options for negative symptoms can create a sense that measuring them is less important than measuring positive symptoms. However, accurate assessment can improve clinical care by aiding physicians in fully evaluating and documenting the patient’s baseline level of illness severity to measure treatment response at follow-up
providing treatment goals to work toward. It can also allow for systematic outcome evaluations and documenting quantitative assessments in a consistent and reliable fashion.
Quick Scale for Assessment of Positive Symptoms
This document is a brief scale for assessing positive symptoms of psychotic disorders.
Raising Difficult Issues with Your Service Provider
This booklet was designed to help you discuss sensitive issues with your case manager, therapist, psychiatrist, or other counselor. It will help you learn how to bring up tough issues in a way that is non-threatening and allows the other person to hear you. It’s important that you make your own needs and desires clear to others.
Reach Out 4 Teens Protocol – Suicide/Self-Harm Risk
This protocol was designed to assess patient’s safety and create an appropriate triage and notification system.
Reach Out 4 Teens Safety Plan
The purpose of this document is to create a written plan of what to do if a mental health crisis, including thoughts of suicide, were to occur.
Recent Developments in Family Psychoeducation as an Evidence-Based Practice
Among potential resources for people with serious mental illnesses (SMI) and their families, professionally delivered family psychoeducation (FPE) is designed to engage, inform, and educate family members, so that they can assist the person with SMI in managing their illness. In this article, we review research regarding FPE outcomes and implementation since 2001, updating the previous review in this journal (McFarlane, Dixon, Lukens, & Lucksted, Journal of Marital and Family Therapy 2003; 29, 223). Research on a range of FPE variations continues to return mostly positive effects for adults with schizophrenia and increasingly, bipolar disorder. More recent studies include functional outcomes as well as the more common relapse and hospitalization. FPE research involving adults with other diagnoses is increasing, as is FPE research outside the United States In both cases, uneven methodologies and multiple FPE variations make drawing conclusions difficult, although the core utility of access to information, skill building, problem solving, and social support often shines though. Since the previous review, several FPE programs for parents of children or youth with mood disorders have also been developed, with limited research showing more positive than null results. Similarly, we review the developing inquiry into early intervention and FPE, short-form FPE, and cost studies involving FPE. The second half of the article updates the paradox of FPE's evidence base versus its persistently low use, via recent implementation efforts. Multiple challenges and facilitating factors across healthcare systems and financing, individual programs and providers, family members, and consumers shape this issue, and we conclude with discussion of the need for empirical evaluation of implementation strategies and models.
Recommendations for Competency Based Supervision
Competence is a dynamic construct in which expertise, established on habitual forms of practices requires accommodations to the continuous advancement of knowledge in the field. This requires clinicians and supervisors to abandon the comfort afforded by the subjective experience of expertise and to commit to processes of self-assessment in which the limits of what one knows are confronted. The ability to self-assess and to identify discrete domains for one’s career development is complex and, while initiated in clinical training requires intrinsic motivation to carry on throughout.
Reduction in Instances of Hospitalizations for Psychotic Episodes Through Early Identification and Intervention
This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis.
The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12-35 were identified by professionals in a wide variety of educational, health, and mental health settings. PIER program staff assessed, confirmed risk of psychosis, and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of first hospital admission for psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area (Greater Portland) and in aggregated urban areas of Maine (control areas). Autoregressive integrated moving-average (ARIMA) models were used to assess the effect.
On the basis of ARIMA models, the rate of first hospital admission for psychosis decreased significantly by 26% (95% confidence interval [CI]=-64% to -11%) in the Greater Portland area. The rate increased by 8% (CI=-5% to 36%) in the control areas. Taking into account the increase in the control areas, the actual percentage reduction in Greater Portland during the intervention period was 34% (26% plus 8%). The reduction in admissions was largest for individuals with nonaffective nonschizophrenic psychosis.
PIER has demonstrated that populationwide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a midsized city.
Relationship Between Relapse and Hospitalization in First-Episode Psychosis
Relapse is a frequently used outcome measure in schizophrenia research. However, difficulties in reliably measuring relapse diminish its usefulness. Hospitalization is a potential alternative, but its relationship to relapse has not been assessed.
This study used data from a two-year, prospective study to examine associations between relapse and hospitalization in a cohort of 200 Canadian patients with first-episode psychosis. First, the relationship between relapse and hospitalization was assessed by cross-tabulating relapse and hospitalization. Next, survival curves of time to first relapse or hospitalization were compared. Finally, to examine the convergent validity of relapse and hospitalization, the predictive capacity of three predictors were examined: a substance use disorder diagnosis, prior hospitalization, and medication adherence.
Rates of both relapse and hospitalization were similar. During the two-year follow-up, 37% of the patients experienced a relapse, and 26% were hospitalized. As an indicator of relapse, hospitalization had a low sensitivity (47%) and high specificity (87%). A higher risk of hospitalization and relapse was associated with prior hospitalization, a substance use disorder diagnosis, and medication nonadherence.
Results indicated that relapse and hospitalization are separate but related outcome measures. They had similar frequencies and were found to have similar relationships with some predictors. Relapse is a more useful outcome measure in smaller clinical studies in which routine standardized clinical measures can be used. Hospitalization is more relevant in larger studies or as a quality indicator for studies using administrative databases, and it serves as a good measure for quality management in health systems.
Requirements for Civil Commitment for Individuals with Psychosis in Oregon
Sometimes people experiencing psychosis become involved in the civil commitment process. Knowing your state’s laws on civil commitment can help you respond in ways that protect your rights and safety.
The requirements for and process of civil commitment are different in each state. This handout provides information specific to the state of Oregon. It is important to know that, in Oregon, the civil commitment requirements for people with diagnoses of schizophrenia or manic-depression are different from those who do not.
Resources for Supported Education in Early Psychosis Programs
Riding the Sleep Wave: Sleep + Young People
This tipsheet describes adolescent sleep habits and how to form healthy sleep habits.
RWJF Program Results Report: Early Detection and Intervention for the Prevention of Psychosis in Adolescents and Young Adults
The Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP) helps to Identify and curb acute psychotic illness before it begins. Targeted at young people, the $16.9 million national program of the Robert Wood Johnson Foundation (RWJF) combines community outreach, research, and treatment, and emphasizes family involvement and strategies for recognizing at-risk individuals.
Sample Electronic Communication With/About Clients Protocol
Electronic communications protocol from Yamhill County Adult Mental Health in Oregon.
Sample IPS Supported Employment Fidelity Report
Sample Texting Protocol
Sample texting protocol from Marion County Children's Behavioral Health in Oregon.
Self-Determination in Mental Health Recovery: Taking Back Our Lives
In this paper I will discuss both my personal perspectives and the perspectives of others on this important topic based on many years of experience as a person, a user of mental health services, a researcher and a teacher. It will include: 1) my personal story of taking back control of my life; 2) breaking down barriers to self-determination; 3) values and ethics that support self-determination; and 4) self-determination facilitators: WRAP and Peer Support.
Self-Determination Theory and First-Episode Psychosis: A Replication
Self-determination theory (SDT) posits that human well-being depends on the satisfaction of three basic psychological needs: autonomy, competence, and relatedness. Although many scholars have suggested that SDT may be relevant to psychotic disorders, only one empirical study of SDT in individuals with psychosis has been completed to date by Breitborde and colleagues (2012). This study revealed that individuals with first-episode psychosis reported lower satisfaction of the three basic psychological needs as compared to individuals without psychosis. Moreover, greater satisfaction of basic psychological needs was modestly associated with lower general symptoms (e.g., anxiety and depression), greater social functioning, and better quality of life. Thus, the goal of this project was to replicate Breitborde et al.’s (2012) investigation of basic psychological need satisfaction among individuals with first-episode psychosis. Our results supported the conclusion that individuals with first-episode psychosis report lower autonomy, competence, and relatedness than individuals without psychosis. Moreover, our results comport with the finding that greater need satisfaction was associated with less severe symptomatology and better social functioning and quality of life. In total, the findings lend further credence to the hypothesis that SDT may help to inform the development of improved clinical services for individuals with psychotic disorders.
Self-Determination Theory and First-Episode Psychosis: Associations with Symptomatology, Social and Vocational Functioning, and Quality of Life
Self-determination theory (SDT) postulates that satisfaction of three basic psychological needs (i.e., autonomy, competence, and well-being) promotes motivation, well-being, growth across domains of functioning. Thus, per SDT, we examined satisfaction of basic psychological needs among individuals with first-episode psychosis. First, we quantified the level of need satisfaction among a sample of individuals with first-episode psychosis and compared their level of need satisfaction to that of individuals without psychosis. Second, we examined the association between need satisfaction and several domains of well-being among individuals with first-episode psychosis (i.e., symptomatology, social/vocational functioning, and quality of life). Our results indicated that individuals with first-episode psychosis experience less satisfaction of basic psychological needs as compared to their same-aged counterparts. There was a modest association between need satisfaction and well-being among individuals with first-episode psychosis, with the need of relatedness being the need most frequently associated with indices of well-being. Although modest in scope, the results of the current study raise the possibility that further investigation of SDT among individuals with first-episode psychosis may reveal important strategies through which early intervention services can better promote well-being and recovery.
Shared Decision-Making (SDM) in Mental Health Care: Practice, Research, and Future Directions
This report is intended to provide a general overview of SDM and the available
research on its effects in both general and mental health care. It includes recommendations from the participants of the SDM meeting. Participant perspectives are included throughout the report, as well as in a section specifically devoted to learnings
from the meeting. A resource list, to assist those seeking further information about
the concept and practice of SDM, is included in Appendix A.
Shared Decision-Making for Mental Health
This evidence summary will review available evidence for the effectiveness of SDM for mental disorders and related research about the effectiveness of components of SDM such as allowing clients to choose treatment options.
‘Sleep hygiene’ is the term used to describe good sleep habits.
Considerable research has gone into developing a set of
guidelines and tips which are designed to enhance good
sleeping, and there is much evidence to suggest that these
strategies can provide long-term solutions to sleep difficulties.
Social anxiety in schizophrenia: A cognitive behavioural group therapy programme
This workbook provides a walk-through with handouts for group CBT sessions.
Standards and Guidelines for Early Psychosis Intervention (EPI) Programs
This document identifies minimum program requirements for evidence-based Early Psychosis Intervention (EPI) programs as well as guidelines to facilitate implementation and ongoing operations of these programs. Successful EPI programs demonstrate improved client outcomes and follow similar standards to those identified in the document, including, for example, low client/staff ratio, use of multidisciplinary teams, specialized assessments and interventions, client and family psycho-education, and staff training on best practices.
State Mental Health Policy: An Interactive Tool to Estimate Costs and Resources for a First-Episode Psychosis Initiative in New York State
The New York State Office of Mental Health (OMH), which is a partner in the RAISE (Recovery After Initial Schizophrenia Episode) Connection program, is scaling up services for individuals with first-episode psychosis (FEP) and must estimate the number of specialized treatment teams needed across the state. This column describes a modeling tool that allows users to input various estimates for relevant variables and see the impact on projections for number of FEP teams needed and the costs of those teams. The interactive, Excel-based tool can be adapted for other treatment settings and programs.
Steps and Decisions Points in Starting an Early Psychosis Program
New early psychosis programs are joining a thriving international movement with many available resources. Within the United States there is active national collaboration to help organize and disseminate the resources that new sites need. In addition to identifying the steps involved, this guide will also provide introductory information about some of those resources.
Strategies for Coping with Voices
The following are suggestions for coping with the experiences of hearing voices, and
seeing visions and having tactile sensations. It is hoped some of these ideas can help you, or someone you care about, towards living positively with these experiences and to
maintain a sense of ownership over them.
Structured Interview for Psychosis-Risk Syndromes (SIPS)
Researchers at Yale University’s PRIME Clinic developed the SIPS structured interview to help identify symptoms of the schizophrenia prodrome before the patient become fully psychotic. These symptoms are resemble those of schizophrenia but are milder.
Supplementary Modules to the Core Cultural Formulation Interview (CFI)
These modules supplement the core Cultural Formulation Interview and can help clinicians conduct a more comprehensive cultural assessment. The first eight supplementary modules explore the domains of the core CFI in greater depth. The next three modules focus on populations with specific needs, such as children and adolescents, older adults, and immigrants and refugees. The last module explores the experiences and views of individuals who perform caregiving functions, in order to clarify the nature and cultural context of caregiving and how they affect social support in the immediate environment of the individual receiving care. In addition to these supplementary modules, an Informant version of the core CFI collects collateral information on the CFI domains from family members or caregivers.
Surviving Stress: Prevention Strategies
We all experience stress. It’s so normal it’s almost invisible. The good news is that there are many ways to tame the stress monster. The first step is to recognize it. Then you can learn to master it. Experiment with these tips to see which ones work for you. And remember, you can always work with your treatment team to identify other ways to
deal with stress.
Talk About It: Shared decision making communication skills for providers and helper
Shared decision making is more than asking someone what is important to him or her. Combining these communication skills with information resources, structured decision aids, and decision support tools can result in a productive and satisfying shared decision making experience. It also empowers individuals and encourages their involvement.
Teen Depression Brochure
Brochure targeting teens with depression.
Termination of Therapy: What Can Clinicians Do to Maximize Gains?
This article aims to explain how clinicians can help clients overcome a sense of loss or attachment when a phase of care comes to a close, and how to guide clients to successful ongoing support resources.
AN’s Accommodation and Compliance Series is designed to help employers and educators determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information. The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each student’s individual limitations and accommodation needs.
The BeST Kind of Help: Tips for Family Members and Friends of Individuals Affected by Schizophrenia
Tip sheet for families of young adults experiencing schizophrenia.
The Brain’s Inner Workings: A Guide for Students
This is an informative and fun guide that presents information on different aspects of the brain with activities that follow.
The Effectiveness of Motivational Interviewing for Young People Engaging in Problematic Substance Use
Despite some difficulties in making firm conclusions from current research literature, MI appears to be a promising intervention for young people engaging in problematic substance use. The growing body of evidence indicates that MI may promote reductions in substance use and related consequences, however there is insufficient evidence to make conclusions
about its effectiveness in preventing or delaying the onset of disordered substance use in at-risk young people over the long term. Until further research is available, MI’s use does not appear to cause harm and may in fact be beneficial. Incorporating components of personalised feedback and normative comparisons within the MI framework may be useful
and counsellors adhering to the underlying style and principles of MI (e.g., MI-Spirit and MI-Consistent behaviours), while avoiding the use of warnings, scare tactics, and confrontational or overly directive approaches (e.g., MI-Inconsistent behaviours), may
have greater success effecting change.
The Effects of Trauma on Recovery
The goal of this module is to be able to recognize the effects of trauma (in
ourselves and others) and identify skills of peer support that can be used to
demonstrate that healing from trauma is possible.
The Evidence introduces all stakeholders to the research literature and other resources on Medication Treatment, Evaluation, and Management (MedTEAM). This booklet includes a selected bibliography for further reading, references for the citations presented throughout the KIT, and acknowledgements of KIT developers and contributors.
The Evidence introduces all stakeholders to the research literature and other resources on Integrated Treatment for Co-Occurring Disorders.
This booklet includes two key resources included in the KIT, additional resources for further reading, and references for the citations presented throughout the KIT.
The Family Experience with Primary Care Physicians and Staff
The data included in this report is based on information received by NAMI in response to a web-based survey, conducted from June 1 to July 1, 2009. NAMI received 554 survey responses. Responses to the 23 survey questions came from parents and caregivers of children and adolescents living with mental illness. Parents and caregivers answered a variety of questions related to their experiences discussing mental health concerns about their child with primary care physicians and staff. The survey took approximately 30 minutes to complete. NAMI also asked colleague mental health advocacy organizations to send the survey out through their networks.
The Key Elements of Dialogic Practice in Open Dialogue: Fidelity Criteria
Open Dialogue is both a community-based treatment system and a form of therapeutic conversation that occurs within that system, specifically within the treatment meeting. These two layers of Open Dialogue are guided by the seven principles, of which “dialogue (polyphony)” and “tolerance of uncertainty” are the two fundamental coordinates of therapeutic conversation, or Dialogic Practice. Dialogic Practice in Open Dialogue is the same for both acute crises and more longstanding repetitive, so-called “chronic” situations.
This document has focused on defining Dialogic Practice by identifying and describing twelve, key elements. In the treatment meeting, the principal aim is for the therapists to foster a dialogue in which everyone’s voice is heard and respected. The starting point is the language the family uses to describe their situation. The stance of the therapist is different from that of traditional psychotherapy, in which the therapist makes the interventions and does not disclose personal issues. While many family therapy schools concentrate on specific forms of interviewing, the dialogical therapist focuses more on listening and responding to what has touched them.
The OnTrackNY Program Team Manual
The OnTrackNY Program Treatment Team is a multidisciplinary unit that works collaboratively with the individual diagnosed with first episode psychosis (FEP) to achieve recovery goals. The team is made up of the team staff, the client, and sometimes the family. This manual describes the governing principles of the team, the team’s activities, and approaches to treatment. The overall structure of the team described rests upon the phases and activities of the Critical Time Intervention (CTI) model that is adapted for individuals experiencing FEP. OnTrackNY acknowledges that the first episode of psychosis may represent a turning point, a critical time in the life of individuals, and that by intervening appropriately, the outcome of this critical time can be optimized to assist the client in meeting age-appropriate life goals including returning to school, work and a meaningful life in society. The CTI model de-emphasizes the notion of chronicity and posits recovery as the expected outcome for people. Hence the CTI model has stages and is time-limited. The approaches specified in this manual are integrated throughout the person’s involvement with the team, and all team members should be knowledgeable about these approaches.
The open dialogue approach to acute psychosis: its poetics and micropolitics
n Finland, a network-based, language approach to psychiatric care has emerged, called "Open Dialogue." It draws on Bakhtin's dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: "tolerance of uncertainty," "dialogism," and "polyphony in social networks." A treatment meeting shows how these poetics operate to generate a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment. Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment-as-usual settings. In a nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild, psychotic symptoms remaining; and only 23% were on disability allowance.
The Past and Future Career Patterns of People with Serious Mental Illness: A Qualitative Inquiry
This study of the past career patterns and future career prospects of persons with serious mental illness provides a longitudinal portrait of the ways in which those who are often characterized as having an unsuccessful work history and only modest vocational prospects in the years ahead relate to the world of competitive employment. Its emphasis is on discerning long term patterns: where have these folks been and where are they going? Oddly enough, neither our mental health nor our vocational rehabilitation systems have complete answers to these questions.
The Prevention of Schizophrenia
The authors weigh current research in causing factors of schizophrenia and gauge current and possible future prevention mechanisms.
The PRIME Screen
Researchers at Yale University’s PRIME Clinic developed the PRIME Screen to help identify symptoms of the schizophrenia prodrome before the patient become fully psychotic. These symptoms are resemble those of schizophrenia but are milder.
The Psychosis High-Risk State: A Comprehensive State-of-the-Art Review
During the past 2 decades, a major transition in the clinical characterization of psychotic disorders has occurred. The construct of a clinical high-risk (HR) state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms. The importance of this HR state has been increasingly recognized to such an extent that a new syndrome is being considered as a diagnostic category in the DSM-5.
To reframe the HR state in a comprehensive state-of-the-art review on the progress that has been made while also recognizing the challenges that remain.
Available HR research of the past 20 years from PubMed, books, meetings, abstracts, and international conferences.
STUDY SELECTION AND DATA EXTRACTION:
Critical review of HR studies addressing historical development, inclusion criteria, epidemiologic research, transition criteria, outcomes, clinical and functional characteristics, neurocognition, neuroimaging, predictors of psychosis development, treatment trials, socioeconomic aspects, nosography, and future challenges in the field.
Relevant articles retrieved in the literature search were discussed by a large group of leading worldwide experts in the field. The core results are presented after consensus and are summarized in illustrative tables and figures.
The relatively new field of HR research in psychosis is exciting. It has the potential to shed light on the development of major psychotic disorders and to alter their course. It also provides a rationale for service provision to those in need of help who could not previously access it and the possibility of changing trajectories for those with vulnerability to psychotic illnesses.
The Therapeutic Alliance: Is It Necessary or Sufficient to Engender Positive Outcomes?
Although significant research has focused on the importance of the therapeutic relationship, debate continues as to how it should be defined, measured, and its precise mechanism of action on the therapeutic process.
The Therapeutic Relationship in CBT for Psychosis: Client, Therapist, and Therapy Factors
Background: This study investigated which factors are associated with the therapeutic relationship in Cognitive-Behavioural Therapy for psychosis (CBTp). Method: Measures were taken between sessions two to nine in 24 therapist-client dyads. Clients and therapists completed the Working Alliance Inventory and measures of client (gender, age, ethnicity, positive and negative symptoms of psychosis, length of illness, admissions, social contacts, employment, cognitive insight, reaction to hypothetical contradiction), therapist (empathy, expertness, attractiveness, trustworthiness, number of years qualified and previous CBTp clients seen, confidence in CBTp), and therapy (number of sessions and CBTp interventions carried out, presentation of a formulation) factors. Results: On average, clients and therapists rated the therapeutic relationship as good, with clients giving higher ratings. None of the client variables was related significantly to the quality of the relationship. However, a number of therapist and therapy factors were linked to a better therapeutic relationship, namely clients' ratings of therapist empathy, expertness, attractiveness, and trustworthiness and, at trend level, a greater number of sessions and of CBTp interventions, and the presentation of a formulation. Conclusions: These results suggest that therapists are able to develop a good therapeutic relationship with clients with psychosis, regardless of the severity of the psychosis and the confidence and experience of the therapist, although non-significant findings need interpreting with caution due to the lack of a full range of therapeutic alliances. The findings also suggest that the basic tenets of CBTp, such as empathy and collaborative goals, may be important factors for the development of the therapeutic relationship.
The Trauma of First Episode Psychosis
First episode psychosis can be a distressing and traumatic event which has been linked to comorbid symptomatology, including anxiety, depression and PTSD symptoms (intrusions, avoidance, etc.). However, the link between events surrounding a first episode psychosis (i.e. police involvement, admission, use of Mental Health Act, etc.) and PTSD symptoms remains unproven. In the PTSD literature, attention has now turned to the patient’s appraisal of the traumatic event as a key mediator. In this study we aim to evaluate the diagnostic status of first episode psychosis as a PTSD-triggering event and to determine the extent to which cognitive factors such as appraisals and coping mechanisms can mediate the expression of PTSD (traumatic) symptomatology.
There Are Too Many Steps Before You Get to Where You Need to Be: Help-seeking by Patients with First-Episode Psychosis
There has been substantial research on pathways to care in first-episode psychosis (FEP); however, few studies have used a qualitative research paradigm or have been done from the perspective of the person experiencing the psychotic episode.
We sought to describe the experiences of patients with FEP on their pathway to care and to identify factors that help or hinder help-seeking efforts.
Using a qualitative descriptive approach, we conducted semi-structured interviews with 16 patients recruited from an early intervention program. Data were analyzed using content analysis to organize the findings into themes.
Self-stigma and a pervasive lack of knowledge regarding the symptoms of psychosis and availability of services were barriers to help-seeking. Participants highlighted the crucial role of significant others in initiating the help-seeking process. Participants typically described a complex series of contacts along the pathway to care which resulted in feelings of being misunderstood and losing control, but many individuals identified unexpected benefits of their experience.
Our findings suggest a shift in the philosophy and orientation of service delivery towards the creation of services that address these concerns and are relevant to the young people who utilize them.
Tips and Techniques for Engaging and Managing the Reluctant, Resistant, or Hostile Young Person
Assessment of most mental health problems in primary care is undertaken opportunistically. Here, we discuss some of the challenges to engaging and treating young people, and suggest strategies to manage difficulties in the doctor–patient relationship.
Training Frontline Staff
Training Frontline Staff is intended to help mental health authorities, agency administrators, and program leaders think through and develop training to teach the principles, processes, and skills necessary to deliver effective Medication Treatment, Evaluation, and Management (MedTEAM) services. This booklet includes information about developing new documentation practices, ongoing training on medications, and integrating outcome measures into clinical assessments.
Training Frontline Staff
This five-part workbook, along with the Training Frontline Staff: Demonstration Video, will help program leaders teach mental health and substance abuse practitioners about the principles, processes, and skills necessary to deliver effective integrated treatment to consumers with co-occurring disorders.
Trauma and Psychosis: An Essential Link
Research has consistently supported a link between trauma and psychosis.
Treating the trauma of first episode psychosis: A PTSD perspective
Over the past decade there has been a huge growth of interest in identification and rapid
intervention for recent onset of psychosis. Effective treatment in the early years after the onset of psychosis is thought to be important for several reasons. First, the duration of untreated psychosis in first episode patients is predictive of short- and long-term outcomes. Second, deterioration in symptoms and psychosocial functioning in schizophrenia occurs rapidly after the first episode, usually within 2–5 years. Third, adherence to treatment is especially problematic in recent onset psychosis. These problems suggest that if effective and engaging interventions can be delivered in a timely fashion to individuals who have recently experienced an onset of psychosis, the longterm trajectory of the illness could be improved.
Understanding Psychosis: Resources and Recovery
This booklet is for young adults who have had a first episode of psychosis
and their friends and families. It offers information about psychosis,
treatment, resources, wellness and recovery. It offers information about
how to manage after a first episode of psychosis and how to get help
from the mental health care system.
Understanding Psychosis: Resources and Recovery
This booklet is for young adults who have had a first episode of psychosis and their friends and families. It offers information about psychosis, treatment, resources,
wellness and recovery. It offers information about how to manage after a first episode of psychosis and how to get help from the mental health care system.
Understanding the Impact of Trauma
Adult survivors of trauma are disproportionately represented in the mental health system.
Research suggests that at least half of all women and a substantial number of men who are
diagnosed with a mental illness have a history of physical or sexual abuse or both (Brennan, 1997). Data on children and adolescents suggest even higher percentages (Massachusetts Department of Mental Health, 1995). Traditional treatment modalities, including the use of seclusion and restraint, are not always appropriate for trauma survivors, and may in fact be retraumatizing. “Any intervention that recreates aspects of previous traumatic experiences or that uses power to punish is harmful to the individual involved” (NASMHPD, 1998). It is important for staff to recognize the impact trauma can have on people diagnosed with a mental illness. Understanding how seclusion and restraint can in fact retraumatize and further abuse individuals who are already coping with a number of issues is vital to the elimination of the practice of seclusion and restraint.
Understanding the trauma of first-episode psychosis
This study examined the distress of first-episode psychosis (FEP) beyond the acute episode. It focused on how people understand the experience of FEP and its negative impact and how this relates to the traumagenic phenomena.
Using Multimedia to Introduce Your EBP
Using Multimedia to Introduce Your EBP is a collection of educational tools to help you introduce your Integrated Treatment for Co-Occurring Disorders program to a variety of stakeholder groups.
Using Your Voice: TIPS for talking with your mental health service provider
Using your voice means speaking up and saying what is important to you. Using your voice is an important part of recovery. This worksheet may help you prepare for speaking up.
Validity of Hospital Admission as an Outcome Measure of Services for First-Episode Psychosis
The objective of this study was to assess the external validity of hospitalization as an outcome measure for first-episode psychosis services.
A two-year, prospective cohort design was used to examine the associations between hospitalization, general psychopathology, and quality of life in a cohort of 606 participants treated for a first episode of psychosis.
In bivariate analyses, general psychopathology and quality of life were each significantly associated with hospitalization at both time points. After analyses controlled for all covariates in the logistic models, both clinical measures continued to be significantly correlated with hospitalization at both one and two years.
These results validate hospitalization as an outcome measure for first-episode psychosis services, and they extend the existing research showing a relationship between hospitalization and process measures to include other valid and reliable clinical measures.
Values Clarification Exercise
The goal of this exercise is to help participants clarify their personal values and how they relate to family involvement in care, through the use of the values clarification exercise.
Vitamins and Supplements Log
It is important to keep track of the vitamins, supplements, and over-the-counter medications you use. This chart may help you track the supplements you use.
What Every Teacher and School Professional Needs to Know About Psychosis and Young People
This booklet is designed to introduce school professionals to the core competencies of detection, referral, and support of students experiencing the early signs of psychosis. It aims to assist school professionals in: Recognizing the early symptoms of psychosis, understanding the causes of psychosis, utilizing a Learning Support Toolkit of easy-to-use student support strategies, facilitating referrals to mental health resources.
What is Right for Me? How to Make Important Decisions in Everyday Life
Following the steps outlined in the workbook can help you make any important decision in your life, not just decisions about medical care or mental health treatment and services. There are several ways you can use the workbook:
- As a tool to make an important personal decision on your own;
- As a guide for talking with someone else about your situation and options;
- As an aid for making a collaborative or shared decision together with others;
- As a way to prepare for meeting with a provider for planning or decision making about treatment and services.
What is Schizophrenia?
This guide is an educational resource about the different aspects of schizophrenia and the recovery process.
What to Do If a Brother or Sister Develops Psychosis
This handout list first steps for siblings of individuals experiencing psychosis.
Why Families Should Consider Harm Reduction
This paper assists parents encourage harm reduction while respecting the adulthood and independence of their son or daughter.
Working Alliance Inventory-Short Revised (WAI-SR): Psychometric Properties in Outpatients and Inpatients
The Working Alliance Inventory-Short Revised (WAI-SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The WAI-SR demonstrated good psychometric properties in an initial validation in psychotherapy outpatients in the USA. The generalizability of these findings is limited because in some countries a substantial portion of individual psychotherapy is delivered in inpatient settings. This study investigated and compared the psychometric properties of the WAI-SR in German outpatients (N = 88) and inpatients (N = 243). In both samples reliability (alpha > 0.80) and convergent validity with the Helping Alliance Questionnaire were good (r > 0.64). Confirmatory factor analysis showed acceptable to good model fit for the proposed Bond-Task-Goal model in both samples. Multi-group analysis demonstrated that the same constructs were measured across settings. Alliance ratings of outpatients and inpatients differed regarding the overlap of alliance components and the magnitude of the alliance ratings: The differentiation of the alliance components was poorer in inpatients and they reported lower alliances. Unique aspects of the alliance in inpatient treatment are discussed and a need for further research on the alliance in inpatient settings is pointed out. Overall, the WAI-SR can be recommended for alliance assessment in both settings.
Youth Engagement: Empowering Youth Voices to Improve Services, Programs, and Policy
This document summarizes the report called Working with Children and Youth in Challenging Contexts to Promote Youth Engagement, produced by the CYCC Network.
It is important to understand youth engagement as central to any best practice intervention. Valuing youth engagement puts the focus on the positive contribution that youth make to programs and their effectiveness; this moves programs from being done “for” youth to “with” youth. There is a gap in the research in how to identify the source and implications of youth vulnerability for their engagement. The purpose of this report is to explore how different youth engagement strategies are being used to help children and youth in the most challenging of contexts nurture resilience, prevent mental health problems and build a special place for themselves in the collective life of their communities.