BackgroundEarly intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams (‘First-episode Services’ or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES?Methods/DesignThe primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREPR) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREPR over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral.DiscussionSTEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes.Trial registrationClinicalTrials.gov: NCT02069925. Registered 20 February 2014.

Changes in global patterns of residence mean that preschool teachers welcome immigrant children and families into preschools in increasing numbers. Many teachers report both anticipation and apprehension about having immigrant children in the classroom. Apprehension is related to concerns about a lack of enough knowledge about languages and cultures to sensitively work with children and families. To overcome apprehensions and challenges, teachers are encouraged to learn from the work of other adults. This study builds upon research that suggests that teachers can also look to the children as a source of knowledge. The purpose of this study was to explore how preschool immigrant children might use a disposable camera to communicate with their teachers. The participants of this qualitative study were immigrant and nativeborn students in a local preschool. Each child was given a disposable camera, instruction about taking photographs and the request to take pictures of what was important to them. Data were collected by recording each child telling the teacher about the pictures. Data were analyzed for themes, patterns and categories. Findings indicated that the messages that the children conveyed to their teachers included important information about language development and family cultural identity. Findings also identify teacher strategies that helped and hindered child ability to communicate during the photo-narration process. An implication of the study was a shift of child agency within the teacher child relationship during photo-narration activity.

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“I just can't seem to find time to get math into the [instructional] day with everything else we are expected to cover in kindergarten. Our curriculum is so heavy on literacy.”—Michelle, an urban kindergarten teacher, January 2006