Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program

Abstract

Introduction The RAISE Connection Program Implementation and Evaluation study (RAISE-IES) developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This paper presents the treatment model and reports on service utilization and outcomes. Using a within-group analysis, it was hypothesized that individuals’ symptoms and functioning would improve over time. Methods A total of 65 individuals in RAISE Connection Program treatment across two sites, (Baltimore, MD and Manhattan, NY) were enrolled and received services for up to two years. Primary outcomes included social and occupational functioning as well as symptoms. Trajectories for individuals’ outcomes over time were examined using linear and quadratic mixed-effects models with repeated measures. Results Measures of occupational and social functioning improved significantly over time; symptoms declined, and rates of remission improved. Visits were most frequent during the first 3 months, with a mean of 23.1± 11.5 unduplicated staff encounters per quarter, decreasing to 8.8±5.2 such encounters in the final quarter of year 2. Conclusions The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced. The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model and the associated high rates of engagement among individuals who are typically difficult to engage in treatment. Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.

Characteristics associated with the pursuit of work and school among participants in a treatment program for first episode of psychosis.

“…As previously reported, participants in RAISE CP showed significantly improved occupational functioning over the course of the study (Dixon et al, 2015, Marino et al, 2015). A full-time specialist trained in the IPS supported employment model, and trained in supported education service delivery, was integrated into each treatment team (Dixon et al, 2015). All participants were eligible to receive SEE services, and the SEE specialist attempted to meet with all participants.…”

Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program

“…42,43 Treatment-related reductions in hospital service use and related cost savings are limited where the baseline supply and utilization of inpatient services is low to begin with and the RAISE-ETP sample averaged only 3 mental health inpatient days per client per month. NAV showed lower rates of hospitalization at 12 months than other recent demonstrations of multimodal FEP treatment (20% for NAV vs 32% for the RAISE Connection program and 23% for the STEP program), 44 reflecting generally low levels of inpatient use at both NAV and CC sites.…”

The RAISE Connection Program: Psychopharmacological Treatment of People With a First Episode of Schizophrenia

“…An overview of the RAISE CP Implementation and Evaluation Study and primary and secondary study outcomes are provided elsewhere (23–26). In brief, RAISE CP was a multi-disciplinary and multi-element program designed to reduce morbidity and disability in individuals experiencing a first episode of psychosis suggestive of schizophrenia.…”

“…Information on previous antipsychotic prescriptions was collected through research interviews (23). Information on prescribed antipsychotic medications, including start and stop dates and dosages, and dates on which side effect assessments were completed were obtained from chart extractions (25).…”

“…We conducted a longitudinal, observational study to evaluate the adherence of psychiatrists to the Antipsychotic Schedule in individuals with first episode schizophrenia participating in the RAISE CP Implementation and Evaluation Study (23). …”