Pennsylvania coordinated specialty care programs forfirst‐episodepsychosis: 6‐ and 12‐month outcomes

Abstract

Aim Pennsylvania (PA) first‐episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA‐OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6‐ and 12‐month outcomes. Methods Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re‐administered at 6‐ and 12‐month follow‐up, and data were analysed for individuals (n = 230) who had completed 12‐months of treatment. Domains assessed via clinician report and/or self‐report included symptoms, role and social functioning, self‐perceived recovery and service utilization. Results PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self‐perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school‐enrolment. Nearly all improvements were observed at 6‐month follow‐up, with earlier gains maintained at 12‐months. Conclusions PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society.

Development of empirically derived brief program evaluation measures in Pennsylvania first‐episode psychosis coordinated specialty care programs

“…FEP participants ( N = 759) were from nine CSC programs across Pennsylvania, described in detail elsewhere (Westfall et al, 2020). Most participants (65%) were male and had high school education (12 years) or less.…”

“…Despite its many advantages and applicability (Westfall et al, 2020), one major disadvantage to the PA-FEP-PE core assessment battery is posed by the sheer size of the measures (taking more than an hour for administration). Its applicability is restricted by the time required when a rapid assessment is needed in clinical settings, which has posed a barrier to gathering complete and comprehensive clinical and functional data.…”

“…Since 2016, the Pennsylvania (PA) State Office of Mental Health and Substance Abuse Services (OMHSAS) has partnered with the University of Pennsylvania to develop and implement a state‐wide program evaluation (PE) of Pennsylvania's CSC programs serving individuals with FEP (Westfall et al, 2020). Named the “Pennsylvania First‐Episode Psychosis Program Evaluation” (PA‐FEP‐PE), it is unique in establishing a computerized PE battery and complementary fidelity scale measuring delivery of evidence‐based care and clinical and service outcomes across a variety of CSC models delivered by both academic and community‐based programs (Westfall et al, 2020). As a standard and comprehensive clinical assessment and data collection tool, the PA‐FEP‐PE core assessment battery was designed according to five key criteria: domain coverage (including key FEP constructs), clinical utility (clinically informative according to National Association of State Mental Health Program Directors Research Institute [NRI/NASMHPD] surveys or clinician experience), reliability and validity (based on inclusion in the PhenX toolkit), practical utility (easily administered with reasonably low staff and participant burden), and high utility to multiple stakeholders (reflecting outcomes important to clinicians, researchers, payors and administrators) (Westfall et al, 2020).…”

“…Named the “Pennsylvania First‐Episode Psychosis Program Evaluation” (PA‐FEP‐PE), it is unique in establishing a computerized PE battery and complementary fidelity scale measuring delivery of evidence‐based care and clinical and service outcomes across a variety of CSC models delivered by both academic and community‐based programs (Westfall et al, 2020). As a standard and comprehensive clinical assessment and data collection tool, the PA‐FEP‐PE core assessment battery was designed according to five key criteria: domain coverage (including key FEP constructs), clinical utility (clinically informative according to National Association of State Mental Health Program Directors Research Institute [NRI/NASMHPD] surveys or clinician experience), reliability and validity (based on inclusion in the PhenX toolkit), practical utility (easily administered with reasonably low staff and participant burden), and high utility to multiple stakeholders (reflecting outcomes important to clinicians, researchers, payors and administrators) (Westfall et al, 2020). Participation in PA‐FEP‐PE mandates data collection by Community Mental Health Block Grant funded program sites for all participants referred after 01 January 2017.…”

“…Since 2016, the Pennsylvania (PA) State Office of Mental Health and Substance Abuse Services (OMHSAS) has partnered with the University of Pennsylvania to develop and implement a state-wide program evaluation (PE) of Pennsylvania's CSC programs serving individuals with FEP (Westfall et al, 2020). Named the "Pennsylvania First-Episode Psychosis Program Evaluation" (PA-FEP-PE), it is unique in establishing a computerized PE battery and complementary fidelity scale measuring delivery of evidence-based care and clinical and service outcomes across a variety of CSC models delivered by both academic and community-based programs (Westfall et al, 2020).…”