Psychosis screening in schools: Considerations and implementation strategies

Meyer, Martha; Rosenthal, Adi; Bolden, Khalima; Loewy, Rachel; Savill, Mark; Shim, Ruth S.; Rodríguez, Jacqueline; Flores, Victoria; Pavao, Earl; Niendam, Tara A.

doi:10.1111/eip.12858

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…School settings that provide broad social-emotional support were better able to implement screening with a wide array of students compared with special education services, but they still struggled with parent engagement to obtain consent for treatment referral. 24 In a related qualitative study, we identified ethical concerns, logistics, screening population, and stigma as factors contributing to feasibility of screening in school settings. 24 Fewer cases, and likely shorter DUP, would be expected overall in schools where screening was a selected prevention strategy compared with the indicated prevention approach in CMHCs.…”

Section: Discussionmentioning

confidence: 99%

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis

et al. 2023

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ImportanceReducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days.ObjectiveTo determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone.Design, Setting, and ParticipantsThis cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021.InterventionsAll sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire–Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone.Main Outcomes and MeasuresPrimary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview.ResultsTwenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P &lt; .001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P = .03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2]).Conclusions and RelevanceIn this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact.Trial RegistrationClinicalTrials.gov Identifier: NCT02841956

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Section: Discussionmentioning

confidence: 99%

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis

et al. 2023

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“…The BASC‐2 is a consistent, reliable tool that is designed for and standardized in college settings within and outside of the U.S. (Ahn, Ebesutani, & Kamphaus, 2014; Nowinski et al, 2008). Efforts are currently underway to implement psychosis‐spectrum screening into K‐12 schools (Meyer et al, 2019), and the BASC‐2, in both self‐ and parent‐report forms, may be helpful in these efforts for earlier identification (Thompson et al, 2013, 2014). Given these results and pending further research, similar identification efforts in colleges/universities may also consider the BASC‐2.…”

Section: Discussionmentioning

confidence: 99%

Preliminary support for using the Atypicality Scale from the Behavior Assessment System for Children, Second Edition, to screen for psychosis‐spectrum disorders within a college counselling centre

Thompson

Petti

Rouhakhtar

et al. 2020

Early Intervention Psych

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Aim Evidence supports the use of brief psychosis‐spectrum screeners for identifying individuals at risk for psychosis. Screening has not been well‐studied in help‐seeking college samples. This study investigated the use of the Behavior Assessment System for Children, Second Edition (BASC‐2) Atypicality Scale as a psychosis‐spectrum screening tool within a university counselling centre. Methods Atypicality scores from the BASC‐2 were compared to interview‐based assessment, the Structured Interview for Psychosis‐risk Syndromes (SIPS), to explore associations across the measures and evaluate the scale's ability to identify individuals who meet criteria for a psychosis‐spectrum diagnosis. Results Forty‐three participants completed the BASC‐2 and SIPS, and 23 were SIPS‐positive. Compared to the SIPS‐negative group, the SIPS‐positive group had significantly higher Atypicality scores. Exploratory results indicated that Atypicality scores identified SIPS‐positive individuals with an overall accuracy of 72% (78% sensitivity, 65% specificity). Conclusion The Atypicality Scale may be an appropriate first‐line psychosis‐spectrum screening tool in college counselling centres.

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“…ocena przesiewowa na terenie szkoły jest możliwa, choć wiąże się z wieloma logistycznymi trudnościami i koniecznością analizy kwestii etycznych, jak opisują to Meyer i wsp. [25]) lub uwzględniać osoby poszukujące pomocy. Opieka powinna być kompleksowa, a świadczenia ośrodków wczesnej interwencji adresowane są często do adolescentów i młodych dorosłych.…”

Section: Wczesna Interwencja W Pierwszym Epizodzie Psychotycznym U Ch...unclassified

Polish Psychiatric Association diagnostic and therapeutic management guidelines for patients with early-onset schizophrenia

Janas–Kozik¹,

Dudek²,

Heitzman³

et al. 2022

Psychiatr Pol

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Wczesne zachorowanie na schizofrenię (przed 18 r.ż.) jest związane z wyższym niż w przypadku osób dorosłych ryzkiem opóźnionej lub niewłaściwej diagnozy, cięższym przebiegiem choroby, zwiększoną wrażliwością na działania niepożądane leków przeciwpsychotycznych. Celem pracy jest przedstawienie zaleceń na temat postępowania diagnostycznego i terapeutycznego u chorych na schizofrenię o wczesnym początku, przygotowanych na podstawie przeglądu literatury i konsensusu grupy ekspertów zajmujących się leczeniem schizofrenii. Formalne kryteria, których spełnienie wymagane jest do postawienia diagnozy schizofrenii, są takie same u dzieci i u dorosłych. Schizofrenia o wczesnym początku wymaga starannego różnicowania z zaburzeniami afektywnymi jedno i dwubiegunowymi, zaburzeniami ze spektrum autyzmu (ASD), zaburzeniami lękowymi. Ocena diagnostyczna w kierunku zaburzeń psychotycznych konieczne jest także w przypadku występowania zaburzeń zachowania, zachowań niszczycielskich i agresji oraz samouszkodzeń. Podstawową formą leczenia schizofrenii jest leczenie farmakologiczne, które jest stosowane w leczeniu ostrych epizodów, leczeniu podtrzymującym - zapobieganiu nawrotom. Stosowanie interwencji farmakologicznych u dzieci i młodzieży jedynie w celu zmniejszenie ryzyka rozwoju psychozy nie jest jednak zasadne. Leki przeciwpsychotyczne istotnie różnią się profilem tolerancji, ale też skutecznością kliniczną. Leki przeciwpsychotyczne II generacji zarejestrowane do leczenia schizofrenii o wczesnym początku – arypiprazol, lurazydon i paliperydon umożliwiają jej skuteczne i bezpieczne leczenie. Niezbędnym uzupełnieniem leczenia farmakologicznego są interwencje pozafarmakologiczne, które powinny być dostosowane do wieku pacjenta, jego możliwości poznawczych, fazy choroby, a także potrzeb całej rodziny.

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Psychosis screening in schools: Considerations and implementation strategies

Cited by 12 publications

References 23 publications

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis

Preliminary support for using the Atypicality Scale from the Behavior Assessment System for Children, Second Edition, to screen for psychosis‐spectrum disorders within a college counselling centre

Polish Psychiatric Association diagnostic and therapeutic management guidelines for patients with early-onset schizophrenia

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