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Treatment and Support Resources for Providers

Information on evidence-based, evidence-informed, or promising models of care, fidelity, treatment, psychoeducation, peer and family support, discharge/transition planning, and engagement strategies for enrollment and retention.

Co-occurring Conditions

Recognizing Psychosis in Autism Spectrum Disorder (PDF | 300 KB)
Frontiers in Psychiatry
This paper reviews the available scientific literature about the co-occurrence of psychosis and autism, focusing attention on four specific dimensions: delusions, hallucinations, negative symptoms, and clinical course.

Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-Analysis
Journal of Autism and Developmental Disorders
This article reviews information on autism spectrum disorders (ASD) and CHR-P and includes a meta-analysis of the proportion of CHR-P in ASD.

First-Episode Psychosis and Co-Occurring Substance Use Disorders (PDF | 1.6 MB)
SAMHSA
This guide reviews the literature on treating substance misuse and substance use disorders in the context of first-episode psychosis, distills the research into recommendations for practice, and provides examples of the ways that these recommendations can be implemented by first-episode psychosis treatment programs.

Substance-Induced Psychosis in First Episode Programming (PDF | 2.2 MB)
NASMHPD
This issue brief provides an overview of the epidemiology, presentation, diagnosis, and treatment of individuals with substance-induced psychosis who may present to First Episode Psychosis (FEP) programs.

Treating Affective Psychosis and Substance Use Disorders Within Coordinated Specialty Care (PDF | 959 KB)
NASMHPD
This brief describes several adaptations and recommendations that CSC teams may consider to enhance the effectiveness of the specialized treatment model to best serve persons with affective psychosis or individuals with substance use disorders.

Treatment Considerations for Youth and Young Adults with Serious Emotional Disturbances and Serious Mental Illnesses and Co-occurring Substance Use (PDF | 19.5 MB)
SAMHSA
This guide reviews interventions on treating substance misuse and substance use disorders (SUD) in youth with serious emotional disturbances (SED), distills the research into recommendations for practice, and provides examples of the ways that these recommendations can be implemented.

Serious Mental Illness/Substance Use Disorders and Tailoring FEP Programs to Serve Women
NASMHPD
This webinar explores how mental health and substance use treatment providers currently care for women with co-occurring first episode psychosis (FEP), serious mental illness (SMI), and substance use disorder (SUD), and what questions remain in relation to treating this population.

Trauma

Trauma, PTSD, and First Episode Psychosis (PDF | 1.1 MB)
NASMHPD
This fact sheet provides FEP program directors and administrators with a brief introduction to the intersection of trauma and psychosis and an overview of a trauma-informed approach.

Addressing Trauma and PTSD in First Episode Psychosis Programs (PDF | 1.2 MB)
NASMHPD
This issue brief provides an overview of the attributes of a trauma-informed First Episode Psychosis program using SAMHSA’s 10 organizational domains of a trauma-informed approach, as well as a range of clinical interventions, tools, and resources to support effective trauma treatment.

Treatment

Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains
The American Journal of Psychiatry
This report characterizes differences in outcomes among help-seeking individuals at CHR-P by identifying covariant longitudinal patterns of symptoms and functioning.

Cognitive Behavioral Therapy for Psychosis (CBTp) (PDF | 697 KB)
NASMHPD
This fact sheet provides an overview of the principles and practices of CBTp, with case examples illustrating each of the key components in its application.

The Clinical High-Risk State for Psychosis (CHR-P), Version II
Schizophrenia Bulletin
This article introduces three studies that advance current knowledge on deconstructing the CHR-P paradigm across its three subgroups: genetic risk, attenuated psychotic symptoms, and short-lived and remitting psychotic episodes.

Cognitive Behavioral Therapy for Prodromal Stage of Psychosis—Outcomes for Transition, Functioning, Distress, and Quality of Life: A Systematic Review and Meta-analysis
Schizophrenia Bulletin
This study aimed to provide insight into the efficacy of CBTp in patients with CHR-P.

Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression
JAMA Psychiatry
This report compares early intervention services with treatment as usual for early-phase psychosis.

Early Intervention in Psychosis: A Primer
NASMHPD
This course is designed for professionals in diverse settings who work with teens and young adults and who are interested in learning about the early warning signs of psychosis, appropriate early intervention treatment and supports, and strategies for successfully engaging youth in effective, recovery-oriented care.

Introduction to Cognitive Behavioral Therapy for Psychosis (PDF | 1.4 MB)
Research and Training Center for Pathways to Positive Futures (Pathways RTC)
This presentation provides a background of CBTp, an overview of the evidence base, and key skills associated with CBTp, including engagement and befriending, normalizing, and curious questioning.

Clinical Practice Guideline for the Management of First-Episode Psychosis and Schizophrenia (PDF | 2 MB)
Va/DoD
This provider summary of the VA/DoD First-Episode Psychosis and Schizophrenia clinical practice guideline (CPG) provides an evidence-based framework for evaluating and managing care for patients with first-episode psychosis and schizophrenia toward improving clinical outcomes. Successful implementation of this CPG will assess the patient’s condition and collaborate with the patient, family, and caregivers to determine optimal management of patient care, emphasize the use of patient-centered care and shared decision making, minimize preventable complications and morbidity, and optimize health outcomes.

Shared Decision Making
OnTrackNY
This video series provides an overview of shared decision making, which reflects the values of collaboration, engagement, self-determination, and respect that infuse every aspect of what teams do.

Stepped Care as an Implementation and Service Delivery Model (PDF | 1.4 MB)
Community Mental Health Journal
This article describes how the stepped care model can be applied to cognitive behavioral therapy for psychosis in the U.S. to increase access to intervention in community mental health settings by leveraging the multidisciplinary team.

Symptomatic and Functional Outcomes Among Individuals at High Risk for Psychosis Participating in Step-Based Care
Psychiatric Services
This article reports outcomes from the step-based care program for individuals at CHR-P at The Ohio State University Early Psychosis Intervention Center.

The Ohio State University Early Psychosis Intervention Center (EPICENTER) Step-based Care Programme for Individuals at Clinical High Risk for Psychosis: Study Protocol for An Observational Study (PDF | 406 KB)
British Medical Journal (BMJ) Open
The article outlines the evaluation component of a step-based care program for individuals at CHR-P at The Ohio State University Early Psychosis Intervention Center—one of the twenty-one sites funded by SAMHSA to develop, implement, and evaluate such a specialized care program.

Behavioral Health Diagnoses and Treatment Services for Children Involved with the Child Welfare System
Office of the Assistant Secretary for Planning and Evaluation (ASPE)
This research brief uses claims data from the Medicaid and Children's Health Insurance Programs to examine the behavioral health diagnoses and treatment services received by children and youth involved with the child welfare system in 2019.

Post-Treatment/Continuing Care

Best Practices in Continuing Care after Early Intervention in Psychosis
NASMHPD
This short training series consists of three parts: An Overview of Psychosis, Early Intervention and Transition, and Recommendations for Continuing Care.

Continuity of Care Services Following Coordinated Specialty Care: An Environmental Scan (PDF | 1.8 MB)
Office of the Assistant Secretary for Planning and Evaluation (ASPE)
This report provides an overview of transition services for clients graduating from CSC.

Transitioning Clients from Coordinated Specialty Care: A Guide for Clinicians (PDF | 2.9 MB)
NASMHPD
This guide provides recommendations to Coordinated Specialty Care (CSC) staff who help facilitate transitions from CSC programs and provides practical strategies for assessing readiness for transition, identifying post-CSC goals and needs, finding appropriate community resources to meet these needs, making referrals to formal services, managing the actual transition, and conducting follow-up. In addition to discussing the steps involved in making a single referral, this guide offers suggestions for building a referral network.

Discharge and Step-Down in Coordinated Specialty Care (CSC) for Persons with a First Episode of Psychosis - Part I
NASMHPD
This webinar provides an overview of the current findings regarding longer term outcomes for persons being discharged from FEP programs and alternative discharge strategies, as well as discusses the experiences of two CSC programs regarding a two-year limit on FEP enrollment and the strategies that they have used to address concerns.

Support Services

The Coordinated Specialty Care Transition Study: Final Report
ASPE
This report provides an overview of transition services for clients from CSC. The report synthesizes findings from an environmental scan of programs and case studies of nine CSC programs.

Family Involvement in Programming for Early Serious Mental Illness (1.4 MB)
NASMHPD
This tip sheet for clinicians describes strategies to successfully engage families, including helping solve practical problems and understanding the family’s goals.

Family-focused therapy for individuals at high clinical risk for psychosis: A confirmatory efficacy trial
Early Intervention in Psychiatry
This report compares the efficacy of a family-focused therapy for youth at CHR-P to a psychoeducational and supportive intervention (enhanced care) on attenuated psychotic symptoms and social functioning in individuals at CHR-P over the course of 18 months.

Improving Access to Care through Family Involvement & Engagement in Coordinated Specialty Care: Innovations & Best Practices
NASMHPD
This webinar provides an overview of the landscape of family involvement practices in CSC and approaches taken to engaging families in different programs and models, discusses key challenges in family engagement related to cultural diversity and socioeconomic disadvantage, and then focuses in on Texas’ efforts to utilize family partners in CSC, describing the development of the family partner role, and the specifics of implementation in the context of the OnTrackUSA model.

Facilitating Meaningful Engagement of Young People and Their Families in Early Intervention Programs
NASMHPD
The aim of this course is to increase providers’ awareness of and ability to respond to diverse stakeholder perspectives on early psychosis, including the perspectives of members of underrepresented socioeconomic, racial/ethnic, and cultural minority groups. It is grounded in dozens of in-depth interviews with early-intervention clients and former clients, parents, and community-based providers, and features nine characters whose stories are all derived from actual interviews.

Supported Education for Persons Experiencing a First Episode of Psychosis (PDF | 2.6 MB)
NASMHPD
This issue brief provides a primer on the rationale for and techniques that are involved in delivering supported education services in First Episode Psychosis (FEP) programs.

Integrating Individual Placement and Support Model of Supported Employment with Supported Education for Transition Age Youth (PDF | 573 KB)
NASMHPD
This issue brief reports the results that emerged in interviews with staff who are implementing programs that integrate the Individual Placement and Support Model (IPS) and Supported Education for Transition age youth (SEd), with program developers/implementers who are continuing to explore promising new integrative approaches and with individuals who have statewide roles in IPS/SEd.

Using Peers to Support Re-Engaging Families
NASMHPD
This webinar explores the use of peers to support family engagement and re-engagement, including describing the use of peers to prevent losing family supports and facilitation of family reunification following disconnection. Two programs address strategies, challenges, and lessons learned about how to facilitate and support continued family engagement and re-engagement.

Implementation/Fidelity

Coordinated Specialty Care for First Episode Psychosis Manual II: Implementation (PDF | 683 KB)
NIH
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 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 discussed 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 People with First Episode Psychosis: Assessing Fidelity to the Model (PDF | 3.1 MB)
NASMHPD
This issue brief reviews the importance of measuring implementation fidelity, lists the core components of CSC to monitor via fidelity measures, suggests potential data sources for measuring these core components, and reviews ways data from these sources can be aggregated into measures of CSC fidelity. 

Last Updated: 03/18/2024