An Inventory & Environmental Scan of Evidence-Based Practices for Treating Persons in Early Stages of Serious Mental Disorders Updated: October, 2017 Developed for SAMHSA by NASMHPD and NRI JBS Contract Reference: HHSS283201200002I/Task Order No. HHSS28342002T Contents Note Regarding 2017 Update: ................................................................................................................................2 Introduction ................................................................................................................................................................2 Overview of EBP Inventory and Environmental Scan .................................................................................................3 Methodology ..............................................................................................................................................................4 Limitations ..................................................................................................................................................................6 Matrix A: Examples of Coordinated Care Models for Persons in Early Stages of Illness ............................................7 Matrix B: Examples of Individual Evidence-Based Practices ................................................................................... 26 Selected Additional Resources ................................................................................................................................ 37 Resources Focusing on Early Intervention in Schizophrenia and other Psychotic Illnesses ............................... 37 Federal Agencies .................................................................................................................................................. 37 Directories of Early Intervention Programs ......................................................................................................... 38 Organizations/Networks Addressing Early Psychosis .......................................................................................... 39 Archived Webinars ............................................................................................................................................... 40 Citations for Selected Peer-Reviewed Articles and Books of Relevance.............................................................. 50 Resources Focusing on Depression and Bipolar Disorder ................................................................................... 74 General Mental Health Resources of Relevance for First Episode Programs ..................................................... 77 Early Diagnosis and Preventive Treatment (EDAPT) & Sacramento EDAPT (SacEDAPT) ..................................... 81 FIRST Early Identification and Treatment of Psychosis Program ......................................................................... 83 The BeST Center is providing FIRST program training, consultation and technical assistance to the community mental health agencies in Ohio that received Mental Health Block Grant five percent set-aside funds to establish first episode psychosis programs. ......................................................................................................... 86 RAISE Connection Model at the University of Maryland Medical Center and School of Medicine ..................... 87 NAVIGATE RAISE Early Treatment Program (ETP) ................................................................................................ 91 OnTrackNY ............................................................................................................................................................ 96 Early Assessment and Support Alliance (EASA).................................................................................................. 102 Felton Early Psychosis Program (formerly called PREP) ..................................................................................... 106 University of North Carolina Outreach and Support Intervention Services (OASIS) .......................................... 111 Specialized Treatment in Early Psychosis (Yale STEP) ........................................................................................ 115 Calgary Early Psychosis Treatment Services ....................................................................................................... 119 Bipolar Disorder Early Assessment and Management (BEAM) Program ........................................................... 131 POTENTIAL Outpatient Program Clinic: Early Psychosis and Young Adult Services ........................................... 135 Index ...................................................................................................................................................................... 138 1 Contract No. HHSS283201200002I/Task Order No. HHSS28342002T Updated: October 2017 Note Regarding 2017 Update: This document was first produced in late 2014. Because of the rapid growth in first episode programming over the past few years, this resource guide has been updated annually. Hyperlinks have been checked, and any that may have become inactive over the past year have been revised. New content has been added under the “Selected Additional Resources” section to capture additional areas of research emerging in the recent peer-reviewed literature and to incorporate listings of new publications and archived webinars that have been produced over the past year. Introduction The Fiscal Year 2014 SAMHSA appropriation (part of the Consolidated Appropriations Act, 2014) included a new requirement within the Mental Health Block Grant (MHBG) that “States shall expend at least five percent of the amount each receives… to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset.” Congress specifically provided an increase to the MHBG over prior-year levels to help states meet this new requirement without losing funds for existing services. In FY 2016, Congress increased the set-aside funding level to 10%, and stipulated that funds be used specifically to address first episode psychosis (FEP). In December, 2016, Congress passed the 21st Century Cures Act, which codified the 10% set-aside and requires that the funding be used “to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset.” (P.L. 114-255) The set aside was intended to stimulate state programming to better identify and more adequately respond to individuals who are experiencing their first episode of serious mental illness. Earlier and more assertive responses to these individuals are intended to help reduce the disability that these individuals will ultimately experience and to assist them in pursuing their life goals with appropriate treatment and support. Often individuals receiving care, especially from public systems, are required to meet criteria for serious and persistent mental illnesses to access care. Individuals meeting these criteria generally have significant, long-term disabilities. While delivering services for persons with serious and disabling illnesses continues to be an important role for state mental health systems, the development of responsive programming to first episode consumers may eventually reduce the rates at which they become disabled, benefitting both the client and the treatment system. This inventory reviews a variety of programs and practices to address early stages of serious mental disorders, including schizophrenia, bipolar and affective disorders, as well as other serious mental illnesses. A majority of research and program models, both in the United States and internationally, have focused on addressing First Episode Psychosis (FEP), with an emphasis on programs for persons with non-affective psychosis. FEP programs implemented in the United States, Australia, Canada, the United Kingdom, and Scandinavia have been shown to improve symptoms, reduce relapse and prevent deterioration and disability. In the NIMH- supported studies, common components of these FEP programs include practices such as assertive community treatment, psychotherapy, supported employment and education, family education and support, and low dosages of antipsychotic medications all delivered as parts of a Coordinated Specialty Care (CSC) model. The 2 Contract No. HHSS283201200002I/Task Order No. HHSS28342002T Updated: October 2017 inclusion criteria for clinical trials of CSCs have included persons who are ill with non-organic and non-affective psychotic disorders for five or fewer years. CSCs are typically targeted toward individuals ages 12 to 35, and are designed to coordinate existing services, including primary medical care, and to eliminate service gaps based on age group. They emphasize collaboration with clients to develop shared treatment goals, sometimes employing shared decision-making approaches to address preferences and recovery goals. CSCs coordinate activities with a multi-disciplinary treatment team and often involve family members as key supports. To help states best use the MHBG Set Aside in the most efficacious manner, SAMHSA and the National Institute of Mental Health (NIMH) have reviewed the evidence supporting specific practices as effective in reducing the impacts of the first episodes