IEPA 2018 Posters

Development and Implementation of Early Intervention Services in Recent Years: a Scoping Review

Poster C114, Wednesday, October 10, 11:30 am - 1:00 pm, Essex Ballroom

Tin Ngo-Minh1,3,4, Line Leblanc2; 1University McGill, 2Université du Québec en Outaouais, 3CISSSO - Pierre Janet, 4University of Ottawa

Over the last 20 years, the development and implementation of early intervention services (EIS) around the world has followed the natural rule of maturation of innovative ideas of leaders in the field. Several regions in the world will also see the birth of new EIS programs in the coming years, as it is currently the case in the United States and Quebec thanks to new public funding. The absence of structuring research projects, medical leadership, prior exposure of clinicians and the environment to the new EIS paradigm may complicate the process. The purpose of this scoping review is to determine the barriers and enablers to the development and implementation of EIS from the most recent literature. Medline/Pubmed and PsycINFO were searched from 1/1/2012 until December 31/12/2017 using the keywords "development" or "implementation" in addition to keywords related to first episode psychosis programs. The 25 included articles originated from the United States, Europe and Asian countries. Obstacles to development and implementation of EIS could be classified into 3 broad and interrelated categories: 1) Resources (financial, physical infrastructure, staff/caseload); 2) Knowledge / Training of clinicians and the milieu (social stigma, change of medical paradigm), 3) Organization (access to care, public / private health care systems, wait times, etc.). Some obstacles are more specific of certain regions, such as the higher level of mental illness stigma across Asian countries limiting access to care and requiring strategies such as awareness campaigns, redefinition of the word psychosis, etc. Other solutions are proposed.

*Core components of the EIP (Early Intervention in Psychosis) derived from elements reported from key articles: -Stavely, H., & Centre, O. Y. H. R. (2013). EPPIC model & service implementation: Parkville, Vic Orygen Youth Health Research Centre.-Addington, D. E., McKenzie, E., Norman, R., Wang, J., & Bond, G. R. (2013). Essential evidence-based components of first-episode psychosis services. Psychiatric Services, 64(5), 452-457. -Oregon Health Authority. (2012). Practice Guidelines for Oregon Early Assessment and Support Alliance (EASA). In., S. M., Nossel, I. R., McNamara, K., Bennett, M. E., Buchanan, R. W., Kreyenbuhl, J. A., . . . Dixon, L. B. (2015). Practical Monitoring of Treatment Fidelity: Examples From a Team-Based Intervention for People With Early Psychosis. Psychiatric Services, 66(7), 674-676. Data Supplement 2 - Table 1 Performance expectations and associated fidelity measures for the RAISE Connection Program’s team-based intervention for people with early psychosis, grouped by treatment domain.-International Early Psychosis Association Writing, G. (2005). International clinical practice guidelines for early psychosis. British Journal of Psychiatry - Supplementum, 48, s120-124.

25 articles included in the review:

Baumann, P. S., Crespi, S., Marion-Veyron, R., Solida, A., Thonney, J., Favrod, J., . . . Conus, P. (2013). Treatment and early intervention in psychosis program (TIPP-Lausanne): Implementation of an early intervention programme for psychosis in Switzerland. Early intervention in psychiatry, 7(3), 322-328. doi:10.1111/eip.12037

Bedard, T. E., Nadin, S., Zufelt, C., & Cheng, C. (2016). Implementation and evaluation of a quality improvement project: carepaths for Early Psychosis Intervention Programmes in Northeastern Ontario. Early intervention in psychiatry, 10(6), 547-553. doi:10.1111/eip.12321

Bello, I., Lee, R., Malinovsky, I., Watkins, L., Nossel, I., Smith, T., . . . Dixon, L. B. (2017). OnTrackNY: The Development of a Coordinated Specialty Care Program for Individuals Experiencing Early Psychosis. Psychiatric Services, 68(4), 318-320. doi:10.1176/

Breitborde, N. J., Bell, E. K., Dawley, D., Woolverton, C., Ceaser, A., Waters, A. C., . . . Harrison-Monroe, P. (2015). The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service. BMC Psychiatry, 15, 266. doi:10.1186/s12888-015-0650-3

Brewer, W. J., Lambert, T. J., Witt, K., Dileo, J., Duff, C., Crlenjak, C., . . . Murphy, B. P. (2015). Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes. Lancet Psychiatry, 2(1), 29-37. doi:10.1016/s2215-0366(14)00127-8

Caplan, B., Zimmet, S. V., Meyer, E. C., Friedman-Yakoobian, M., Monteleone, T., Jude Leung, Y., . . . Seidman, L. J. (2013). Prevention and recovery in early psychosis (PREP((R))): building a public-academic partnership program in Massachusetts, United States. Asian J Psychiatr, 6(2), 171-177. doi:10.1016/j.ajp.2012.10.009

Cocchi, A., Cavicchini, A., Collavo, M., Ghio, L., Macchi, S., Meneghelli, A., & Preti, A. (2015). Implementation and development of early intervention in psychosis services in Italy: a national survey promoted by the Associazione Italiana Interventi Precoci nelle Psicosi. Early intervention in psychiatry. doi:10.1111/eip.12277

Dixon, L. B., Goldman, H. H., Bennett, M. E., Wang, Y., McNamara, K. A., Mendon, S. J., . . . Essock, S. M. (2015). Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program. Psychiatric Services, 66(7), 691-698. doi:10.1176/

Ghio, L., Natta, W., Peruzzo, L., Gotelli, S., Tibaldi, G., & Ferrannini, L. (2012). Process of implementation and development of early psychosis clinical services in Italy: a survey. Early intervention in psychiatry, 6(3), 341-346. doi:10.1111/j.1751-7893.2012.00340.x

Goldman, H. H., Karakus, M., Frey, W., & Beronio, K. (2013). Economic grand rounds: financing first-episode psychosis services in the United States. Psychiatric Services, 64(6), 506-508. doi:10.1176/

Hui, C. L., Chang, W. C., Chan, S. K., Lee, E. H., Tam, W. W., Lai, D. C., . . . Chen, E. Y. (2014). Early intervention and evaluation for adult-onset psychosis: the JCEP study rationale and design. Early intervention in psychiatry, 8(3), 261-268. doi:10.1111/eip.12034

Kane, J. M., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L., Rosenheck, R. A., . . . Heinssen, R. K. (2016). Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. Am J Psychiatry, 173(4), 362-372. doi:10.1176/appi.ajp.2015.15050632

Kollias, C., Xenaki, L. A., Dimitrakopoulos, S., Kosteletos, I., Kontaxakis, V., Stefanis, N., & Papageorgiou, C. (2016). Early psychosis intervention outpatient service of the 1st Psychiatric University Clinic in Athens: 3 Years of experience. Early intervention in psychiatry. doi:10.1111/eip.12407

Kwon, J. S., Byun, M. S., Lee, T. Y., & An, S. K. (2012). Early intervention in psychosis: Insights from Korea. Asian J Psychiatr, 5(1), 98-105. doi:10.1016/j.ajp.2012.02.007

Lee, M. S., Ahn, S. R., Park, J. I., & Chung, Y. C. (2012). Development of an early psychosis intervention system in Korea: focus on the continuing care system for first-episode psychosis treatment in Seoul. East Asian Arch Psychiatry, 22(3), 105-109.

Mantas, C. M., Venetsanos. (2012). Establishing and operating an early intervention service for psychosis in a defined catchment area of northwestern Greece within the context of the local mental health network. Early intervention in psychiatry, 6(2), 6.

Nemoto, T., Funatogawa, T., Takeshi, K., Tobe, M., Yamaguchi, T., Morita, K., . . . Mizuno, M. (2012). Clinical practice at a multi-dimensional treatment centre for individuals with early psychosis in Japan. East Asian Arch Psychiatry, 22(3), 110-113.

Nkire, N., Sardinha, S., Nwosu, B., McDonough, C. M., De Coteau, P. A., Duffy, I., . . . Russell, V. (2015). Evaluation of knowledge and attitudes among primary care physicians in Cavan-Monaghan as 'gatekeepers-in-waiting' for the introduction of Carepath for Overcoming Psychosis Early (COPE). Early intervention in psychiatry, 9(2), 141-150. doi:10.1111/eip.12069

Nordentoft, M., Melau, M., Iversen, T., Petersen, L., Jeppesen, P., Thorup, A., . . . Jorgensen, P. (2015). From research to practice: how OPUS treatment was accepted and implemented throughout Denmark. Early intervention in psychiatry, 9(2), 156-162. doi:10.1111/eip.12108

Oppetit, A., Bourgin, J., Martinez, G., Kazes, M., Mam-Lam-Fook, C., Gaillard, R., . . . Krebs, M. O. (2016). The C'JAAD: a French team for early intervention in psychosis in Paris. Early intervention in psychiatry. doi:10.1111/eip.12376

Rangaswamy, T., Mangala, R., Mohan, G., Joseph, J., & John, S. (2012). Early intervention for first-episode psychosis in India. East Asian Arch Psychiatry, 22(3), 94-99.

Secher, R. G., Hjorthoj, C. R., Austin, S. F., Thorup, A., Jeppesen, P., Mors, O., & Nordentoft, M. (2015). Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophr Bull, 41(3), 617-626. doi:10.1093/schbul/sbu155

Simon, A. E., Theodoridou, A., Schimmelmann, B., Schneider, R., & Conus, P. (2012). The Swiss Early Psychosis Project SWEPP: a national network. Early intervention in psychiatry, 6(1), 106-111. doi:10.1111/j.1751-7893.2011.00322.x

Wong, G. H. (2012). Early psychosis declaration for Asia by the Asian Network of Early Psychosis. East Asian Arch Psychiatry, 22(3), 90-93.

Wong, G. H., Hui, C. L., Wong, D. Y., Tang, J. Y., Chang, W. C., Chan, S. K., . . . Chen, E. Y. (2012). Developments in early intervention for psychosis in Hong Kong. East Asian Arch Psychiatry, 22(3), 100-104.

Practicing mindfulness using virtual reality simulations of potentially stressful daily activities: an innovative approach to the treatment of first episode psychosis

Poster C45, Wednesday, October 10, 11:30 am - 1:00 pm, Essex Ballroom

Tin Ngo-Minh1,3,4, Claudie Loranger2, Catherine Brisebois2, Stéphane Bouchard2, Ian Vachon2, Tin Ngo-Minh; 1University of Ottawa, 2Université du Québec en Outaouais, 3University McGill, 4Centre de Recherche du CISSS Outaouais

The main therapeutic applications of virtual reality (VR) for people presenting psychotic features focus on social skills training, AVATAR therapy or cognitive behavior therapy combined with VR that facilitates cognitive restructuring, exposure or cognitive training. The possibilities of VR are multiple and other applications deserve considerations. One example is mindfulness-based interventions, which shows growing interest and support. Objective: The long term goal of this research is to propose a treatment program that would allow people presenting first episodes of psychosis to practice mindfulness skills in virtual environments depicting progressively challenging day to day activities and stressors. The aim of the current project is to assess the acceptability and feasibility of a few sessions combining mindfulness-based interventions for schizophrenia and immersions in VR. For this poster, we will present the treatment manual and results from our pilot patients. Method: The sample consist of five participants suffering from schizophrenia recruited from a first episode psychosis clinic. The mindfulness-based intervention program proposes five 60-minute sessions. Participants are invited to practice mindfulness skills in a virtual restaurant depicting everyday life situations that can be challenging for patients suffering from psychosis. The therapist: (a) coaches and supports the participants in learning the skills before the immersion, (b) helps the patient through guided-mastery techniques to apply the skills in progressively challenging VR immersions, (c) provides post-immersions feedback to improve patient’s awareness of the situation and how to apply the skills, and (d) facilitates generalisation through examples of how to apply the skills between sessions.

Pre-implementation evaluation of a new psychoeducational tool for patients with first episode psychosis

Poster C61, Wednesday, October 10, 11:30 am - 1:00 pm, Essex Ballroom

Tin Ngo-Minh1,3,4, Line LeBlanc2; 1McGill University, 2Université du Québec en Outaouais, 3University of Ottawa, 4Centre de recherche CISSSO

Individual psychoeducation, despite being the most prevalent component of early intervention services, is rarely a subject for studies. While it has been shown to improve the prognosis of individuals with first episode psychosis (FEP), there is no widely accepted content or practice standards specifically in the field of early interventions. A new psychoeducational tool for this population and their families has been developed and evaluated based on Rogers' theory of diffusion of innovation. The research aimed to evaluate the appreciation, adoption and use of this new tool with experienced professionals working in the FEP clinics in Québec, Canada (n=25). The results indicate that professionals agree with the rational that led to its development, in particular the difficulty of adhering to pharmacological treatment in the absence of standard psychoeducation. The degree of appreciation as well as the degree of adoption are relatively high. The factors that may have contributed to this rate were examined, namely mental health professionals opinion of the relative benefits, compatibility, complexity and anticipated effects of the tool. When using the tool, professionals report that patients have made positive comments. Indeed, images, metaphors and graphics are generally appreciated, however some images are more controversial. In conclusion, the results make it possible to improve the tool on the basis of experience and to plan the conditions for success of its future implementation. Better integration of the concept of recovery and the contribution of customers for the choice of images should be considered to make the tool more accessible.