Coordinated Specialty Care: A New Approach to Addressing Emerging Serious Mental Illness in Young Adults

Transcription

1 Coordinated Specialty Care: A New Approach to Addressing Emerging Serious Mental Illness in Young Adults Rhonda Thissen, M.S.W. DBHDS Office of Adult Community Behavioral Health DBHDS Vision: A life of possibilities for all Virginians

2 Background The majority of people with serious mental illnesses such as Schizophrenia experience the first signs of illness during adolescence or early adulthood Long delays often occur between symptom onset and consistent, effective treatment Lack of early intervention is associated with significant mental health disability later in life Slide 2

3 Background Incidence of Schizophrenia Occurs worldwide in approximately 0.5% to 1.5% of the population 25% of all hospital bed days 40% of all long-term care days 20% of all Social Security benefit days Costs the nation as much as $65 billion per year Impact to individuals and families Slide 3

4 Background First Episode Psychosis Youth experiencing first-episode psychosis (FEP) are often frightened and confused, and struggle to understand what is happening to them. They may exhibit irrational behavior, aggression against self or others, difficulties communicating and relating, and have conflicts with authority figures. Early intervention can improve symptoms and functioning and assist youth to develop recovery skills. Slide 4

5 Mental Health Service Use Gap Among Young People Prevalence Service Use McGorry, P. (2007). The specialist youth mental health model: strengthening the weakest link in the public mental health system. Med J Aus 187: S53 S56

6 New Findings on Mortality Risk and FEP NIMH study of health care and morbidity outcomes among 1,357 individuals with commercial insurance aged receiving a first observed diagnosis of psychosis in month mortality was 24 times greater than in the agematched general population (GP), and 89 times greater than GP across all age groups In the year after diagnosis: 62% at least one hospitalization and/or one emergency department visit during the initial year of care 61% filled no antipsychotic prescriptions 41% received no individual psychotherapy Slide 6

7 The Duration of Untreated Psychosis (DUP) Long-term recovery is impacted by the period of time between onset of psychotic symptoms and initiation of appropriate treatment A recent meta-analysis provides convincing evidence for an influence of DUP on early outcomes, but questions remain Two potential mechanisms: o o Active morbid process, or the neurotoxicity hypothesis Psychosocial toxicity of untreated psychosis Slide 7

8 Background RAISE Study To demonstrate the benefits of early intervention, in 2009 the National Institute of Mental Health began the multi-site Recovery After Initial Schizophrenia Episode (RAISE) research study. Ages: Diagnoses: Disorders with psychotic symptoms lasting at least one week Duration of Illness: No more than 2 years since the first onset of psychotic symptoms Slide 8

9 Examples of RAISE Study Results Two-year randomized trial comparing individuals in RAISE Early Treatment (N = 223) across 17 sites to usual care (N = 181) Participants were significantly more likely to remain in treatment, experience significantly greater improvements in quality of life, and participate in work or school Four additional randomized trials replicated these results in about 800 participants The model studied in RAISE research became the new evidence-based practice called Coordinated Specialty Care (CSC) Slide 9

10 Elements of CSC Assertive outreach and engagement to identify youth in need of services Team-based, phase-specific treatment provided by a multi-disciplinary treatment team using a shared decisionmaking model Team leader Primary Clinician/Therapist Prescriber (MD or NP) Outreach and Recruitment Coordinator Supported Employment and Education Coordinator Peer Support Specialist Slide 10

11 Elements of CSC Evidence-supported interventions Low-dose antipsychotic medications Cognitive and behavioral therapy Family education and support Educational and vocational rehabilitation Peer support Case management Recovery-focused, person-centered, culturally competent care that weighs the duty to care with the dignity of risk Slide 11

12 Virginia CSC Initiative Expansion of services to transition-age/emerging adults was a recommendation of the Governor s School and Campus Safety Task Force (2013) Funded with a combination of State (~80%) and federal funds set aside for First Episode Psychosis treatment (~20%) Oversight at the state level by DBHDS Slide 12

13 Virginia CSC Initiative DBHDS solicited applications from CSBs in July 2014 Eight programs funded from across the 5 major regions: aalexandria afairfax-falls Church, with PRS, Inc. as subcontractor aloudoun, with PRS, Inc. as subcontractor ahenrico ahighlands (Abingdon/Bristol/Washington County) aprince William, with Community Residences, Inc. as subcontractor awestern Tidewater (Suffolk, Franklin, Southampton) Slide 13

14 Virginia CSC Initiative Current Activities Collaborative work to develop data reporting mechanisms and outcome measures: Increased participation in employment and/or school Decreasein symptoms Decrease in criminal justice involvement Improvement in functioning through individual s self-report of recovery Decrease in use of emergency/crisis services, including hospitalization Satisfaction with services Improvement in social functioning Increased family engagement Slide 14

15 Questions? Rhonda Thissen, MSW DBHDS Office of Mental Health For additional information and to access contact information for Virginia s Coordinated Specialty Care programs, visit the DBHDS Web Site at