Clinical Interviews With Detainees With Early Psychosis
Condition: First-Episode Psychosis
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The investigators are studying a jail-based intervention to reduce the duration of untreated
      psychosis (DUP) among young adults with previously undetected first-episode psychosis who are
      detained in jail. Longer DUP (or treatment delay) is linked to poorer outcomes in
      first-episode psychosis and there is evidence that justice-involved young adults with
      first-episode psychosis have an alarmingly long DUP. Thus, despite the expansion of
      Coordinated Specialty Care (CSC) programs that improve outcomes through early,
      multi-component care, there is a need to establish early detection services in the criminal
      justice system and create pathways from justice involvement to CSC. This intervention offers
      a novel and potentially high impact approach for reducing DUP in jail settings: a jail-based
      Specialized Early Engagement Support Service that receives referrals, engages detainees, and
      serves as a bridge to community-based CSC. The study team will design and implement the
      intervention, thoroughly study its feasibility and acceptability, and prepare an intervention
      manual for broader use in diverse jails and future formal research.
    

Detailed description: 
      Persons with serious mental illnesses are overrepresented in jails. Criminal justice (CJ)
      involvement, including jail detention, is common among those with first-episode psychosis
      (FEP) and frequently precedes psychiatric treatment engagement. Yet, no documented
      interventions currently exist specifically to identify/engage such individuals while in jail
      and connect them to Coordinated Specialty Care (CSC) in the community upon release. Expansion
      of CSC programs across the U.S. provides an opportunity for partnership with the CJ
      system-one that has the potential to reduce the duration of untreated psychosis (DUP) and
      thus improve outcomes.

      To detect FEP and reduce DUP among detainees in a large, urban jail, the investigators
      propose to implement: a Specialized Early Engagement Support Service (SEESS) in 3 jails on
      Rikers Island in New York City (NYC): Anna M. Kross Center (AMKC), Rose M. Singer Center
      (RMSC) and Robert N. Davoren Complex (RNDC).

      The investigators expect the multimedia TEC to generate referrals to the Correctional Health
      Services (CHS), and to reduce DUP-1 (psychosis onset to antipsychotic initiation). Then, the
      jail-based SEESS (a Social Worker and Peer Specialist) will link those identified to
      community-based CSC (primarily OnTrackNY sites in NYC), thus reducing DUP-2 (psychosis onset
      to CSC enrollment).

      The investigators will examine a set of hypothesized targets/mediators (the "how's"). These
      are key ingredients that underpin the intervention's ability to reduce DUP.

      The multi-media TEC will generate referrals to the CHS, by improving the behavioral
      capabilities, expectations, and self-efficacy (constructs from Social Cognitive Theory) of
      the Correction Officers trained. The SEESS will then link detainees with FEP, using tenets of
      person-centered treatment and shared decision-making, and the Critical Time Intervention
      model, to community-based CSC. This will occur through engagement of detainees while in jail,
      and telephonically (when possible) after release. The investigators will assess feasibility
      and acceptability to lay the groundwork for a multi-site, definitive effectiveness trial.
    

Intervention name(s): Specialized Early Engagement Support Service
Intervention type(s): Behavioral
Intervention description(s): The Specialized Early Engagement Support Service (SEESS - a Social Worker and Peer Specialist) will link detainees with first-episode psychosis (FEP), using tenets of person-centered treatment and shared decision-making, and the Critical Time Intervention model, to community-based Coordinated Specialty Care (CSC).
Intervention model: Sequential Assignment
Intervention model description: Feasibility and Acceptability Study
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Detainees; Early Psychosis