Psychosis Screening in Juvenile Justice
Condition: Psychotic Disorders; Psychosis Nos/Other
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      This study will investigate the occurrence of psychosis-spectrum disorders among youth in the
      Juvenile Justice System and track mental health referrals for these youth in Phase 1, a
      standard care condition. Then, in Phase 2, an enhanced referral and linkage to care model
      will be employed, with the aim of bolstering motivation for and engagement in mental health
      treatment. It is hypothesized that the enhanced referral protocol will promote completion of
      mental health care referrals.
    

Detailed description: 
      Among adolescents in the Juvenile Justice System (JJS), an estimated 3% have a psychotic
      illness, and it can be reasonably assumed that many more experience subthreshold
      psychotic-spectrum symptoms that may be indicative of risk. Evidence suggests that as many as
      25% of those with first episode psychosis (FEP) have their first contact with care through
      criminal justice agencies. Duration of untreated psychosis (DUP), a negative prognostic
      factor, has been shown to be longer among those within the criminal justice system. This
      suggests that youth with psychotic symptoms who end up in the JJS may not receive appropriate
      mental health care. This study will first track mental health referrals for JJ youth with
      psychosis-spectrum symptoms in Phase 1, a standard care condition, and then an enhanced
      referral and linkage to care model will be investigated in Phase 2 of the study.

      The current study will be conducted in the Rhode Island Family Court Juvenile Intake
      Department where all youth receive a mental health screen (Massachusetts Youth Screening
      Instrument - 2nd Ed; MAYSI -2). All youth who screen positive on the MAYSI-2 Thought
      Disturbance scale, and a second gate screening with the Prodromal Questionnaire - Brief
      Version (PQ-B), will be given referral information for Coordinated Specialty Care (CSC)
      services by JJS staff. Enrolled families will also participate in the research assessment,
      regardless of whether they pursue the CSC referral, which involves the Structured Interview
      for Psychosis-risk Syndromes [SIPS] and other measures to thoroughly assess history of
      psychotic symptoms, comorbid difficulties, and mental health care engagement. A comparison
      sample of youth who screen negative on the MAYSI-2 Thought Disturbance subscale will also be
      assessed with the SIPS to determine accuracy of the MAYSI-2/PQ-B screen in the identification
      of psychosis-risk. During the first phase of the study, JJS staff will follow standard
      procedures in referring youth to the state CSC. In the second phase of the study, JJS will be
      instructed in an enhanced referral/linkage to care protocol, including a "warm hand-off"
      where referrals will be put in direct and immediate contact with CSC staff. CSC staff will
      also be trained in procedures to increase the likelihood of follow through with the referral
      to the CSC. Three month follow-up qualitative interviews and quantitative assessments
      regarding referral pathways, bottlenecks and gaps in care, youth psychiatric symptoms, and
      JJS contacts will be conducted. This design maps onto the stated goals of PAR 16- 264
      including: 1) Identify baseline rates of DUP within the JJS (and the investigators will also
      look at rates of psychosis-spectrum symptoms and disorders); 2) Map referral pathways to CSC;
      3) Identify implementation and service level factors that create bottlenecks and gaps in
      linkage to the CSC; 4) Investigate the relationship between treatment linkage and psychotic
      symptoms/DUP; and, 5) Pilot test feasible strategies for reducing DUP.
    

Intervention name(s): Enhanced Referral/Linkage to Care; Standard Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The JJ worker reviews with the family psychoeducation material about the role of mental health care in emotional/behavioral problems. The JJ intake worker will contact the CSC program directly with the family for a "warm hand-off". The CSC worker will speak with the parent and arrange for an intake evaluation. For families already receiving treatment, the CSC referral will be for consultation. Via phone, the CSC clinician will use a motivational interviewing style to encourage families to attend the appointment. Three and seven days after referral, the JJ worker will text the caregiver to see if the CSC appointment was kept. If not, the JJ worker will text the parent the CSC phone number and also ask permission to contact the CSC to assist the family in setting up another appointment.; Referral to the Coordinated Specialty Care (CSC) clinic
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: The intervention will have two phases: 1) a Standard Care (baseline control) condition, followed by, 2) an Enhanced Referral/Linkage to Care condition. Because this is a roll-out trial, the two conditions will be compared using a non-randomized open trial design.
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: psychosis; clinical high risk