Feasibility of an Early Detection Program for Early Psychosis on a College Campus
Condition: Psychosis; First Episode Psychosis; Clinical High Risk for Psychosis
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The objective of the proposed study is to determine the feasibility of an Early Detection
      program that aims to: (i) identify college students at clinical high risk (CHR) of psychosis
      or with first episode psychosis (FEP), and (ii) efficiently link them to coordinated
      specialty care (CSC) services for a 2nd stage screen, a clinical assessment, and appropriate
      treatment. Preliminary estimates of effectiveness with respect to the intervention will also
      be provided.
    

Detailed description: 
      Specific Aims: Feasibility of an Early Detection Program for Early Psychosis on a College
      Campus Long duration of untreated psychosis (DUP) is associated with poor outcomes, including
      higher rates of suicide, hospitalization, and overall low functioning. More widespread use of
      effective strategies to decrease DUP are needed to address the substantial discrepancy
      between the actual (i.e., on average 2 years) and recommended time (i.e., 3 months) between
      the appearance of psychotic symptoms and the initiation of treatment. Early detection (ED)
      programs aim to decrease DUP by increasing case identification and removal of barriers to
      coordinated specialty care (CSC). The most studied components of ED programs include: (i)
      educational campaigns; ED response teams designed to optimize the referral processes to CSC;
      and to a lesser extent, screening among high-risk groups. While results of studies on
      individual ED components have been inconsistent, combinations of ED components have had more
      success in reducing DUP. For example, the Treatment and Intervention in Psychosis ED program,
      which included educational campaigns and ED teams, reported an average decrease in DUP from
      1.5 years to 0.5 years pre-post implementation. The evidence on community-based ED programs
      is large and growing but very little is known about the effectiveness of ED services on
      college campuses in the United States. This gap in the literature is problematic because,
      with the first symptoms of psychosis being most likely to surface among college age young
      adults, college campuses are critical locations to identify and refer individuals to CSC who
      are at increased risk of first episode psychosis (FEP). The investigators aim to address this
      gap in the literature.

      The long-term goal of this program of research is to improve clinical and functional outcomes
      among college students with early stages of psychosis by reducing DUP. The objective of the
      proposed study is to determine the feasibility of an ED program that aims to: (i) identify
      college students at CHR of psychosis or with FEP, and (ii) efficiently link them to CSC
      services for a 2nd stage screen and a clinical assessment among those determined eligible.
      Students will be referred to treatment based on the results of the assessment (the University
      of New Mexico Department of Psychiatry CSC program includes clinical services for both FEP
      and CHR). The investigators will also provide preliminary estimates of effectiveness with
      respect to the intervention. The ED program will include two organizational level changes.
      First, a universal screening will be implemented (i.e., the Prodromal Questionnaire Brief)
      for psychosis among college students who are seeking help at a college counseling center.
      Second, a collaborative, person-centered, and rapid referral process (<2 weeks) to CSC will
      be implemented. Person-centered elements of the referral process include shared-decision
      making and a warm handoff (i.e., transfer of care between the college counseling center and
      CSC with the student present). The organizational-level changes will be facilitated by
      training, monthly meetings, and a decision support tool. The focus on these two components
      was informed by: (i) input collected from the existing CSC clinical team, college counseling
      center staff, and students through campus-based meetings; (ii) evidence for universal
      screening and processes that facilitate rapid access to CSC; and (iii) the pathways to care
      literature showing a strong link between health system factors and extended DUP. The planned
      intervention will evaluate it based on a combination of two theoretical frameworks: (i)
      Precede-Proceed Public Health Model, and the (ii) RE-AIM. Mixed methods will be used to
      attain the objective and achieve the following two specific aims:

        1. Identify whether (i) case identification, and (ii) referral-related barriers to CSC are
           important targets for ED programs on college campuses. The number of referrals from the
           college counseling center to the CSC program in the preceding three years will be
           compared to the number received during the 2.5 years of implementation. Also, during the
           same time-period DUP will be compared, and pathways and perceived barriers to care
           between college students referred from the college counseling center and students
           presenting to CSC from other referral sources. The hypothesis is that through the two
           mechanisms of change, the number of college students referred to CSC will increase. The
           investigators also hypothesize that, among college students referred to CSC from the
           college counseling center compared to those presenting from other referral sources, DUP
           will be shorter among those with FEP, and there will be fewer steps and perceived
           barriers for students with FEP or at CHR. The psychosis literacy among referrers from
           the counseling center will be examined. The investigators hypothesize that psychosis
           literacy will increase pre-post implementation.

        2. Evaluate the feasibility of an ED program from the perspectives of various stakeholders.

      The proposed study is innovative because it will be pilot testing an ED program on a college
      campus. At the completion of the proposed research, the expected outcomes are preliminary
      data and knowledge on the feasibility of and effective targets for an ED program on a college
      campus. If determined feasible and effective, the proposed ED program has a high potential
      for widespread uptake and scale-up given the nominal costs and ease of replication of its
      components. The brief screener will be part of the routine intake and the warm handoff/rapid
      CSC access will be facilitated by CSC staff posing minimal burden on college counseling
      centers. With a diverse target population in terms of ethnicity and race, the findings will
      be generalizable to college campuses nationwide and may therefore ultimately impact DUP - a
      major public health problem.
    

Intervention name(s): Screening; Warm Hand-Off
Intervention type(s): Other; Other
Intervention description(s): Screening for Early Psychosis and Clinical High Risk of Psychosis; Among those determined eligible, transfer of care between the student health and counseling center and the coordinated specialty care program outreach coordinator occurring over the phone while the student is in the counselor's office immediately following the results of the screening.
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: A staggered intervention design will be implemented with three distinct stages. 1. Treatment as usual enhanced with a brief psychosis literacy training (45-60 minutes) for counselors at a university's student health counseling center (SHAC); 2. implementation of a screening tool for risk of psychosis; 3. Addition of a warm hand-off to Coordinated Specialty Care (CSC)
Masking: None (Open Label)
Primary purpose: Screening