Improving Access to Early Psychosis Coordinated Specialty Care
Condition: Psychosis
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The aim of this study is to evaluate the feasibility of developing an Early Psychosis CSC
      service delivery model suitable for rural settings in NC. Major challenges to delivery of
      specialized health care services for persons in the early stages of psychosis include the
      high level of provider expertise and the frequency and intensity of services. These
      challenges limit the feasibility of brick-and-mortar programs to serve individuals living in
      rural settings. This study proposes to expand service delivery methods to include telehealth
      as a potential solution.
    

Detailed description: 
      The UNC OASIS program currently provides evidenced-based outpatient coordinated specialty
      care services (CSC) to persons within the first five years of a psychotic disorder. Medical
      management and psychotherapy services are mainly provided in brick and mortar offices.
      Supported education, supported employment, and peer support services are provided in offices
      and also in the community. The service model is relatively intense, involving treatment
      sessions up to several times a week. Thus a barrier to persons in rural North Carolina
      receiving CSC services is the time taken to travel to office based appointments.

      The purpose of this study is to determine feasibility and acceptability of providing some of
      the services provided by OASIS via telehealth.

      Participants: Up to 10 patients who have been accepted by the OASIS program and who live
      45-minutes or more from the UNC OASIS program or another CSC program. Participants must also
      have home internet bandwidth sufficient to support the telehealth platform and own a computer
      or other device (smart phone, tablet, etc.) compatible with the telehealth platform.

      Procedures (methods): The OASIS program does not exclude patients based on where they live in
      North Carolina. Potential OASIS patients and their families participate in an initial
      psychosocial and medical evaluation. At this time the OASIS program director reviews the
      OASIS program expectations with the patient and family. If the OASIS program and the patient
      and the patient's family member agree that the OASIS program is a good fit, the patient is
      then accepted into the program. After acceptance into the OASIS program patients who live 45
      minutes or more away from the UNC OASIS or another CSC program and who reside in North
      Carolina will be informed about the availability of the telehealth pilot project by the OASIS
      program director.

      UNCH has developed a telehealth service that is provided via the UNC electronic medical
      record platform, EPIC. If interested, the OASIS patient and their family member will meet
      with a study staff person, who will evaluate whether their internet bandwidth is sufficient
      to support the EPIC telehealth platform and if they own a computer or other device that
      supports the EPIC telehealth platform. Patients who are interested and who meet these
      requirements will then participate in the oral and written informed consent process.

      Participants who consent to participate in the study will receive some of their CSC services
      via telehealth, and will continue to receive some of their services in the OASIS offices.
      During this pilot phase the project will be flexible about the relative proportion of
      services delivered via telehealth and in-person. The main study participant is the patient,
      however since family therapy may be delivered via telehealth interested family members are
      also asked to consent to study participation.

      The OASIS program routinely collects quality assurance data via self-report and
      clinician-administered assessments. The study will obtain consent from study participants to
      access this information. In addition to the Quality Assurance document patients who are
      subjects and their family members who also consent to participate in the the telehealth pilot
      project will also complete a self-report survey inquiring about their satisfaction with
      telehealth services.
    

Intervention name(s): Telehealth
Intervention type(s): Other
Intervention description(s): Early Psychosis Coordinated Specialty Care Services via telehealth.
Other intervention name(s): Video visits
Intervention model: Single Group Assignment
Intervention model description: Open feasibility trial of addition of telehealth to an Early Psychosis Coordinated Specialty Service
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Telehealth; Specialty Care; Rural Initiative