M244. PENNSYLVANIA FIRST-EPISODE PROGRAM EVALUATION OF COORDINATED SPECIALTY CARE: SIX- AND 12-MONTH OUTCOMES
Authors: Calkins Monica , Westfall Megan , Hurford Irene 
Published: May 2020

Abstract

Background
Interest in early intervention for first-episode psychosis (FEP) has increased globally in recent decades in response to evidence that multi-component programs may reduce individual and societal burden of psychotic disorders. In 2016, the Pennsylvania (PA) Office of Mental Health and Substance Abuse Services (OMHSAS) provided funding to develop a statewide Program Evaluation (PE) initiative. PA-FEP-PE assesses benefits of nine PA coordinated specialty care (CSC) programs both individually and in aggregate. We previously (SIRS 2019) presented preliminary data from initial participants. We now present data from 598 participants enrolled across PA.

Methods
Our CSC programs serve youth age 12–34 experiencing early psychosis onset between 12–24 months before admission. Services, including pharmacotherapy, CBT-based psychotherapy, case management, supported employment and education, peer support, and multi-family groups and psychoeducation, are offered for &gt;=2 years. Participant characteristics at referral, admission, follow-up and discharge are collected via standardized computerized (REDCap) forms. The computerized clinical battery, administered at admission and at 6-month follow-up intervals, is composed of measures selected for domain coverage, clinical utility, reliability/validity (from the PhenX toolkit), practical utility, low burden, and high utility to multiple stakeholders. Domains include symptoms and diagnosis (Brief Psychiatric Rating Scale, Beck Depression Inventory-7, Hopelessness Scale, Self-Esteem-Scale-Revised, Loneliness Scale, Defeatist Beliefs Scale, Post-Traumatic Stress Disorder Symptom Scale), psychosocial functioning and recovery (Global Function Role and Social Scales, Psychosis Recovery Assessment Questionnaire, Quality of Life Functional Assessment, Systematic Clinical Outcome Routine Evaluation), medication side effect monitoring (Extrapyramidal Symptom Rating Scale, Glasgow Antipsychotic Side Effect Scale), and service quality and satisfaction (Youth Services Survey).

Results
Between 1/1/17-7/1/19, 1,917 referrals were received, of whom 598 participants (mean age=21.1 SD=4.5; 35% female; 45% Caucasian, 41% African-American) were enrolled. Unspecified/other psychotic disorder was the most common diagnosis at admission (48%). Mean age at psychosis onset was 20.2 years (SD=4.6). An average 13.7 (SD=21.8) months lapsed between symptom onset and admission. The majority (78%) of participants had prior hospitalizations. At admission, participants showed moderate severity of psychiatric symptoms, serious impairment in global role and social functioning, and 72% reported experiencing &gt;=1 traumatic events. At 6-month follow-up, participants (n=142) exhibited several significant improvements, including decreased hospitalizations and hospitalization days, suicidal ideation, substance use, overall psychopathology, and positive psychosis symptoms, and increased employment and school enrollment, global role and social function, self-rated quality of life, medication side effects, and satisfaction with mental health services. Individuals who engaged for 12 months (n=60) continued to maintain significant improvement in clinical features.

Discussion
PA-FEP-PA is a comprehensive model yielding clinical and functional improvements after 6 and 12 months of CSC participation. Continued data collection will enable increased power to analyze population and site differences to illuminate mediators and moderators underlying individual variations and improve personalized prediction of salient outcomes. Further, the PA-FEP-PE model offers PA CSC programs a collaborative learning network for ongoing quality improvement.