T224. TESTING THE EFFECTIVENESS OF A BRIEF, PEER SUPPORT INTERVENTION TO FACILITATE TRANSITION FROM PSYCHIATRIC HOSPITALIZATION FOR A SCHIZOPHRENIA SPECTRUM POPULATION
Authors: Kidd Sean , Davidson Larry , Velligan Dawn , Voineskos Aristotle 
Published: May 2020

Abstract

Background
The period immediately following discharge is highly stressful for many individuals with schizophrenia spectrum illnesses as they transition from protracted inpatient stays to community settings with minimal support. In this period the risk of hospital re-admission is at its highest, many do not engage with community supports and clinical resources, and the risk of suicide is greatest. The evidence base for brief, effective interventions to support such transitions is to date underdeveloped.

Methods
This randomized controlled trial examined the effectiveness of a Peer Support intervention that combines components of Cognitive Adaptation Training (CAT) and the Welcome Basket Program. CAT is an evidence-based intervention that provides environmental supports to help people with schizophrenia compensate for the cognitive impacts of the illness. The Welcome Basket Program is a peer intervention approach that helps bridge discharge through the provision of a small individualized ‘basket’ of staple supplies and comfort items along with the facilitation of engagement with community resources. The intervention involves peer supports engaging patients in the days preceding discharge to assess goals and needs followed by weekly visits post-discharge for 1 month providing Welcome Basket and CAT supports. The study also collected pilot data examining the outcomes of an abbreviated, two contact version of the intervention. Inpatients with a schizophrenia spectrum diagnosis were randomized with a 2:2:1 ratio to treatment as usual, the full intervention, and the abbreviated intervention. Along with feasibility assessments, outcome metrics included re-hospitalization, symptomatology, quality of life, and community functioning. Assessments at baseline, 1-month post-discharge, and 6 months post-discharge facilitated the examination of relative effectiveness and sustainment of gains.

Results
The trial was successfully implemented with data collected from 106 participants at baseline, 82 at post-intervention, and 74 at 6-month follow up. Overall, the interventions and the study design appeared feasibility with attrition primarily due to the high acuity nature of a population recruited largely through an early psychosis inpatient unit (mean age 34.6 years). Preliminary analysis suggests limited effects on community functioning though completed analyses of other metrics are pending and may provide insight into the possible mechanisms of action of this intervention should it prove to be effective.

Discussion
This study was designed to assess the development and dissemination of a cost-effective method for mitigating relapse risk and promoting community involvement and engagement in care. The effort to better support successful care transitions through approaches such as this is a priority area for service systems globally and contributes to the literature on peer support. While widely implemented, models of peer support have seldom been examined for effectiveness in clinical trials.