Transcript EIP Presentation - NAMI Howard County

The Maryland Early Intervention Program
A collaborative for the early identification and treatment
of mental illness with psychosis
Objectives
• Review the symptoms and impact of psychosis
• Discuss the impact of stigma on psychosis
• Offer strategies for engaging individuals
experiencing early psychosis in treatment,
including RA1SE
• Learn about the services available through the
Maryland Early Intervention Program
Objectives
• Review the symptoms and impact of psychosis
• Discuss the impact of stigma on psychosis
• Offer strategies for engaging individuals
experiencing early psychosis in treatment,
including RA1SE
• Learn about the services available through the
Maryland Early Intervention Program
The Impact of Psychosis
Approximately 3% develop a psychotic disorder (lifetime)
100,000 adolescents and young adults develop a first episode
each year (Heinssen, Goldstein, & Azrin, 2014)
Heavy impacts
 Mortality - 2.5x more likely to die than peers, reduced life
expectancy by 20 years (Laursen et al., 2014)
 Independent functioning
 Quality of life
 Family functioning, burden & distress
 US $62.7 billion per year
Psychosis
5 types of psychotic symptoms (DSM-5
‘Criterion A’)
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Hallucinations
Delusions
Disorganized speech
Disorganized/catatonic behavior
Negative symptoms
Positive Symptoms
Delusions: false and fixed beliefs
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I think people are talking about me
Someone is following me
People are talking about me to plot against me
Aliens are sending me messages through the TV
Hallucinations: perception/sensory abnormalities
 Auditory, visual, or tactile
 Auditory or “hearing voices” is most common
Positive Symptoms
Disorganized speech
 Speech difficult to follow
 Idiosyncratic use of words
Disorganized behavior
 Unpredictable and untriggered agitated behavior
 Dressing in unusual way (appearing disheveled or
wearing multiple layers on a hot day)
Negative Symptoms
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Social withdrawal
Academic decline
Decreased motivation
Limited facial expression
Decreased activity
Diagnoses/Conditions Associated
with Psychosis
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Schizophrenia
Schizophreniform
Depression with psychotic symptoms
Bipolar disorder
Reaction to trauma
Certain medical conditions
Substance abuse
Who Experiences Early Psychosis?
• Onset generally occurs
between the ages of 15-25
• Onset may begin in
adolescence and continue
into young adulthood
• Occurs equally in males
and females [1]
• Males typically present with the disease in their late teens and
early 20s
• Females present in their early 20s to early 30s
[1] Schultz, North, & Shields, 2007
Duration of Untreated Psychosis
(DUP)
Onset of
Psychosis Treatment
Onset of
Risk State
Premorbid
Risk Syndrome
Psychosis
DUP
DU Illness
Marshall et al., 2005
Duration of untreated psychosis (DUP)
• Shorter DUP is associated with better social,
emotional, and occupational outcomes
• Longer DUP is associated with increased risk of
suicide and violence
1) 10-30% of suicide attempts occur prior to treatment
2) 15-20% have had some experience of violence prior to
treatment
-Per year risk of committing homicide is 15 times higher in
untreated individuals
- of the homicides committed by people with mental illness with
psychosis, 4 in 10 occur prior to treatment
Objectives
• Review the symptoms and impact of psychosis
• Discuss the impact of stigma on psychosis
• Offer strategies for engaging individuals
experiencing early psychosis in treatment,
including RA1SE
• Learn about the services available through the
Maryland Early Intervention Program
A word about “person-first language”
• A “person with schizophrenia”
• As compared to a “schizophrenic”
What People “Know” About Schizophrenia
Myths About Schizophrenia
 Multiple Personality Disorder
 Violent
 Homeless
 Can’t hold a job
 Caused by poor parenting
Media Coverage
Can you relate?
 Depression/Anxiety
Can you relate?
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Dreams
Hypnagogic/hypnopompic experiences
Cell phone ringing
Hearing name called
Seeing a shadow or a tree and thinking it’s a person
Belief in things that are not necessarily scientific
Déjà vu
Seeing a group of people & thinking they’re talking about you
Not being able to enjoy things sometimes
Feeling confused
Cautionary note
 Real life experiences of psychosis are far more
challenging, interfering, & distressful than
analogies & simulations
Reducing Stigma
Brave people are standing up and sharing their
stories which helps in stigma reduction and is one
way to increase peoples’ willingness to get treatment
Liselle
Video Clips
• Reflecting on her journey towards recovery,
Liselle describes how by accepting and
acknowledging the challenges of her illness
she ironically disempowers their impact on
her. At the same time, this process has
allowed her to see the future in a bright and
optimistic light.
Objectives
• Review the symptoms and impact of psychosis
• Discuss the impact of stigma on psychosis
• Offer strategies for engaging individuals
experiencing early psychosis in treatment,
including RA1SE
• Learn about the services available through the
Maryland Early Intervention Program
RA1SE
• Recovery after Initial (1st) Schizophrenia Episode
• An early intervention program based on Critical
Time Intervention (CTI)
• A person-centered, recovery-based program
• Assists individuals in moving forward and working
toward goals
• Provides education and support to individuals
and their families
RA1SE
• Coordinated specialty care that is:
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Orchestrated by a “case-manager”
Phase specific
Low-dose antipsychotic meds
Family education and support
Cognitive behavior therapy
Supported employment/education
• Shared decision making foundation of treatment
decisions
RA1SE
• Treatment focused on recovery/recovery
process
– Development and pursuit of recovery goals
– Breaking goals down into smaller objectives
– Identifying and addressing barriers to these goals
RA1SE
• Addressing individual and family concerns
• Working across multiple systems: hospitals,
schools/colleges, employers, judicial system
RA1SE Strategies
• Listen to the client and their goals
• Describe how treatment will help them
• Work with each individual where they are
Tips for
Treatment Engagement
Family members and primary supports
are often the strongest allies in
treatment
The importance of family involvement
Families and friends often first to notice and
voice concerns about psychosis
• Families are often the care providers
• Ability to recognize changes in the individual
• Stressful for the whole family
• Strong family support is key to recovery
Tips for
Treatment Engagement
• Family and loved ones can show care
• Help families understand their loved one’s experience
• Make sure that families and primary supports
understand:
– No one is to blame
– There is hope for living a full and enjoyable life
• Offer families resources for support, such as NAMI
• Support families in learning about the mental health
system and adjusting to their loved one’s illness
Tips for
Treatment Engagement
• Work with families on how to discuss
symptoms with their loved ones and facilitate
treatment engagement
• Encourage families to contact providers with
information and questions
• Include families in safety planning (see video
for safety planning on
www.mdbehavioralhealth.com
Recommendations From Families
Be patient
Make expectations…that are reasonable
Involve youth in activities
Monitor activities, peers, time
Have structure that reduces stress
Don’t forget about yourself
Provide LOVE
Objectives
• Review the symptoms and impact of psychosis
• Discuss the impact of stigma on psychosis
• Offer strategies for engaging individuals
experiencing early psychosis in treatment,
including RA1SE
• Learn about the services available through the
Maryland Early Intervention Program
The Maryland Early Intervention Program
“A collaborative for the early identification and
treatment of mental illness with psychosis”
Maryland Early Intervention
Program
Our Goals:
1. To reduce chronicity and enhance the likelihood that a
person with early signs of psychosis will be able to:
a.
b.
c.
manage their illness
move successfully through the appropriate stages of development
establish a life of their choosing
2. To take a broad public health perspective, in which we
directly address issues of aggression, violence, and substance
use
3. To optimize the likelihood of recovery from serious mental
illness with psychosis
Maryland Early Intervention
Program
Our Structure:
1. The EIP is comprised of four service components:
a.
b.
c.
d.
Outreach and Education Services
Clinical Services
Consultation Services
Training and Implementation Support Services
2. Research is integrated into each of these components and
focuses on early detection and prediction of disease
emergence, progress or recovery; and treatment
development
Maryland Early Intervention
Program
Multidisciplinary Effort:
1. The Maryland EIP is comprised of professionals from
multiple disciplines, including health policy and
professionals from the youth and family advocacy
community
2. The Maryland EIP clinical programs are comprised of health
care providers from multiple disciplines, including
psychiatrists, psychologists, and social workers
Outreach and Education
• Lack of knowledge about mental health problems
and treatments and stigma related to mental
illness lead to increased threshold for treatmentseeking, prolonged duration of untreated
psychosis (DUP)
• Strategies for reducing DUP include:
– increase awareness of the signs and symptoms of
psychosis
– reduce stigma and other barriers to obtaining a
clinical evaluation and referral
Outreach and Education
• Approach
– Teach providers how to identify signs of clinical high risk
and early psychosis
– Familiarize providers with relevant assessments and
evidence-based practices
– Provide providers with ample ways to refer individuals
for further consultation and treatment if needed
• Settings
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Secondary educational institutions
Colleges/Universities
Behavioral health and primary care settings
Advocacy groups
Maryland Early Intervention
Program
Clinical Services:
1. High Risk of Psychosis
– Strive for Wellness Program
2. First Episode Clinics
– MPRC First Episode Clinic (FEC)
– RAISE Connection Program
3. Statewide Consultation Service
– For providers and institutions on diagnosis,
treatment recommendations, and school and family
management (by phone or in person)
Maryland Early Intervention
Program
All of Our Clinical Services:
• Are recovery oriented
• Are designed to help each individual achieve
their full potential
– employment, finishing school, reaching other
personal goals
• Emphasize safety, including extensive
– Risk assessment
– Safety planning
Strive for Wellness Program
• Clinical prevention/treatment for youth/young adults (12-25)
at risk of psychosis
• Services
– screening assessments to identify individuals experiencing psychosis
as soon as possible
– modular treatment approach to customize treatment to individual
needs
– psychoeducation for individuals and family members
• Engagement in outpatient treatment services may prevent
negative first experiences with mental health system that
might impact future engagement
– Police
– Emergency Treatment
– Mandated Treatment
MPRC First Episode Clinic
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The first specialty care FEC in Maryland
Expert clinical services for adolescents (12 &
up) and young adults experiencing FEP
Strong emphasis on evidence-based FEP care
using antipsychotic treatment, individual and
family education/support, and supported
education/employment
RAISE Connection Program
• Recovery After Initial Schizophrenia Episode (RAISE) Connection Program
– Established through an NIMH-funded initiative to study services for
people with newly diagnosed schizophrenia and psychotic illnesses
• Team-based coordinated specialty care model recommended
by NIMH
• The RAISE Connection Program is:
– early intervention based on a critical time intervention (CTI)
– person-centered, recovery-based program assisting individuals in
moving forward and working towards goals
– provide education and support to individuals and their families
RAISE Connection Program
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Team-based
Emphasis on outreach and engagement
Shared decision-making
Located at University of Maryland Midtown
Campus in the Carruthers Clinic, but separated
from services for more chronically ill clients
• Clinic Capacity: 30 clients
RAISE Connection Program
Team Roles/Description:
• Team Leader: overall coordination of services, including individual
therapy, case management, crisis intervention, information gathering,
safety planning
• Recovery Coach: social skills training, weekly participant group, monthly
family group, school coordination
• Employment/Education specialist: job development, addressing work
and school related goals and problems
• Psychiatrist: prescribing, shared decision-making, education
Consultation Services
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Provide consultations on diagnosis, treatment
recommendations, and school and family management
Consultations may be provided
• On-site (1 to 3 visits)
• By telephone or e-mail
We accept consultation requests from schools,
colleges, psychiatrists, primary care and pediatric care,
state institutions
Currently piloting telepsychiatry consultation service
Training & Implementation
Support Services
• Establish Early Intervention Teams throughout the State
– Train teams in evidence-based interventions for youth with
early psychosis
– Support ongoing training of teams via an existing
infrastructure
– Teams currently available in Baltimore City and
Montgomery County
• Create learning opportunities for teams and others
providing services to those with early psychosis
– To support collaboration, sharing of resources, and
coordination of service delivery
Who should contact the EIP?
• Individuals experiencing early symptoms of a mental illness with
psychosis
• Family Members, Friends, or Professionals who are seeking services
for an individual experiencing symptoms of a mental illness with early
psychosis
• Providers seeking formal consultations on complex cases
• Professionals interested in receiving education or information about
early psychosis or using program services
• Providers interested in establishing an early intervention team within
their treatment setting
When in doubt, feel free to ask
• Website: www.MarylandEIP.com
• Toll free numbers
– Phone: (877) 277-MEIP (6347)
– Fax: (877) 689-9185
• Centralized E-mail
– [email protected]