Aim Pennsylvania (PA) first‐episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA‐OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6‐ and 12‐month outcomes. Methods Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re‐administered at 6‐ and 12‐month follow‐up, and data were analysed for individuals (n = 230) who had completed 12‐months of treatment. Domains assessed via clinician report and/or self‐report included symptoms, role and social functioning, self‐perceived recovery and service utilization. Results PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self‐perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school‐enrolment. Nearly all improvements were observed at 6‐month follow‐up, with earlier gains maintained at 12‐months. Conclusions PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society.
Tree crown ratio is useful in various applications such as prediction of tree mortality probabilities, growth potential, and fire behavior. Crown ratio is commonly assessed in two ways: (1) compacted crown ratio (CCR—lower branches visually moved upwards to fill missing foliage gaps) and (2) uncompacted crown ratio (UNCR—no missing foliage adjustment). The national forest inventory of the United States measures CCR on all trees, whereas only a subset of trees also are assessed for UNCR. Models for 27 species groups are presented to predict UNCR for the northern United States. The model formulation is consistent with those developed for other US regions while also accounting for the presence of repeated measurements and heterogeneous variance in a mixed-model framework. Ignoring random-effects parameters, the fit index values ranged from 0.43 to 0.78, and root mean squared error spanned 0.08–0.15; considerable improvements in both goodness-of-fit statistics were realized via inclusion of the random effects. Comparison of UNCR predictions with models developed for the southern United States exhibited close agreement, whereas comparisons with models used in Forest Vegetation Simulator variants indicated poor association. The models provide additional analytical flexibility for using the breadth of northern region data in applications where UNCR is the appropriate crown characteristic.
Aim The Pennsylvania first episode psychosis program evaluation (PA‐FEP‐PE) core assessment battery was developed as a standard and comprehensive clinical assessment and data collection tool in Pennsylvania coordinated specialty care programs (CSC). To reduce administrative time and maximize clinical utility by maintaining acceptable levels of precision, we aimed to generate a short form using item response theory (IRT)‐based computer‐adaptive test (CAT) simulation and analyse the implementation and acceptability of the short form among providers from PA‐CSC. Methods FEP participants (n = 759; age 14–36) from nine coordinated specialty care programs completed 156 items drawn from the PA‐FEP‐PE battery. Multidimensional IRT‐based CAT simulations were used to select the best PA‐FEP‐PE items for abbreviated forms. Results A 67‐item PA‐FEP‐PE short form was developed to capture six factors: (1) positive affect and surgency (with negative loadings on Anxious‐Misery items); (2) psychiatric services satisfaction; (3) antipsychotic side effect severity; (4) family turmoil and associated traumas; (5) trauma load; and (6) psychosis. The total number of items was reduced more than 50% in the PA‐FEP‐PE shortened forms. The short form demonstrated good psychometric properties, and it was well accepted by our providers in the implementation. Conclusions The empirical derivation and implementation of abbreviated measures of key domains and constructs in FEP care have streamlined and facilitated PA‐FEP program evaluation. Our work supports potential application of IRT based methods to empirically reduce core assessment battery measures in large‐scale data collection efforts such as in the Early Psychosis Intervention Network.
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 >=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 >=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.
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