and Mental Hygiene when individuals ages 18-30 are hospitalized for first-episode psychosis (FEP). This study examined the implementation of NYC START, a program that meets patients hospitalized with FEP to offer a voluntary, 3-month critical time intervention provided by social workers and peer specialists to connect individuals to appropriate community mental health services after discharge.Methods: Service logs completed by program staff were summarized to determine the mean number of contacts received per client per week, types of services provided by social workers and peer specialists, survival analyses of time to discharge from NYC START, and connection rates with community mental health services.• This study examined the implementation of NYC START, a program that meets patients hospitalized with FEP to offer them a voluntary, 3-month critical time intervention.• Of the 285 clients who accepted NYC START services in 2016, 87% attended an initial mental health appointment after hospital discharge and 78% completed at least 3 months of the program.• The program has been well received by clients, as evidenced by high enrollment rates, with the vast majority of enrollees continuing mental health services before discharge from NYC START.
the patient to offer services to improve linkage to care and transition back into the community.To identify missed opportunities to intervene with young adults with FEP before the first hospitalization, we manually reviewed hospital discharge summaries from 145 NYC START enrollees discharged between January 1 and July 31, 2016. We noted time from behavior change to hospitalization (TBCH), measured from the time when the patient or others reported first noticing behavior suggestive of early psychosis (e.g., withdrawing or talking to self ) to time of admission as a proxy for duration of untreated psychosis (DUP). Because the World Health Organization recommends limiting DUP to less than 90 days (2), we divided the sample into TBCH #90 days versus .90 days. We reviewed 30 discharge summaries to identify common areas of potential missed opportunities, then coded these opportunities as present or absent in the remaining summaries.Of 145 discharge summaries examined, 38 were removed from analysis, 31 (82%) of which indicated psychiatric hospitalization prior to that precipitating NYC START referral, six (16%) indicated lengthy prior outpatient treatment for psychosis, and one (2%) indicated substanceinduced psychosis. Of 107 remaining, there were no statistically significant differences in gender, age, race, or insurance between those with TBCH #90 days (N555) and those with TBCH .90 days (N552). After adjusted logistic regression analysis, we found that discharged patients with declines in educational performance or discontinued education had greater odds of TBCH .90 days compared with those who stayed in school or had completed a degree (odds ratio [OR]5 4.33, 95% confidence interval [CI]51.72-10.87). Those with family or friends noticing behavior changes had greater odds of TBCH .90 days compared with those who did not (OR54.01, 95% CI51.31-12.34). [A table in the online supplement indicates demographic and additional information.]Findings suggest that family and friends often identify behavior changes that constitute the prodromal phase of psychosis. Also, expectedly, FEP may cause major
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