A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients

Compton, Michael T.; Esterberg, Michelle L.; Druss, Benjamin G.; Walker, Elaine F.; Kaslow, Nadine J.

doi:10.1007/s00127-006-0065-z

Cited by 50 publications

(54 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another study from the current setting revealed that urban African Americans have highly variable pathways to care [10]. These findings indicate various barriers to care which impact DUP, including factors within health services that are difficult to navigate.…”

Section: Discussionmentioning

confidence: 80%

“…Pathways to care likely differ for various populations [9][10][11][12][13]. Given the importance of discovering determinants of DUP, some of which evolve during pathways to care, and in light of the fact that families commonly initiate evaluation and treatment, this study explored narrative accounts of family members who had been actively involved in initial treatment-seeking for their loved ones with first-episode psychosis.…”

Section: Introductionmentioning

confidence: 99%

“…Given the importance of discovering determinants of DUP, some of which evolve during pathways to care, and in light of the fact that families commonly initiate evaluation and treatment, this study explored narrative accounts of family members who had been actively involved in initial treatment-seeking for their loved ones with first-episode psychosis. This study engaged an urban, African American sample, given that the African American population has been understudied with regard to early-course help-seeking for psychosis [10,14].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The period of untreated psychosis before treatment initiation:

Bergner

Leiner

Carter

et al. 2008

Comprehensive Psychiatry

Self Cite

View full text Add to dashboard Cite

Aim-This study employed a qualitative research methodology to explore common themes pertaining to the period of untreated psychosis prior to treatment initiation in hospitalized, urban, African American, first-episode psychosis patients.Methods-Twelve family members of 10 patients were interviewed at length to gather detailed narrative accounts of factors related untreated psychosis and treatment delay. Using qualitative analysis, verbatim transcripts were reviewed by two researchers to identify prominent themes useful for generating future research hypotheses.Results-Four themes emerged as informative of the period of untreated psychosis prior to treatment initiation: (1) misattribution of symptoms or problem behaviors (e.g., depression, drug use, adolescent rebellion), (2) positive symptoms causing unusual or dangerous behaviors that served as a catalyst for initiating treatment, (3) views about personal autonomy of an adult or nearly adult patient, and (4) system-level factors (e.g., unaffordability of healthcare, inefficiency on the part of healthcare providers).Conclusions-Family members encountered numerous barriers when seeking treatment, including their own misattributions, the nature of the patient's symptoms, financial issues, and system-level delays. The themes uncovered in this formative analysis merit further exploration with additional qualitative and quantitative research.

show abstract

Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The period of untreated psychosis before treatment initiation:

Bergner

Leiner

Carter

et al. 2008

Comprehensive Psychiatry

Self Cite

View full text Add to dashboard Cite

show abstract

“…The substance use disorders modules were administered to diagnose substance use disorders. As reported previously (Compton et al, 2006; Compton et al, 2008b) DUP was defined as the number of weeks from the onset of positive psychotic symptoms until first hospital admission, and was measured in a systematic manner using the Symptom Onset in Schizophrenia (SOS; Perkins et al, 2000) inventory, in addition to select items from the semi-structured Course of Onset and Relapse Schedule / Topography of Psychotic Episode (CORS/TOPE; Norman and Malla, 2002) interview. Onset of positive symptoms was operationalized as the date on which hallucinations or delusions met the threshold for a PANSS (Kay et al, 1987) score of ≥3, and systematic methods were used to resolve difficulties in obtaining exact dates for the onset of psychotic symptoms.…”

Section: Methodsmentioning

confidence: 99%

Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients

Compton

Goulding

Gordon

et al. 2009

Schizophrenia Research

Self Cite

View full text Add to dashboard Cite

Background-Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain.Methods-From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazards models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP-mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level.Results-The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP.Conclusions-Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.

show abstract

“…Violent behavior, male gender, experiencing more severe psychosocial stressors, and spending more time in the emergency setting have been found to characterize those patients referred by law enforcement officers to PES compared to other modes of referral, such as referral by health care providers, selfreferral, and other referral sources (Redondo and Currier 2003;Way et al 1993). Furthermore, race/ethnicity and its socioeconomic correlates may play a role in pathways to care, as exemplified by research indicating high rates of police involvement and police referral to psychiatric services for ethnic minorities with psychotic disorders (Bhugra et al 2000;Burnett et al 1999;Commander et al 1999;Compton et al 2006a, Fisher et al 2004Garety and Rigg 2001;Jarvis et al 2005;Morgan et al 2004Morgan et al , 2005a. In recognition of the role that police officers often assume in psychiatric referral and mental health crisis situations, as well as the widespread problem of criminalization of people with mental illnesses, many law enforcement agencies have implemented crisis intervention programs in collaboration with community partners.…”

Section: Introductionmentioning

confidence: 98%

Characteristics of Patients Referred to Psychiatric Emergency Services by Crisis Intervention Team Police Officers

Broussard

McGriff

Neubert

et al. 2010

Community Ment Health J

Self Cite

View full text Add to dashboard Cite

The Crisis Intervention Team (CIT) program trains police officers in crisis intervention skills and local psychiatric resources. Because the safety and appropriateness of any new intervention is a crucial consideration, it is necessary to ensure that CIT training does not result in excessive or inappropriate referrals to psychiatric emergency services (PES). Yet, aside from one prior report by Strauss et al. (2005) in Louisville, Kentucky, little is known about the comparability of patients referred to PES by CIT-trained officers in relation to other modes of referral. The research questions driving this retrospective chart review of patients referred to PES were: (1) What types of patients do CIT-trained officers refer to PES?, and (2) Do meaningful differences exist between patients referred by family members, non-CIT officers, and CIT-trained officers? Select sociodemographic and clinical variables were abstracted from the medical records of 300 patients during an eight-month period and compared by mode of referral. Differences across the three groups were found regarding: race, whether or not the patient was held on the locked observation unit, severe agitation, recent substance abuse, global functioning, and unkempt or bizarre appearance. However, there were virtually no differences between patients referred by CIT-trained and non-CIT officers. Thus, while there were some expected differences between patients referred by law enforcement and those referred by family members, CIT-trained officers appear to refer individuals appropriately to PES, as evidenced by such patients differing little from those referred by traditional, non-CIT police officers. Trained officers do not have a narrower view of people in need of emergency services (i.e., bringing in more severely ill individuals), and they do not have a broader view (i.e., bringing in those not in need of emergency services). Although CIT training does not appear to affect the type of individuals referred to PES, future research should examine the effect of CIT training on the frequency of referrals or proportion of subjects encountered that are referred, which may be expected to differ between CIT-trained and non-CIT officers.

show abstract

A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients

Cited by 50 publications

References 38 publications

The period of untreated psychosis before treatment initiation:

The period of untreated psychosis before treatment initiation:

Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients

Characteristics of Patients Referred to Psychiatric Emergency Services by Crisis Intervention Team Police Officers

Contact Info

Product

Resources

About