Caught in the “NEET Trap”: The Intersection Between Vocational Inactivity and Disengagement From an Early Intervention Service for Psychosis

Maraj, Anika; Mustafa, Sally; Joober, Ridha; Malla, Ashok; Shah, Jai; Iyer, Srividya N.

doi:10.1176/appi.ps.201800319

Cited by 25 publications

(15 citation statements)

References 29 publications

(37 reference statements)

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“…41 Prior FEP research has similarly reported the presence of a substantial patient subpopulation with poor functioning 2 and pointed to such psychosocial disability being stable, and often beginning early in the illness course and even before the formal onset of psychosis. 13,17,19,42,43 In our study, functional recovery status at randomization (the 2-year mark) continued to be a significant predictor of time spent in functional recovery over the subsequent 3 years. The stability in SOFAS scores, with average scores being around the functional recovery point, and employment/education status between Years 2 and 5 suggests a plateauing of gains in functioning that are well known to occur in the first 2 years after initiation of early intervention.…”

Section: Symptom Remission Functional Recovery and Disabilitysupporting

confidence: 46%

Unfinished business: Functional outcomes in a randomized controlled trial of a three‐year extension of early intervention versus regular care following two years of early intervention for psychosis

Mustafa

Malla

Joober

et al. 2021

Acta Psychiatr Scand

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Objective: To investigate whether first-episode psychosis patients receiving extended early intervention had better functional outcomes than those in regular care and to examine the predictors of functional outcomes.Methods: This is a randomized controlled single-blind trial of 220 patients randomized after 2 years of early intervention to receive early intervention or regular care for the subsequent 3 years. Outcomes included cumulative time in functional recovery during the 3-year trial assessed using the Social and Occupational Functioning Assessment Scale (SOFAS); and employment/education at last assessment which were, respectively, analyzed using multiple linear regression and logistic regression, accounting for well-known predictors. Linear mixed and generalized linear models were also used to examine the course of SOFAS and employment/education over the 3-year period. Results: The extended early intervention and regular care groups did not differ on time in functional recovery (mean = 50.17 weeks, SD = 46.62 vs. mean = 46.18 weeks, SD = 51.54); percent employed/in school (60.4% vs. 68.8%) or change in SOFAS or employment/education status over time. SOFAS scores were stable between years 2 and 5. Individuals with longer periods of total symptom remission experienced significantly longer periods of functional recovery and were likelier to be employed/in school. Those who had completed high school were nine times likelier to be employed/studying. Conclusion:Most individuals maintained functional gains accrued from 2 years of early intervention with no further improvement whether in extended early intervention or regular care. There was a gap between symptomatic and functional recovery, and one-third were unemployed/not in school at year 5. The lack of additional progress even in extended early intervention suggests that specific | 87 MUSTAFA et al.

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Section: Symptom Remission Functional Recovery and Disabilitysupporting

confidence: 46%

Unfinished business: Functional outcomes in a randomized controlled trial of a three‐year extension of early intervention versus regular care following two years of early intervention for psychosis

Mustafa

Malla

Joober

et al. 2021

Acta Psychiatr Scand

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“…Consistent with prior research (Maraj et al, 2019;Maraj, Veru, et al, 2018;Stowkowy et al, 2012), patients were considered disengaged if they had no contact with treating teams for three consecutive months before the completion of treatment, i.e., Month 24. Time to disengagement was recorded as the time from program entry to the first of the three consecutive months of no contact.…”

Section: Service Engagementmentioning

confidence: 84%

Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada

et al. 2020

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Background It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. Methods Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). Results The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = −1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81–0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). Conclusions This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.

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“…We will treat the pandemic indicator variable as a time-varying predictor with a potential change point on survival analysis. We anticipate a disengagement rate of 15%-20% by 9 months, based on prior data from our own program as well as another Canadian EPI program [ 60 ]. This will provide pilot data for future tests of noninferiority of virtual delivery of NAVIGATE compared to in-person NAVIGATE.…”

Section: Methodsmentioning

confidence: 99%

Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study

Tempelaar¹,

Barwick²,

Crawford³

et al. 2021

JMIR Res Protoc

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Background Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. Objective This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. Methods The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. Results Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. Conclusions This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. International Registered Report Identifier (IRRID) DERR1-10.2196/34591

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Caught in the “NEET Trap”: The Intersection Between Vocational Inactivity and Disengagement From an Early Intervention Service for Psychosis

Cited by 25 publications

References 29 publications

Unfinished business: Functional outcomes in a randomized controlled trial of a three‐year extension of early intervention versus regular care following two years of early intervention for psychosis

Unfinished business: Functional outcomes in a randomized controlled trial of a three‐year extension of early intervention versus regular care following two years of early intervention for psychosis

Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada

Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study

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