Disengagement Processes Within an Early Intervention Service for First-Episode Psychosis: A Longitudinal, Qualitative, Multi-Perspective Study

Tindall, Rachel; Simmons, Magenta; Allott, Kelly; Hamilton, Bridget

doi:10.3389/fpsyt.2020.00565

Cited by 6 publications

(12 citation statements)

References 24 publications

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“…The setting and atmosphere of the treatment program and the willingness/ ability of staff to meet participants in the community are also important elements. 11,12 In this context, the Headspace community centers are having an impact far beyond Australia and may prove to be a particularly good model. 13…”

Section: Mdedgecom/psychiatrymentioning

confidence: 99%

“…Still, substantial evidence indicates that outreach, long-acting injectable antipsychotics, early consideration of clozapine, family therapy, CBT for psychosis/attenuated psychosis, and services focused on competitive employment can preserve social and occupational functioning. 16,34 Until these broader questions are more definitively addressed, it seems reasonable to apply what we have learned (Table, 11,12,35,[37][38][39]46 page 29).…”

Section: A Strength-based Approachmentioning

confidence: 99%

“…Simply avoiding the most divisive aspects of the medical model that inadvertently promote stigma and undercut selfconfidence may help maintain patients' willingness to learn how best to apply their strengths and manage their limitations. 11 The progression to enduring psychotic features (eg, fixed delusions) may reflect ongoing social isolation and alienation. A strength-based approach seeks first to establish common goals (eg, school, work, friends, family support, housing, leaving home) and then works to empower the patient to successfully reach those goals.…”

Section: A Strength-based Approachmentioning

confidence: 99%

“…They both deviate markedly from the standard medical model by including psychosocial services designed to promote restoration of a self-defined trajectory to greater independence. [11][12][13][14] The 2 differ, however, in the challenges they must overcome to produce their sample populations and establish effective interventions. 10,15,16 In this article, we provide a succinct overview of these issues and a set of recommendations based on a "strength-based" approach.…”

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confidence: 99%

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Early interventions for psychosis

Goldman¹

2021

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Hence, evidence that a longer duration of untreated psychosis (DUP) aggravates-and early intervention with medication and social supports ameliorates-the long-term adverse consequences of psychotic disorders generated a great deal of interest. 3,4 This knowledge led to the development of diverse early intervention services worldwide aimed at this putative "critical window." It raised the possibility that appropriate interventions could prevent the long-term disability that makes chronic psychosis one of the most debilitating disorders. 5,6 However, even beyond the varied cultural and economic confounds, it is difficult to assess, compare, and optimize program effectiveness. 7 Obstacles include paucity of sufficiently powered, well-designed randomized controlled trials (RCTs), the absence of diagnostic biomarkers or other prognostic indicators to better account for the inherent heterogeneity in the population and associated outcomes, and the absence of modifiable risk factors that can guide interventions and provide intermediate outcomes. 4,[8][9][10] To better appreciate these issues, it is important to distinguish whether a program is designed to prevent psychosis, or to mitigate the effects of psychosis. Two models include the:• Prevention model, which focuses on young individuals who are not yet overtly psychotic but at high risk • First-episode recovery model, which focuses on those who have experienced a first episode of psychosis (FEP) but have not yet developed a chronic disorder. Early interventions for psychosis

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Section: Mdedgecom/psychiatrymentioning

confidence: 99%

Section: A Strength-based Approachmentioning

confidence: 99%

Section: A Strength-based Approachmentioning

confidence: 99%

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confidence: 99%

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Early interventions for psychosis

Goldman¹

2021

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“…International qualitative research, chiefly from Australia, the United Kingdom and the United States, has highlighted transition to and from EIPS at service entry and service discharge can be a challenging time [11][12][13][14][15][16][17][18]. However, there remains a paucity of Australian qualitative research that explores how YP and their SP experience EIPS support across all stages of their journey through the service.…”

Section: Introductionmentioning

confidence: 99%

Experiences of service transitions in Australian early intervention psychosis services: a qualitative study with young people and their supporters

Milton

Powell²,

Conn

et al. 2022

BMC Psychiatry

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Background Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed. Methods Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion. Results The analysis identified four major service-related transitions in a YP’s journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services. Conclusion Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.

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