Essential Evidence-Based Components of First-Episode Psychosis Services

Abstract

OBJECTIVE The purpose of this study was to identify essential evidence-based components of first-episode psychosis services. METHODS The study was conducted in two stages. In the first stage a systematic review of both peer-reviewed and gray literature (January 1980 to April 2010) was conducted. Databases searched included MEDLINE, PsycINFO, and EMBASE. In the second stage, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential. RESULTS The review identified 1,020 citations; abstracts were reviewed for relevance. A total of 280 peer-reviewed articles met criteria for relevance. Two researchers independently reviewed these articles and identified 75 unique service components. Each component was assigned a level of supporting evidence. Twenty-seven experts completed the first Delphi round, of whom 23 participated in the second. Consensus was achieved in two rounds, with 32 components rated as essential. CONCLUSIONS The two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form a foundation for developing a fidelity scale for such services. It may also be helpful to funders and providers as a summary of essential services.

Essential components of early intervention programs for psychosis: Available intervention services in the United States

“…Of the 31 programs identified and interviewed, most reported using a majority of the 32 essential components identified by D.E. Addington et al (2013). The most prevalent components were individual psychoeducation and outcomes tracking, suggesting that programs are striving to improve individuals' understanding of their emerging disorders and make a measureable impact on observable outcomes.…”

“…We developed a semi-structured interview guide (available from the first author) with items asking about the 32 essential practices outlined by Addington et al (2013), program characteristics (i.e. location, number of sites), and program eligibility criteria.…”

“…Pre-defined categories were generated from the list of 32 essential evidence-based components and program characteristics (Addington et al, 2013). All transcripts were coded for the presence or absence of the pre-defined categories by at least two independent coders (all doctoral students in clinical psychology), who then came to consensus.…”

“…Addington et al (2013), including medication management, individual therapy, and family therapy, which emerged in more than half of transcripts.…”

“…This list of 32 components (Addington et al, 2013) has the capacity to act as a comprehensive starting point for a previously unexamined area. Moreover, as the list was derived from an empirically-sound, systematic literature review and consensus process with early psychosis experts, this study may inform the gap between research and practice that is occurring within U.S. early intervention programs.…”