LAUSR

Abstract Background The early years following a first episode of psychosis (FEP) present unique opportunities to prevent declines in clinical and social function. Early intervention programs target factors known to be associated with poor long-term outcomes, including longer duration of untreated psychosis, treatment non-adherence, affective symptoms, and cognitive dysfunction. The RAISE trial and other work in the U.S. and internationally spurred congress to fund comprehensive specialty care (CSC) programming across the US through a SAMHSA block-grant set-aside that began in 2015 and was doubled in 2016. As a Pennsylvania recipient of these funds since 2015, the Penn Psychosis Evaluation and Recovery Center (PERC) enrolls individuals age 15–34 who have experienced psychosis onset within two years prior to enrollment. We received complementary funding in 2018 to provide step-down care to FEP participants, and to expand PERC services to individuals at clinical high risk for psychosis. Methods PERC services, offered for a minimum of two years, include pharmacotherapy, recovery oriented cognitive therapy and case management, supported employment and education, multi-family group cognitive therapy and psycho-education, peer support, and cognitive remediation. SAMHSA funds are used to provide CSC elements that cannot be supported through available insurance coverage. A comprehensive computerized assessment, conducted at admission and at 6-, 12-, 18- and 24- month follow-up intervals, includes measures from the Pennsylvania FEP Program Evaluation core battery assessing participant-level outcomes (employment and education, hospitalization, criminal justice involvement and risk behaviors, and overall functioning and clinical symptoms), complemented by standardized measures of cognitive insight, sleep quality, and other relevant domains. Systems-level data on outreach efforts, incoming and outgoing referrals, admissions and discharges are also collected. Data collection is integrated into clinical care. Results To date, PERC has enrolled 202 individuals (mean age=22.2, SD=4.4; 78% male; 56% European-American, 31% African-American, 13% other), of whom 106 consented to use of clinical data for research purposes. Admission and 6- month follow-up data reflect improved psychosis and mood symptoms, increased engagement in employment or school, and low re-hospitalization rates. Clinician rated global role and social function significantly increased by 6-month follow-up. Participants self-reported significantly increased satisfaction with mental health services and improved perception of their recovery process at 6-month follow-up. Duration of untreated psychosis prior to PERC admission (mean=7.4 months, SD=7.4) was not correlated with improvements in global role or social function at 6-months. Clinical and functional changes beyond 6 months remain to be analyzed. Discussion Our results add to growing evidence that individuals who have experienced a first episode of psychosis benefit from participating in comprehensive interventions that can improve clinical symptoms, function and quality of life. They also provide further evidence of the feasibility and clinical utility of FEP CSC programs supported by federally mandated funds, which can reduce the personal and societal burdens associated with psychotic disorders. As our program continues to expand, ongoing comprehensive assessment across the early psychosis spectrum will afford evaluation of longer-term therapeutic benefits and analyses of predictors of varying outcomes.