January 2023

Updates from the EPINET-TX State Hub

Lessons from EPINET-TX

The research article highlighted this month emphasizes the important role that families can play in supporting individuals in CSC care and identifying early warning signs of relapse. Let's explore family involvement through our EPINET-TX data and examine some "lessons learned" to date.

  • The vast majority of individuals in care have daily involvement with their family - 89.7%.
  • The majority of individuals in care prefer family involvement with no restrictions - 59.6%. Only 15.4% prefer no family involvement in care. Only 5.3% of families refuse to participate in treatment.
  • In 30.0% of non-baseline assessments (6-, 12-, or 18-month), families received at least one family service in the previous six months.

The graph below presents the most frequent family services provided at follow-up (N=54). Currently, attendance at family groups is the lowest service, which represents an area of future development for many CSC teams.

Family Involvement

Research Highlights

Psychotic relapses from the perspective of patients and family members 

da Silva, A. H. S., Peixoto, L. E., Martin, I. D. S., Galera, S. A. F., Vedana, K. G. G., de Freitas, L. A., & Zanetti, A. C. G. (2022). Psychotic relapses from the perspective of patients and family members. Archives of psychiatric nursing41, 300–305. https://doi.org/10.1016/j.apnu.2022.09.012. Access the article.

Family laughing

Background: Many studies have demonstrated the high rates of relapse after first-episode psychosis (FEP). Additionally, individuals who frequently relapse may have an increased risk of resistance to antipsychotic treatment and lower functional recovery. There is a lack of research on how young persons and their families experience early signs of relapse and their understanding of predictors or early signs. This study evaluated the perceptions of individuals with psychotic disorders and their relatives on psychotic relapses.

Methods: This qualitative study was conducted using semi-structured interviews with 10 dyads of individuals-family members undergoing outpatient treatment for psychosis. Interviews were conducted from April to August 2019 in Brazil and were analyzed using thematic analysis.

Findings:  Four main themes were identified including: (1) defining and describing psychotic relapses; (2) risk factors for relapse; (3) protective factors for relapse; and (4) early warning signs: identification of an episode of relapse. Although individuals are able to recognize changes that precede a relapse episode, some may not be able to recognize early warning signs (EWS) alone. Family is a crucial component in aiding the identification of pre-relapse signs and engaging in help-seeking behaviors, though family members reported limited confidence in preventing, recognizing and managing relapse.

Implications for Practice

  • Psychotic relapses can be traumatic experiences that trigger fear, anxiety and hopelessness in family members. Health professionals need to be able to recognize and validate these feelings in order to support the individual's and family's emotional needs.
  • Familial education can focus on increasing family members' confidence in how to support a young person during relapse.
  • Providers should educate individuals and their families on the broader understanding of early warning signs (EWS), even less specific signs, in order to promote symptom self-monitoring and early recognition before a relapse episode occurs.
  • Providers should explore individual and family perceptions and knowledge surrounding medication usage, continued usage, and the use of pharmacological therapy to further understand potential reasons for discontinuation of medication use.

New Grant Opportunity!

SAMHSA Releases Notice of Funding Opportunity for Clinical High Risk

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a new grant opportunity. The purpose of this program is to provide trauma-informed, evidence-based interventions to youth and young adults (not more than 25 years of age) who are at clinical high risk for psychosis. Award recipients are expected to use evidence-based intervention to: 1) improve symptomatic and behavioral functioning; (2) enable youth and young adults to resume age-appropriate social, academic, and/or vocational activities; (3) delay or prevent the onset of psychosis; and (4) minimize the duration of untreated psychosis for those who develop psychotic symptoms. Currently, Integral Care, the Center for Health Care Services, and The Harris Center hold one of these grants.

Grant: Up to $400,000 annually for 4 years

Due Date: March 14, 2023

Learn More

Upcoming Events and Training Opportunities

Case Conceptualization for First Episode Psychosis Series 2: Session 1: Culturally Informed Therapy for Schizophrenia

Attendees will learn how case conceptualization can inform team-based, recovery-oriented care and the foundations of three different approaches: Next up is a 3-part focus on Culturally Informed Therapy for Schizophrenia.

February 9 at 10:00 - 11:00 AM CST | Zoom Registration

Southwestern MHTTC: Healing and Transformation Learning Academy

Join led by Mx. Yaffa, a renowned leader in peer support, equity, and justice work for a four-month healing and transformation learning academy where you will be in a small cohort of other peer support specialists. The academy will provide instrumental skill-building opportunities as well as a space for support as you move through your transformation journey during the four months. Stipend available for selected participants.

Must apply by February 13 |Apply Here

Contact jessi.davis@austin.utexas.edu with any questions.

First Episode Psychosis (FEP) Provider Well-Being Community Calls

The purpose of the virtual FEP Provider Well-Being Community Calls is for FEP providers to provide

mutual aid to one another by discussing shared experiences, offering empathy, and facilitating change. Community calls will be structured to include one skill-based practice (e.g. mindfulness, compassion), discussion about relevant topics, and resource sharing.

February 16 at 10:00 - 11:00 AM CST | Zoom Registration

Social Determinants of Health for Psychotic Disorders: Why Are They Important and How to Assess Them?

Dilip V. Jeste, MD, will discuss the literature on SDoH for schizophrenia-spectrum disorders, such as early-life adversities, social connections, racism and other forms of discrimination, etc. He will briefly discuss their clinical impact, assessment measures, relationship with biology, and possible interventions to address them.

February 24 at 11:30 AM - 1:00 PM EST | Zoom Registration

2023 Texas Mental Health Creative Arts Contest

The contest aims to raise awareness of mental health experiences, challenge stigma, and provide an opportunity to express complex emotions through creative outlets. Participants may enter by submitting original, creative works in one of three categories (original artwork, writing, or photography), that draws on the contest theme “Why Does Mental Health Matter to You?” The contest is open to Texans of all ages and is judged in four age groups—elementary school, middle school, high school, and adult—across each of the three categories.

Deadline March 10th, 2023. | Enter Here

Education, Special Education, and Accommodations for Students with Psychosis: Working with Youth, Families, Teachers, and Schools

In this webinar, clinical psychologist Dr. Jason Schiffman will provide information and tangible suggestions on how to effectively work with schools, families, and students on behalf of high school students with psychosis.

March 29 at 10:00 AM - 1:00 AM CST | Register

Treating Youth with Early Psychosis and Trauma Related Disorders

Dr. Casey Cragin reviews treatment approaches and clinical guidelines for clients experiencing comorbid psychosis and trauma-related disorders. Resources are shared. This event was sponsored by the New England Mental Health Technology Transfer Center Network. Original air date: October 21, 2022 | View the recording here.

Massachusetts Strategic Plan for Early Psychosis (Mass-STEP)

Awareness, Access, and Action for Psychosis Interventions in MA.

Spotlighting community efforts that support individuals and families experiencing psychosis.

Original air date October 31 - November 1 | View the recordings here.