October 11, 2022

Updates from the EPINET-TX State Hub

Lessons from EPINET-TX

The shared measurement within EPINET-TX allows for the examination of data across the 15 participating CSC programs. Let's examine some of the outcomes that are reflected in the initial outcomes of participants between program entry and the first six months of treatment.

Hospital Stays: Individuals experiencing their first episode of psychosis may be treated within a psychiatric hospital, which is sometimes the pathway to accessing coordinated specialty care. Examination of a sample of EPINET-TX participants with data on hospitalizations at program entry and their first six months in care found that over half of all participants had experienced a hospital stay prior to CSC entry. Only one in four participants experienced a hospital stay during the same time frame after entry. The average number of hospital nights were reduced from 7.27 nights at program entry to 2.34 nights at six months after entry. A reduction in hospital nights results in cost savings and fewer disruptions to school, employment, and life.

Mental Health Symptoms: Individuals used the Colorado Symptom Index to report on 14 different mental health symptoms that they experience at program entry and six months in care. Initial reviews of the data show a reduction in symptoms of an average of 3.96 points in the first six months. The average score at six months of 19.73 remains elevated, representing about the 80th percentile in a peer sample, but is a significant decline from baseline.

Research Highlights

Pathways to Care for Black Americans with Early Psychosis

Oluwoye, O., Davis, B., Kuhney, F. S., & Anglin, D. M. (2021). Systematic review of pathways to care in the US for Black individuals with early psychosis. Schizophrenia, 7,(1), 1-10. Access the article.

Summary: The series of contacts that individuals have as they become connected to Coordinated Specialty Care (CSC) has been termed the "pathway to care." While research has shown that CSC programs perform poorer at engaging Black youth and Black youth have worse outcomes than white youth, little research has examined the pathways to care for this population. This paper reviewed 28 peer-reviewed articles studying racial differences in the duration of untreated psychosis (DUP) or the help-seeking experiences of Black youth and families on the way to CSC. The review noted that Black youth have higher rates of trauma and substance use prior to entering CSC. A number of barriers were identified in help-seeking across studies, including finances/insurance, inflexible appointment times, and inefficient treatment initiation processes. Importantly, Black youth were less likely to seek outpatient mental health services and more likely to use emergency services. Incarceration, substance use, neighborhood disorder, and family involvement were associated with longer DUP.  

Implications for Practice

  • Black youth experience specific barriers to engagement in CSC and may be more likely to access through emergency services, psychiatric hospitals or law enforcement.
  • Flexibility in scheduling and efficient protocols for intake are important in engaging Black youth.
  • The experience of trauma, including racialized trauma, and substance use may be more common for Black youth and put them at greater risk for early psychosis.
  • Activities to reduce stigma and identify signs of psychosis in the Black community can reduce the duration of untreated psychosis.
  • Efforts to address social determinants of health, such as financial stress, neighborhood chaos, and access to insurance, can reduce the inequities experienced by Black youth.

Limitations: This review identified studies from a small group of sites. Many of the studies were from the Georgia mental health care system and focused on low income Black youth. Further research should explore a greater diversity of Black youth with early psychosis, such as socioeconomic and geographic differences. The results of this study may not be generalizable to Texas and specific research about racial disparities in pathways to care in Texas is needed.

Spotlight on Community Healthcore!

Interview with Rene Scherer

What has been happening at Community Healthcore's CSC program?

The team at Community Healthcore in Longview, TX hit the road (and the gym) with CSC participants to break out of the isolation that the pandemic has caused for many. The team took young people to experience a variety of activities - from yoga to painting to the Fort Worth Zoo. These outings gave individuals an opportunity to socialize with each other, practice communication skills, and learn new things about others.

What would you recommend to others who want to replicate this?

I would certainly recommend trips and events to other CSC programs! This not only had an impact on our clients but the families as well, and it helped to strengthen the therapeutic relationships between clients and staff. Our therapeutic alliance is stronger than ever. Lessons we would pass along would be to ensure there is sufficient staff coverage to meet needs. We were able to attend events with the additional support of interns. Typically we would have 19 clients at each even, with 1 staff person to every 4 clients. Clients were also paired up in a buddy system and responsible for each other. Clients who needed more support had 1 staff person to themselves. I would also suggest working closely with administrative staff. It was helpful to work alongside our upper management to be able to create liability waivers, discuss concerns, and find solutions in order to make these events happen. And now other programs within the LMHA are inspired as well!

Upcoming Events and Training Opportunities

Case Conceptualization for First Episode Psychosis

This series will introduce CSC teams to three different case conceptualization approaches. The series will include both didactic and experiential components. Hosted by the South Southwest MHTTC on the second Thursday of each month.

Starting October 13 at 10:00 - 11:00 am CST | Register

Treating Youth with Early Psychosis and Trauma-Related Disorders

During this webinar, Dr. Cragin will review treatment approaches and clinical guidelines for clients experiencing comorbid psychosis and trauma-related disorders. Hosted by the New England MHTTC.

October 21 at 10:30 am - 12:00 pm CST | Register

First Episode Psychosis Peer and Family Partner Mentoring Calls

Join your colleagues in US Region 6 to discuss topics of interest to CSC teams and have an opportunity for casual conversation and networking. Hosted by the South Southwest MHTTC.

November 7 at 9:00 - 10:00 am CST | Learn more

ISPS - US National Conference: Opportunity Through Experience

The 2022 ISPS-US conference is scheduled to be held in Sacramento, California. People with lived experience, family members, clinicians and researchers/ Featured keynote speakers include Celia Brown, Carlos Padron, and Dr. Lionel Corbett.

November 4-6 | Learn more

Texas Early Psychosis Consortium

The quarterly meeting of the Texas Early Psychosis Consortium will be held on December 2nd. We look forward to our on-going discussion of early psychosis care in Texas.

December 2 at 1:00 - 3:00 pm CST

EPINET-TX Workgroups

We are starting a series of workgroups focused on improving the care in Texas CSC programs. Initial workgroups will focus on Outreach and Rural CSCs. Join your colleagues in examining opportunities for shared learning and growth!  Download the flyer to learn more!

Outreach Workgroup: Starting November 1 at 1:00 - 2:00 pm CST | Join Zoom

Rural Workgroup: Starting November 15 at 1:00 - 2:00 pm CST | Join Zoom