Harmonizing Clinical Data Collection in Community-Based Treatment Programs for First-Episode Psychosis » Agenda

Dr. Heinssen will describe the early psychosis ecosystem in the United States, which includes both academic research clinics and a growing number of community-based programs that offer Coordinated Specialty Care (CSC) services. He will introduce the Early Psychosis Intervention Network (EPINET) concept, which envisions a national learning healthcare system grounded in the principles of science-based interventions, easy and timely access to services, and a culture of collaborative, person-centered care. EPINET goals, tasks, and timelines will be presented. Subsequent presentations will elaborate on the early course of psychotic disorders, standard measures for first episode psychosis (FEP) clinical assessment, and informatics approaches to support continuous quality improvement and ongoing scientific discovery among CSC clinics.

• Open discussion  

Dr. Seidman will review research evidence and clinical concepts related to the natural history of FEP. These include characteristic clinical features, predictors of illness course, adverse events (e.g., medical/substance use comorbidities, incarceration, suicide behaviors), and key clinical and functional outcomes (e.g., symptomatic remission/relapse, social, educational, and vocational adjustment, quality of life). Dr. Seidman’s presentation will ground subsequent discussions of FEP domains to be addressed in the envisioned learning health care system for early psychosis.

• Discussant – Tara Niendam, Ph.D. (CA)
• Open discussion

Dr. Dixon will describe the Phenotypes and eXposures (PhenX) consensus process, and how this method was applied to select assessment instruments for the PhenX Early Psychosis Clinical Services Collection (EPCSC). She will identify available measures within the domains of psychiatric diagnosis, severity of psychopathology, psychosocial functioning, family characteristics, experience of care, psychosis recovery, and personal wellbeing. Dr. Dixon will discuss gaps in the PhenX EPCSC, anticipated difficulties in implementing standard measures in community CSC programs, and potential strategies for meeting these challenges.

• Discussant –Ted Lutterman and David Shern, Ph.D. (NASMHPD/NRI)
• Open discussion

The purpose of this Think Tank is to determine which FEP domains and associated measures should be included in a “core” assessment battery for CSC programs. The Core Battery is intended to capture key data elements related to FEP course and outcome, as well as components of CSC service delivery. Think Tank participants are asked to (1) identify which domains and data elements are most important for program evaluation and quality improvement purposes, and (2) consider measures present in the PhenX Early Psychosis Clinical Services Collection (EPCSC) and determine which are feasible for community-based CSC programs. Are CSC programs using alternative measures to those available in the EPCSC? For domains not covered in the EPCSC, participants are encouraged to suggest measures that could be implemented in a uniform manner across CSC clinics.

Dr. Srihari will describe how the Specialized Treatment in Early Psychosis (STEP) program models comprehensive early detection and CSC intervention for a 10-town region in southern CT. STEP applies a population health framework to engage a broad network of local stakeholders to improve pathways to and through care. A core set of patient-centered outcomes have been developed to audit and improve performance in STEP, be accountable to local stakeholders, and support translational research. Dr. Cahill will present an informatics platform developed for STEP, which is designed to support dissemination of the population-based approach within a learning healthcare network of other early intervention providers.

• Discussant – Erik Messamore, M.D., Ph.D. (OH)
• Open discussion

The purpose of Think Tank 2 is to explore challenges in implementing standard measures in community CSC programs, as well as possible solutions. Think Tanks participants are asked to consider which staff can administer standard measures, what training do they need, and how much time is required of clinicians to complete assessments? Can client self-report measures be employed more effectively, without imposing undue burden? What practical constraints must be overcome to conduct standardized assessment in community settings? Consider the feasibility of alternative assessment approaches, such as remote centralized assessment or employing a specially trained staff member to administer standard measures and perform data collection duties across multiple CSC clinics.