Abstract
Coordinated Specialty Care (CSC) is a multidisciplinary team approach to providing care for young and emerging adults having their first episode of psychosis. CSC programs have expanded rapidly throughout the United States going from 12 programs in 2008 to over 160 programs a decade later. The purpose of this historical review is to document the process and conditions that led to the accelerated dissemination of these programs across the country. CSC models began in the US in the early 2000s, but nationwide expansion followed the 2008 Recovery After an Initial Schizophrenia Episode trial. As programs have grown, debates have risen about fidelity to CSC models. The challenges facing CSC programs today include lack of evidence on what are the core components of CSC and how fidelity monitoring relates to positive client outcomes.
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23 February 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10597-022-00954-6
References
Addington, D., Birchwood, M., Jones, P., Killackey, E., McDaid, D., Melau, M., Mizuno, M., Mueser, K., & Nordentoft, M. (2018). Fidelity scales and performance measures to support implementation and quality assurance for first episode psychosis services. Early Intervention in Psychiatry, 12(6), 1235–1242. https://doi.org/10.1111/eip.12684
Addington, D. E., McKenzie, E., Norman, R., Wang, J., & Bond, G. R. (2013). Essential evidence-based components of first-episode psychosis services. Psychiatric Services, 64(5), 452–457. https://doi.org/10.1176/appi.ps.201200156
Addington, D. E., Norman, R., Bond, G. R., Sale, T., Melton, R., McKenzie, E., & Wang, J. (2016). Development and testing of the first-episode psychosis services fidelity scale. Psychiatric Services, 67(9), 1023–1025. https://doi.org/10.1176/appi.ps.201500398
Anderson, K. K., Norman, R., MacDougall, A., Edwards, J., Palaniyappan, L., Lau, C., & Kurdyak, P. (2018). Effectiveness of Early Psychosis Intervention: Comparison of Service Users and Nonusers in Population-Based Health Administrative Data. The American Journal of Psychiatry, 175(5), 443–452. https://doi.org/10.1176/appi.ajp.2017.17050480
Azrin, S. T., Goldstein, A. B., & Heinssen, R. K. (2016). Expansion of coordinated specialty care for first episode psychosis in the US. Pathways. Retrieved March 24, 2020, from fhttps://www.pathwaysrtc.pdx.edu/focal-point-S1603.
Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, 09(01), 65–70. https://doi.org/10.1055/s-0038-1637943
Behan, C., Masterson, S., & Clarke, M. (2016). Systematic review of the evidence for service models delivering early intervention in psychosis outside the stand-alone centre. Early Intervention in Psychiatry, 11(1), 3–13. https://doi.org/10.1111/eip.12334
Bello, I., Lee, R., Malinovsky, I., Watkins, L., Nossel, I., Smith, T., Ngo, H., Birnbaum, M., Marino, L., Sederer, L. I., Radigan, M., Gu, G., Essock, S., & Dixon, L. B. (2017). OnTrackNY: The development of a coordinated specialty care program for individuals experiencing early psychosis. Psychiatric Services. https://doi.org/10.1176/appi.ps.201600512
Breitborde, N. J. K., Bell, E. K., Dawley, D., Woolverton, C., Ceaser, A., Waters, A. C., Dawson, S. C., Bismark, A. W., Polsinelli, A. J., Bartolomeo, L., Simmons, J., Bernstein, B., & Harrison-Monroe, P. (2015). The Early Psychosis Intervention Center (EPICENTER): Development and six-month outcomes of an American first-episode psychosis clinical service. BMC Psychiatry, 15(1), 1–11. https://doi.org/10.1186/s12888-015-0650-3
Breitborde, N. J. K., & Moe, A. M. (2017). Early Intervention in Psychosis in the United States: From Science to Policy Reform. Policy Insights from the Behavioral and Brain Sciences, 4(1), 79–87. https://doi.org/10.1177/2372732216683965
Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., Craig, T. J., Nordentoft, M., Srihari, V. H., Guloksuz, S., Hui, C. L. M., Chen, E. Y. H., Valencia, M., Juarez, F., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., … Kane, J. M. (2018). Comparison of early intervention services vs treatment as usual for early-phase psychosis. JAMA Psychiatry, 75(6), 555. https://doi.org/10.1001/jamapsychiatry.2018.0623
Csillag, C., Nordentoft, M., Mizuno, M., Jones, P. B., Killackey, E., Taylor, M., Chen, E., Kane, J., & McDaid, D. (2016). Early intervention services in psychosis: From evidence to wide implementation. Early Intervention in Psychiatry, 10(6), 540–546. https://doi.org/10.1111/eip.12279
De Maio, M., Graham, P., Vaughan, D., Haber, L., & Madonick, S. (2015). Review of international early psychosis programmes and a model to overcome unique challenges to the treatment of early psychosis in the United States. Early Intervention in Psychiatry, 9(1), 1–11. https://doi.org/10.1111/eip.12132
Dixon, L. (2017). What it will take to make coordinated specialty care available to anyone experiencing early Schizophrenia. JAMA Psychiatry, 74(1), 7. https://doi.org/10.1001/jamapsychiatry.2016.2665
Dixon, L. B., Goldman, H. H., Bennett, M. E., Wang, Y., McNamara, K. A., Mendon, S. J., Goldstein, A. B., Choi, C.-W.J., Lee, R. J., Lieberman, J. A., & Essock, S. M. (2015). Implementing coordinated specialty care for early psychosis: The RAISE Connection Program. Psychiatric Services, 66(7), 691–698. https://doi.org/10.1176/appi.ps.201400281
Dixon, L., Jones, N., Loewy, R., Perkins, D., Sale, T., Huggins, W., & Hamilton, C. (2019). Recommendations and challenges of the clinical services panel of the PhenX early psychosis working group. Psychiatric Services, 70(6), 514–517. https://doi.org/10.1176/appi.ps.201800585
Early Assessment and Support Alliance [EASA]. (2013). Practice guidelines for Oregon early assessment and support alliance (EASA). Retrieved from https://easacommunity.org/PDF/EASA-practice-guidelines-2013.pdf.
Essock, S. M., & Addington, D. E. (2018). Coordinated specialty care for people with first episode psychosis: Assessing fidelity to the model [Issue Brief]. Retrieved from https://www.nasmhpd.org/sites/default/files/Issue_Brief_Fidelity.pdf.
Essock, S. M., Goldman, H. H., Hogan, M. F., Hepburn, B. M., Sederer, L. I., & Dixon, L. B. (2015). State partnerships for first-episode psychosis services. Psychiatric Services, 66(7), 671–673. https://doi.org/10.1176/appi.ps.201400117
Funnell, S. C., & Rogers, P. J. (2011). Purposeful program theory: Effective use of theories of change and logic models. Jossey-Bass. Retrieved from http://proxygw.wrlc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=357492&site=ehost-live&scope=site&authtype=ip,uid&custid=s8987071.
Haynes, A., Brennan, S., Redman, S., Williamson, A., Gallego, G., & Butow, P. (2015). Figuring out fidelity: A worked example of the methods used to identify, critique and revise the essential elements of a contextualised intervention in health policy agencies. Implementation Science, 11, 1–18. https://doi.org/10.1186/s13012-016-0378-6
Henry, L. P., Amminger, G. P., Harris, M. G., Yuen, H. P., Harrigan, S. M., Prosser, A. L., Schwartz, O. S., Farrelly, S. E., Herrman, H., Jackson, H. J., & McGorry, P. D. (2010). The EPPIC follow-up study of first-episode psychosis: Longer-term clinical and functional outcome 7 years after index admission. The Journal of Clinical Psychiatry, 71(6), 716. https://doi.org/10.4088/JCP.08m04846yel
Hetrick, S. E., O’Connor, D. A., Stavely, H., Hughes, F., Pennell, K., Killackey, E., & McGorry, P. D. (2018). Development of an implementation guide to facilitate the roll-out of early intervention services for psychosis. Early Intervention in Psychiatry, 12(6), 1100–1111. https://doi.org/10.1111/eip.12420
Jones, N., Gius, B., Daley, T., George, P., Rosenblatt, A., & Shern, D. (2020). Coordinated specialty care discharge, transition, and step-down policies, practices, and concerns: staff and client perspectives. Psychiatric Services. https://doi.org/10.1176/appi.ps.201900514
Jones, P. B., Radhakrishnan, M., & McCrone, P., Lafortune, L., Everard, L., Fowler, D., Amos, T., Freemantle, N., Singh, S. P., Marshall, M., Sharma, V., & Birchwood, M. . (2016). Cost-effectiveness of Fidelity in early intervention for psychosis: How good is good? [Symposium Abstract]. Early Intervention in Psychiatry, 10(7), 12395. https://doi.org/10.1111/eip.12395
Kane, J. M., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L., Rosenheck, R. A., Addington, J., Brunette, M. F., Correll, C. U., Estroff, S. E., Marcy, P., Robinson, J., Meyer-Kalos, P. S., Gottlieb, J. D., Glynn, S. M., Lynde, D. W., Pipes, R., Kurian, B. T., Miller, A. L., … Heinssen, R. K. (2016). Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. American Journal of Psychiatry, 173(4), 362–372. https://doi.org/10.1176/appi.ajp.2015.15050632
Kline, E., & Keshavan, M. (2017). Innovations in first episode psychosis interventions: The case for a “RAISE-Plus” approach. Schizophrenia Research, 182, 2–3. https://doi.org/10.1016/j.schres.2017.03.035
Lynch, S., McFarlane, W. R., Joly, B., Adelsheim, S., Auther, A., Cornblatt, B. A., Migliorati, M., Ragland, J. D., Sale, T., Spring, E., Calkins, R., Carter, C. S., Jaynes, R., Taylor, S. F., & Downing, D. (2016). Early detection, intervention, and prevention of psychosis program: Community outreach and early identification at six US sites. Psychiatric Services, 67(5), 510–516. https://doi.org/10.1176/appi.ps.201300236
McGorry, P. D., Edwards, J., Mihalopoulos, C., Harrigan, S. M., & Jackson, H. J. (1996). EPPIC: An evolving system of early detection and optimal management. Schizophrenia Bulletin, 22(2), 305–326. https://doi.org/10.1093/schbul/22.2.305
Melton, R., Blajeski, S., & Glasser, D. (2020). Understanding individual and family experiences associated with DUP: Lessons from the Early Assessment and Support Alliance (EASA) Program in Oregon. Community Mental Health Journal. https://doi.org/10.1007/s10597-020-00599-3
Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. https://doi.org/10.1258/jrsm.2011.110180
Mueser, K. T., Meyer-Kalos, P. S., Glynn, S. M., Lynde, D. W., Robinson, D. G., Gingerich, S., Penn, D. L., Cather, C., Gottlieb, J. D., Marcy, P., Wiseman, J. L., Potretzke, S., Brunette, M. F., Schooler, N. R., Addington, J., Rosenheck, R. A., Estroff, S. E., & Kane, J. M. (2019). Implementation and fidelity assessment of the NAVIGATE treatment program for first episode psychosis in a multi-site study. Schizophrenia Research, 204, 271–281. https://doi.org/10.1016/j.schres.2018.08.015
National Associaton of State Mental Health Program Directors [NASMHPD]. (2015). An inventory & environmental scan of evidence-based practices for treating persons with early stages of serious mental disorders. Retrieved from https://www.nasmhpd.org/sites/default/files/Task%2012_Inventory_Environmental%20Scan_0.pdf.
National Association of State Mental Health Program Directors [NASMHPD]. (2018). Snapshot of state plans for using the community mental health block grant 10 percent set-aside to address first episode psychosis. Retrieved from https://www.nasmhpd.org/sites/default/files/Snapshot_of_State_Plans.pdf.
Niendam, T. A., Sardo, A., Savill, M., Patel, P., Xing, G., Loewy, R. L., Dewa, C. S., & Melnikow, J. (2019). The rise of early psychosis care in California: An overview of community and university-based services. Psychiatric Services, 70(6), 480–487. https://doi.org/10.1176/appi.ps.201800394
NRI. (2016). Snapshot of State Plans for Using the Community Mental Health Block Grant (MHBG) Ten Percent Set-Aside for Early Intervention Programs. Retrieved from http://www.nri-inc.org/our-work/nri-reports/fy201617-snapshot-of-state-plans-for-using-the-community-mental-health-block-grant-mhbg-ten-percent-set-aside-for-early-intervention-programs/.
Oluwoye, O., Reneau, H., Stokes, B., Daughtry, R., Venuto, E., Sunbury, T., Hong, G., Lucenko, B., Stiles, B., McPherson, S. M., Kopelovich, S., Monroe-Devita, M., & McDonell, M. G. (2019). Preliminary evaluation of Washington State’s early intervention program for first-episode psychosis. Psychiatric Services. https://doi.org/10.1176/appi.ps.201900199
Perkins, D. O., Gu, H., Boteva, K., & Lieberman, J. A. (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: A critical review and meta-analysis. The American Journal of Psychiatry, 162(10), 1785–1804. https://doi.org/10.1176/appi.ajp.162.10.1785
Pollard, J., & Hoge, M. (2017). Workforce development in coordinated specialty care programs [Issue Brief]. NRI. Retrieved from http://nri-inc.org/media/1591/nri_workforce_development_csc.pdf.
Pope, M. A., Jordan, G., Venkataraman, S., Malla, A. K., & Iyer, S. N. (2019). Everyone has a role: Perspectives of service users with first-episode psychosis, family caregivers, treatment providers, and policymakers on responsibility for supporting individuals with mental health problems. Qualitative Health Research, 29(9), 1299–1312. https://doi.org/10.1177/1049732318812422
Powell, A.-L., Hinger, C., Marshall-Lee, E. D., Miller-Roberts, T., & Phillips, K. (2020). Implementing coordinated specialty care for first episode psychosis: A review of barriers and solutions. Community Mental Health Journal. https://doi.org/10.1007/s10597-020-00644-1
Radhakrishnan, M., McCrone, P., Lafortune, L., Everard, L., Fowler, D., Amos, T., Freemantle, N., Singh, S. P., Marshall, M., Sharma, V., Lavis, A., Jones, P. B., & Birchwood, M. (2018). Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance. Early Intervention in Psychiatry, 12(4), 747–756. https://doi.org/10.1111/eip.12481
Robert Wood Johnson Foundation [RWJF]. (2014). Early detection and intervention for the prevention of pyschosis in adolescents and young adults. Retrieved from https://www.nasmhpd.org/sites/default/files/RWJF%20Findings%20Report%202014.pdf.
Rosenheck, R., Leslie, D., Sint, K., Lin, H., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L., Addington, J., Brunette, M. F., Correll, C. U., Estroff, S. E., Marcy, P., Robinson, J., Severe, J., Rupp, A., Schoenbaum, M., & Kane, J. M. (2016). Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the NIMH RAISE Early Treatment Program. Schizophrenia Bulletin, 42(4), 896–906. https://doi.org/10.1093/schbul/sbv224
Sage, M. G. (Ed.). (2019). EASA team manual. Portland.
Savill, M., Sardo, A., Patel, P., Loewy, R., Melnikow, J., & Niendam, T. (2018). Which components of specialized early intervention for psychosis do senior providers see as most important? Early Intervention in Psychiatry, 13(3), 677–681. https://doi.org/10.1111/eip.12690
Srihari, V. H., Jani, A., & Gray, M. (2016). Early intervention for psychotic disorders. JAMA Psychiatry, 73(2), 101. https://doi.org/10.1001/jamapsychiatry.2015.2821
Srihari, V. H., Tek, C., Kucukgoncu, S., Phutane, V. H., Breitborde, N. J. K., Pollard, J., Ozkan, B., Saksa, J., Walsh, B. C., & Woods, S. W. (2015). First-episode services for psychotic disorders in the U.S. public sector: A pragmatic randomized controlled trial. Psychiatric Services, 66(7), 705–712. https://doi.org/10.1176/appi.ps.201400236
Staffing. (2015). Retrieved November 14, 2020, from http://www.piertraining.com/pier-model/staffing/.
U.S. Department of Health and Human Services. (n.d.). NIMH what is Coordinated specialty Care (CSC)? National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-coordinated-specialty-care-csc.
Uzenoff, S. R., Penn, D. L., Graham, K. A., Saade, S., Smith, B. B., & Perkins, D. O. (2012). Evaluation of a multi-element treatment center for early psychosis in the United States. Social Psychiatry and Psychiatric Epidemiology, 47(10), 1607–1615. https://doi.org/10.1007/s00127-011-0467-4
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Read, H., Kohrt, B.A. The History of Coordinated Specialty Care for Early Intervention in Psychosis in the United States: A Review of Effectiveness, Implementation, and Fidelity. Community Ment Health J 58, 835–846 (2022). https://doi.org/10.1007/s10597-021-00891-w
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DOI: https://doi.org/10.1007/s10597-021-00891-w