Ryan Melton Ph.D rymelton@pdx.edu EASA and IPS: Balancing fidelity guidelines with modifications and cultural adaptations to meet the needs on young adults experiencing psychosis Ryan Melton Ph.D rymelton@pdx.edu Tamara *

Ryan Melton, Ph.D. Clinical Director for the Early Assessment and Support Alliance (EASA) Center for Excellence, OHSU Started the original 5-county implementation in public managed healthcare system in January 2001 Clinical Mental Health Faculty at Northwest Christian Has authored multiple papers, chapters and presentations on early psychosis identification and treatment. Tamara *

My Real BIO

What We Will Cover Today Introduction to the EASA model Introduction to the IPS model Adolescent and young adult Identity Cultural considerations for IPS augmentation with early psychosis clients Specific IPS/CSC fidelity items that interface and are causing concerns. Specific creative solutions will be offered. Nev *

What is EASA? “Uniting the voices and strengths of young adults and their allies to create a thriving community and a revolution of hope!” – Young Adult Leadership Council

Follow us online! Website: www.easacommunity.org Facebook: www.facebook.com/easacommunity Twitter: www.twitter.com/EASACommunityOR

Mission of the Early Assessment and Support Alliance Keep young people with the early signs of psychosis on their chosen life paths by: Building community awareness. Offering easily accessible, effective treatment and support using a public health approach. Provides: Network of educated community members & highly skilled clinicians. Most current evidence-based practices modified to meet the developmental and cultural needs of adolescents and young adults. *

IPS Principles Open to anyone who wants to work Focus on competitive employment Rapid job search Systematic job development Client preferences guide decisions Individualized long-term supports IPS integrated with treatment team Benefits counseling included

Adolescent and Young Adult Development Two overlapping yet distinct developmental stages

Typical growth experiences in Young Adulthood The development of a genuine sense of identity takes center stage as the key developmental task. This involves gaining a sense of greater independence while also maintaining and building trusting relationships. They pursue life experiences that help them better understand their worldviews, beliefs, and values; as well as how they are similar to and different from others. Young adults continue to develop, explore, and refine the developmental tasks of adolescence.

Typical growth experiences throughout adolescence (13-17) and young adulthood (18-25): Strengthen capacity to think abstractly. This can bee seen in grasping higher math concepts, developing personal morality including personal and collective sense of rights and privileges. Seek to develop and foster meaningful relationships. Develop new sense of self and personal purpose in life. Question family values and worldviews while striving to maintain connections and sense of identity.

Typical growth experiences (continued): Involves some separation from family to have experiences that promote identity formation. This process increases during young adulthood. Friends and social networks might take ‘center stage’ as part of the process involved with identity development.

Typical growth experiences (continued): Gaining a greater sense of independence occurs before development of consistently solid decision-making skills. Strong pull to seek and receive validation and acceptance from peers. Continue to need limits set by trusted adults which promotes optimal development and growth, but choices still need to be offered. Reference: https://www.nlm.nih.gov/medlineplus/ency/article/002003.htm

Augmentations to IPS for Young Adults with Early Psychosis Offer help with educational goals/long term career goals Keep clients open in IPS even as goals change Include families in process/SE can lead MFGs. Use youth-friendly modes of communication (e.g. disclosure not necessary but shouldn’t be avoided). Also use text and email Avoid stigmatizing service settings Work mental health appointments around school and work. Use culturally and age appropriate benefits planning. Consider combining Sed and SE.

Systematic Review of 8 Follow-up Studies of Early Intervention Programs Providing IPS (Bond, Drake, & Luciano, 2014)

CSC and IPS fidelity interface standards of practice considerations Case load size: EASA Mandates no wait list. IPS suggestion: temporarily increase caseload until you are able to accommodate a caseload size of 20 or less . CSC suggestion: carefully define caseload. Employment services staff: IPS suggestion: EASA Employment Specialists may facilitate the MFG group or spend time on other activities important to EASA but not necessarily employment   This is especially true in rural counties and may be important to them and not just the EASA program. It may also be important to state why it is important to EASA which includes the evidence that does support shared roles (as long as it isn’t too much) and the evidence of MFG improving employment outcomes. However limit this as ES or make relevant to employment

CSC and IPS fidelity interface standards of practice considerations Role of the employment supervisor. It is not unusual in EASA for the ES to have an IPS supervisor and a EASA supervisor. Both supervisors should attend training on models and be aware of each other’s fidelity practices. Competitive jobs: EASA staff at times encourage volunteerism,/internships and the employment specialists may have offered some supports for volunteer/internship positions. IPS suggestion: if the client  brings up the topic, an ES can help with a volunteer /internship job, as a step towards a paid job  Or an employer recommends volunteer/internship experience before applying for a job. Individualized follow along supports: Occasionally EASA clients are referred to IPS right as the job starts, which can create challenges for the ES and client to connect. IPS suggestion: Keep focus or return focus to career level jobs as a part of follow along supports.

Contact Us! Ryan Melton PhD Clinical Director EASA Center for Excellence rymelton@pdx.edu