Susan Gingerich, MSW gingsusan@yahoo.com A Brief Overview of First Episode Psychosis and A Description of the NAVIGATE Program Susan Gingerich, MSW gingsusan@yahoo.com

Susan Gingerich, MSW gingsusan@yahoo.com A Brief Overview of First Episode Psychosis and A Description of the NAVIGATE Program Susan Gingerich, MSW gingsusan@yahoo.com

NAVIGATE is designed to help individuals with a first episode psychosis related to a schizophrenia diagnosis Schizophrenia Schizoaffective Disorder Schizophreniform

A Few Facts About Schizophrenia Spectrum Disorders Schizophrenia affects one percent of the population, accounts for a fourth of all mental health costs, and take up one in three psychiatric hospital beds. Source: schizophrenia.com

Most common signs of emerging psychosis Performance in school, work, or family life is rapidly dropping Spending a lot of time alone, in their room Doing or saying things that seem strange, even bizarre Seems like they are depressed, or irritable Having problems sleeping

Additional signs of emerging psychosis Social withdrawal Hostility or suspiciousness Decline in personal hygiene Flat, expressionless gaze Inability to cry or express joy Inappropriate laughter or crying Depression Oversleeping or insomnia Odd or irrational statements Forgetful; unable to concentrate Extreme reaction to criticism Strange use of words or way of speaking

Who commonly sees individuals with first episode? Inpatient facilities Emergency rooms Crisis services Religious leaders and their congregations Pediatricians, primary care, and family doctors High Schools (counselors and teachers) Colleges, technical schools Police departments, jail systems Substance abuse programs for young people

NAVIGATE Treatment Program was Developed Under Auspices of the NIMH RAISE Program Based on The stress-vulnerability model Emphasis on recovery and resiliency Principles of illness management Principles of psychiatric rehabilitation In addition, NAVIGATE is informed by special issues for first episode psychosis clients

NAVIGATE Enrollment Criteria Between ages of 15-40 IQ is not below 70 Had or were experiencing psychosis, that would likely be reflecting signs of early schizophrenia, but their symptoms did not look like psychotic depression or bipolar disorder physical reasons for the psychosis had been ruled out Had been on antipsychotic medication for less than 6 months

Common Enrollment Criteria for Non-Research Sites Between ages of 15-35 Have experienced psychosis that would likely be reflecting signs of early schizophrenia, but their symptoms do not look like psychotic depression or bipolar disorder, borderline personality disorder or autism physical reasons for the psychosis had been ruled out Have an IQ of 70 or above Have been experiencing psychotic symptoms for 2 years or less

Medications

Taking into Consideration the Special Issues for First Episode Psychosis Clients Their developmental stage The trauma related to experiencing psychosis

Specific NAVIGATE Interventions Medication Management Family Program Supported Employment and Education (SEE) Individual Resiliency Training (IRT) Sometimes separate case management and/or peer specialist services

Roles on NAVIGATE Team Team leader/Director Family Clinician (usually same person as team leader) Prescriber Supported Employment and Education Specialist Individual Resiliency Trainer Case manager (either as part of another role, or as a separate position) Peer specialist (when possible)

How the team works together Whole team meets together weekly Clients (and usually families) meet all team members at the beginning of treatment Team strives to have each client receive the benefits of each intervention Team members continually share information and strategies Team members “piggyback” appointments In dealing with challenges, team member with strongest rapport is utilized

Initial Results of RAISE Research Compared to clients getting customary treatment, NAVIGATE clients Were more likely to stay in treatment Had greater rates of participation in work or school Had greater reductions in symptoms Had greater improvements in quality of life

RAISE Research Also Taught us the Importance of “Duration of Untreated Psychosis” The earlier people got treatment the better their outcomes were Duration of Untreated Psychosis (DUP) is significant; that is, how long has the person been experiencing symptoms without getting any treatment for them? The shorter the DUP the better

Outreach and Education Help Decrease Duration of Untreated Psychosis RAISE/NAVIGATE teams had to find clients and families, not vice versa Community on the whole did not understand schizophrenia or how to recognize early signs of the illness Families did not either Important to go out into the community to provide education about psychosis and information about how to refer people Teams had to reach out to inpatient programs and emergency services Teams also had to reach out to referral resource they may not have been used to: churches, synagogues, high school guidance departments, police

A Few Words Before We Get Into the Specifics of the Role of the Family Clinician We are greatly looking forward to working with you as you develop first episode treatment in your state By implementing first episode treatment, your community will be contributing significantly to the new era in schizophrenia treatment By using the principles and methods you learn today, whether or not you are officially part of a NAVIGATE team, you will be supporting families and helping the recovery of their loved ones Thank you for your commitment and dedication