1. The Maryland Early Intervention Program A collaborative for the early identification and treatment of mental illness with psychosis

2. Review the symptoms and impact of psychosis Discuss the impact of stigma on psychosis Offer strategies for engaging individuals experiencing early psychosis in treatment, including RA1SE Learn about the services available through the Maryland Early Intervention Program Objectives

3. Review the symptoms and impact of psychosis Discuss the impact of stigma on psychosis Offer strategies for engaging individuals experiencing early psychosis in treatment, including RA1SE Learn about the services available through the Maryland Early Intervention Program Objectives

4. The Impact of Psychosis Approximately 3% develop a psychotic disorder (lifetime) 100,000 adolescents and young adults develop a first episode each year (Heinssen, Goldstein, & Azrin, 2014) Heavy impacts  Mortality - 2.5x more likely to die than peers, reduced life expectancy by 20 years (Laursen et al., 2014)  Independent functioning  Quality of life  Family functioning, burden & distress  US $62.7 billion per year

5. Psychosis 5 types of psychotic symptoms (DSM-5 ‘Criterion A’)  Hallucinations  Delusions  Disorganized speech  Disorganized/catatonic behavior  Negative symptoms

6. Positive Symptoms Delusions: false and fixed beliefs  I think people are talking about me  Someone is following me  People are talking about me to plot against me  Aliens are sending me messages through the TV Hallucinations: perception/sensory abnormalities  Auditory, visual, or tactile  Auditory or “hearing voices” is most common

7. Positive Symptoms Disorganized speech  Speech difficult to follow  Idiosyncratic use of words Disorganized behavior  Unpredictable and untriggered agitated behavior  Dressing in unusual way (appearing disheveled or wearing multiple layers on a hot day)

8. Negative Symptoms  Social withdrawal  Academic decline  Decreased motivation  Limited facial expression  Decreased activity

9. Diagnoses/Conditions Associated with Psychosis  Schizophrenia  Schizophreniform  Depression with psychotic symptoms  Bipolar disorder  Reaction to trauma  Certain medical conditions  Substance abuse

10. Who Experiences Early Psychosis? Onset generally occurs between the ages of 15-25 Onset may begin in adolescence and continue into young adulthood Occurs equally in males and females [1] Males typically present with the disease in their late teens and early 20s Females present in their early 20s to early 30s [1] Schultz, North, & Shields, 2007

11. Duration of Untreated Psychosis (DUP) PremorbidRisk SyndromePsychosis Onset of Psychosis DUP DU Illness Onset of Risk State Treatment Marshall et al., 2005

12. Duration of untreated psychosis (DUP) Shorter DUP is associated with better social, emotional, and occupational outcomes Longer DUP is associated with increased risk of suicide and violence 1 ) 10-30% of suicide attempts occur prior to treatment 2) 15-20% have had some experience of violence prior to treatment - Per year risk of committing homicide is 15 times higher in untreated individuals - of the homicides committed by people with mental illness with psychosis, 4 in 10 occur prior to treatment

13. Review the symptoms and impact of psychosis Discuss the impact of stigma on psychosis Offer strategies for engaging individuals experiencing early psychosis in treatment, including RA1SE Learn about the services available through the Maryland Early Intervention Program Objectives

14. A word about “person-first language” A “person with schizophrenia” As compared to a “schizophrenic”

15. What People “Know” About Schizophrenia

16. Myths About Schizophrenia  Multiple Personality Disorder  Violent  Homeless  Can’t hold a job  Caused by poor parenting

17. Media Coverage

18. Can you relate?  Depression/Anxiety

19. Can you relate?  Dreams  Hypnagogic/hypnopompic experiences  Cell phone ringing  Hearing name called  Seeing a shadow or a tree and thinking it’s a person  Belief in things that are not necessarily scientific  Déjà vu  Seeing a group of people & thinking they’re talking about you  Not being able to enjoy things sometimes  Feeling confused

20. Cautionary note  Real life experiences of psychosis are far more challenging, interfering, & distressful than analogies & simulations

21. Brave people are standing up and sharing their stories which helps in stigma reduction and is one way to increase peoples’ willingness to get treatment Reducing Stigma Liselle

22. Video Clips Reflecting on her journey towards recovery, Liselle describes how by accepting and acknowledging the challenges of her illness she ironically disempowers their impact on her. At the same time, this process has allowed her to see the future in a bright and optimistic light.

23. Review the symptoms and impact of psychosis Discuss the impact of stigma on psychosis Offer strategies for engaging individuals experiencing early psychosis in treatment, including RA1SE Learn about the services available through the Maryland Early Intervention Program Objectives

24. RA1SE Recovery after Initial (1 st ) Schizophrenia Episode An early intervention program based on Critical Time Intervention (CTI) A person-centered, recovery-based program Assists individuals in moving forward and working toward goals Provides education and support to individuals and their families

25. Coordinated specialty care that is: – Orchestrated by a “case-manager” – Phase specific – Low-dose antipsychotic meds – Family education and support – Cognitive behavior therapy – Supported employment/education Shared decision making foundation of treatment decisions RA1SE

26. Treatment focused on recovery/recovery process – Development and pursuit of recovery goals – Breaking goals down into smaller objectives – Identifying and addressing barriers to these goals RA1SE

27. Addressing individual and family concerns Working across multiple systems: hospitals, schools/colleges, employers, judicial system RA1SE

28. RA1SE Strategies Listen to the client and their goals Describe how treatment will help them Work with each individual where they are

29. Tips for Treatment Engagement Family members and primary supports are often the strongest allies in treatment

30. The importance of family involvement Families and friends often first to notice and voice concerns about psychosis Families are often the care providers Ability to recognize changes in the individual Stressful for the whole family Strong family support is key to recovery

31. Tips for Treatment Engagement Family and loved ones can show care Help families understand their loved one’s experience Make sure that families and primary supports understand: – No one is to blame – There is hope for living a full and enjoyable life Offer families resources for support, such as NAMI Support families in learning about the mental health system and adjusting to their loved one’s illness

32. Tips for Treatment Engagement Work with families on how to discuss symptoms with their loved ones and facilitate treatment engagement Encourage families to contact providers with information and questions Include families in safety planning (see video for safety planning on www.mdbehavioralhealth.com www.mdbehavioralhealth.com

33. Be patient Make expectations…that are reasonable Involve youth in activities Monitor activities, peers, time Have structure that reduces stress Don’t forget about yourself Provide LOVE Recommendations From Families

34. Review the symptoms and impact of psychosis Discuss the impact of stigma on psychosis Offer strategies for engaging individuals experiencing early psychosis in treatment, including RA1SE Learn about the services available through the Maryland Early Intervention Program Objectives

35. The Maryland Early Intervention Program “A collaborative for the early identification and treatment of mental illness with psychosis”

36. Our Goals: 1.To reduce chronicity and enhance the likelihood that a person with early signs of psychosis will be able to: a.manage their illness b.move successfully through the appropriate stages of development c.establish a life of their choosing 2.To take a broad public health perspective, in which we directly address issues of aggression, violence, and substance use 3.To optimize the likelihood of recovery from serious mental illness with psychosis Maryland Early Intervention Program

37. Our Structure: 1.The EIP is comprised of four service components: a.Outreach and Education Services b.Clinical Services c.Consultation Services d.Training and Implementation Support Services 2.Research is integrated into each of these components and focuses on early detection and prediction of disease emergence, progress or recovery; and treatment development Maryland Early Intervention Program

38. Maryland Early Intervention Program Multidisciplinary Effort: 1. The Maryland EIP is comprised of professionals from multiple disciplines, including health policy and professionals from the youth and family advocacy community 2. The Maryland EIP clinical programs are comprised of health care providers from multiple disciplines, including psychiatrists, psychologists, and social workers

39. Outreach and Education Lack of knowledge about mental health problems and treatments and stigma related to mental illness lead to increased threshold for treatment- seeking, prolonged duration of untreated psychosis (DUP) Strategies for reducing DUP include: – increase awareness of the signs and symptoms of psychosis – reduce stigma and other barriers to obtaining a clinical evaluation and referral

40. Approach – Teach providers how to identify signs of clinical high risk and early psychosis – Familiarize providers with relevant assessments and evidence-based practices – Provide providers with ample ways to refer individuals for further consultation and treatment if needed Settings – Secondary educational institutions – Colleges/Universities – Behavioral health and primary care settings – Advocacy groups Outreach and Education

41. Maryland Early Intervention Program Clinical Services: 1. High Risk of Psychosis – Strive for Wellness Program 2. First Episode Clinics – MPRC First Episode Clinic (FEC) – RAISE Connection Program 3. Statewide Consultation Service – For providers and institutions on diagnosis, treatment recommendations, and school and family management (by phone or in person)

42. All of Our Clinical Services: Are recovery oriented Are designed to help each individual achieve their full potential – employment, finishing school, reaching other personal goals Emphasize safety, including extensive – Risk assessment – Safety planning Maryland Early Intervention Program

43. Strive for Wellness Program Clinical prevention/treatment for youth/young adults (12-25) at risk of psychosis Services – screening assessments to identify individuals experiencing psychosis as soon as possible – modular treatment approach to customize treatment to individual needs – psychoeducation for individuals and family members Engagement in outpatient treatment services may prevent negative first experiences with mental health system that might impact future engagement – Police – Emergency Treatment – Mandated Treatment

44. The first specialty care FEC in Maryland Expert clinical services for adolescents (12 & up) and young adults experiencing FEP Strong emphasis on evidence-based FEP care using antipsychotic treatment, individual and family education/support, and supported education/employment MPRC First Episode Clinic

45. RAISE Connection Program Recovery After Initial Schizophrenia Episode (RAISE) - Connection Program – Established through an NIMH-funded initiative to study services for people with newly diagnosed schizophrenia and psychotic illnesses Team-based coordinated specialty care model recommended by NIMH The RAISE Connection Program is: – early intervention based on a critical time intervention (CTI) – person-centered, recovery-based program assisting individuals in moving forward and working towards goals – provide education and support to individuals and their families

46. RAISE Connection Program Team-based Emphasis on outreach and engagement Shared decision-making Located at University of Maryland Midtown Campus in the Carruthers Clinic, but separated from services for more chronically ill clients Clinic Capacity: 30 clients

47. Team Roles/Description: Team Leader: overall coordination of services, including individual therapy, case management, crisis intervention, information gathering, safety planning Recovery Coach: social skills training, weekly participant group, monthly family group, school coordination Employment/Education specialist: job development, addressing work and school related goals and problems Psychiatrist: prescribing, shared decision-making, education RAISE Connection Program

48. Regularly prescribed meetings between participant and team Family involvement strongly encouraged Psychoeducation Recovery focus Flexibility (time, services, availability) 24-hour phone availability Varied Treatment modalities – Individual sessions – Participants group – Family groups – Participant/family sessions RAISE Connection Program

49. Consultation Services Provide consultations on diagnosis, treatment recommendations, and school and family management Consultations may be provided On-site (1 to 3 visits) By telephone or e-mail We accept consultation requests from schools, colleges, psychiatrists, primary care and pediatric care, state institutions Currently piloting telepsychiatry consultation service

50. Training & Implementation Support Services Establish Early Intervention Teams throughout the State – Train teams in evidence-based interventions for youth with early psychosis – Support ongoing training of teams via an existing infrastructure – Teams currently available in Baltimore City and Montgomery County Create learning opportunities for teams and others providing services to those with early psychosis – To support collaboration, sharing of resources, and coordination of service delivery

51. Who should contact the EIP? Individuals experiencing early symptoms of a mental illness with psychosis Family Members, Friends, or Professionals who are seeking services for an individual experiencing symptoms of a mental illness with early psychosis Providers seeking formal consultations on complex cases Professionals interested in receiving education or information about early psychosis or using program services Providers interested in establishing an early intervention team within their treatment setting

52. When in doubt, feel free to ask Website: www.MarylandEIP.comwww.MarylandEIP.com Toll free numbers – Phone: (877) 277-MEIP (6347) – Fax: (877) 689-9185 Centralized E-mail – info@MarylandEIP.com info@MarylandEIP.com