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

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

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

4. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Medications

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

14. 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

15. 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)

16. 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

17. 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

18. 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

19. 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

20. 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