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Implementation of NAVIGATE Coordinated Specialty Care for First Episode Psychosis: the Michigan Experience

Published online by Cambridge University Press:  10 May 2021

Eric D. Achtyes
Affiliation:
Network180, Grand Rapids, MI, USA Michigan State University, East Lansing, MI, USA Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
Kari Kempema
Affiliation:
Network180, Grand Rapids, MI, USA
Zhehui Luo
Affiliation:
Michigan State University, East Lansing, MI, USA
Katharine N. Thakkar
Affiliation:
Michigan State University, East Lansing, MI, USA
Catherine Adams
Affiliation:
Michigan State University, East Lansing, MI, USA ETCH: Early Treatment & Cognitive Health, East Lansing, MI, USA
Dale D’Mello
Affiliation:
Michigan State University, East Lansing, MI, USA ETCH: Early Treatment & Cognitive Health, East Lansing, MI, USA
Kellen Stilwell
Affiliation:
Michigan State University, East Lansing, MI, USA Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
Donna Tran
Affiliation:
Michigan State University, East Lansing, MI, USA
Patricia Marcy
Affiliation:
Vanguard Research Group, Glen Oaks, NY, USA
Kim Mueser
Affiliation:
Boston University, Boston, MA, USA
Nina R. Schooler
Affiliation:
SUNY Downstate Health Sciences University, Brooklyn, NY, USA
Delbert G. Robinson
Affiliation:
The Zucker Hillside Hospital, Glen Oaks, NY, USA The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
John M. Kane
Affiliation:
The Zucker Hillside Hospital, Glen Oaks, NY, USA The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Abstract

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Study Objectives

Coordinated specialty care (CSC) is widely accepted as an evidence-based treatment for first episode psychosis (FEP). The NAVIGATE intervention from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study is a CSC intervention which offers a suite of evidence-based treatments shown to improve engagement and clinical outcomes, especially in those with shorter duration of untreated psychosis (DUP). Coincident with the publication of this study, legislation was passed by the United States Congress in 2014–15 to fund CSC for FEP via a Substance Abuse and Mental Health Services Administration (SAMHSA) block grant set-aside for each state. In Michigan (MI) the management of this grant was delegated to Network180, the community mental health authority in Kent County, with the goal of making CSC more widely available to the 10 million people in MI. Limited research describes the outcomes of implementation of CSC into community practices with no published accounts evaluating the use of the NAVIGATE intervention in a naturalistic setting. We describe the outcomes of NAVIGATE implementation in the state of MI.

Methods

In 2014, 3 centers in MI were selected and trained to provide NAVIGATE CSC for FEP. In 2016 a 4th center was added, and 2 existing centers were expanded to provide additional access to NAVIGATE. Inclusion: age 18–31, served in 1 of 4 FEP centers in MI. Data collection began in 2015 for basic demographics, global illness (CGI q3 mo), hospital/ED use and work/school (SURF q3 mo) and was expanded in 2016 to include further demographics, diagnosis, DUP, vital signs; and in 2018 for clinical symptoms with the modified Colorado Symptom Inventory (mCSI q6 mo), reported via an online portal. This analysis used data until 12/31/19. Mixed effects models adjusted by age, sex and race were used to account for correlated data within patients.

Results

N=283 had useable demographic information and were included in the analysis. Age at enrollment was 21.6 ± 3.0 yrs; 74.2% male; 53.4% Caucasian, 34.6% African American; 12.9 ± 1.7 yrs of education (N=195). 18 mo retention was 67% with no difference by sex or race. CGI scores decreased 20% from baseline (BL) to 18 mo (BL=3.5, N=134; 15–18 mo=2.8, N=60). Service utilization via the SURF was measured at BL (N=172) and 18 mo (N=72): psychiatric hospitalizations occurred in 37% at BL and 6% at 18 mo (p<0.01); ER visits occurred in 40% at BL and 13% at 18 mo (p<0.01). 44% were working or in school at BL and 68% at 18 mo (p<0.01). 21% were on antipsychotics (AP) at BL (N=178) and 85% at 18 mo (N=13) with 8% and 54% on long acting injectable-AP at BL and 18 mo, respectively. Limitations include missing data and lack of a control group.

Conclusion

The implementation of the NAVIGATE CSC program for FEP in MI resulted in meaningful clinical improvement for enrollees. Further support could make this evidence-based intervention available to more people with FEP.

Funding

Supported by funds from the SAMHSA Medicaid State Block Grant set-aside awarded to Network180 (Achtyes, Kempema). The funders had no role in the design of the study, the analysis or the decision to publish the results.

Type
Abstracts
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Footnotes

Presenting Author: Eric Achtyes