This application addresses the Funding Opportunity: PAR-13-187 Reducing the Duration of Untreated Psychosis in the United States (R01) Project Title: STEP-ED: Reducing Duration of Untreated Psychosis and its impact in the U.S. The guiding questions for this study are whether a U.S. adaptation of a successful early detection approach undertaken in Norway (TIPS) can substantially reduce the duration of untreated psychosis (DUP) and improve outcomes beyond existing specialty first-episode services (FES) in a policy-relevant U.S. setting. The proposed study involves a quasi-experimental design wherein one site that delivers FES (STEP, New Haven) will add an Early Detection (ED) campaign to reduce DUP in its catchment area, while a control site (PREP, Boston) will continue to deliver equivalent FES without ED. We hypothesize that DUP will be reduced significantly in the early detection site compared to the usual detection site. Also, we hypothesize that this reduction in DUP will translate into improvements 1 year outcomes at the ED site compared to the non-ED site, demonstrating the 'added value'of ED to already established and effective FES. The primary outcome of DUP will be measured in a consistent manner at both sites using the Symptom Onset Scale, which is comprehensive in assessing early symptoms, reliable and has been used by both sites for e5 years. 1 year outcomes will be measured at both sites and will assess three broad domains: 1) clinical status: including hospitalization rate and relapse, suicidality, aggression and symptom scales;2) functional status: including ability to work or attend age- appropriate schooling, social functioning and quality of life and 3) costs: broadly measured to include costs of treatment and social and forensic services used. The Early Detection campaign will include a social marketing component targeting patients and families to increase help-seeking behavior, professional outreach to improve the rapidity of referral to STEP from local agencies and operationalizing rapid responsiveness of the STEP clinic to referrals, all with the aim of minimizing DUP. Analysis for DUP will be centered on the primary outcome of the proportion arriving to each FES with a DUPd3months. Analysis for 1-year outcomes will be centered on proportions who are vocationally engaged at each site.
Psychotic illnesses are severely disabling and costly under usual care in the U.S. The provision of treatment that is effective and delivered early after psychosis onset has the potential to improve long-term outcomes. The Specialized Treatment Early in Psychosis and Early Detection (STEP-ED) project is designed to test addition of an early detection campaign to an existing, comprehensive and effective service (STEP) to shorten the time between psychosis onset and effective treatment and has the potential to significantly improve the long term outcomes of psychotic illnesses in the U.S.