Coordinated specialty care (CSC) has been shown to be more effective for the treatment of first episode psychosis (FEP) than usual care, resulting in better functioning, fewer symptoms, fewer relapses, and less hospital use. The number of CSC teams has increased dramatically in the U.S. since federal funding has been provided to support states' implementation; Texas currently has 26 CSC teams. This rapid growth of early psychosis intervention programs, operating with similar core features and serving similar participants, provides a unique opportunity. By utilizing a standard battery of reliable service and outcome measures, a data informatics system to facilitate shared data and feedback, and staffing to support quality improvement and research infrastructure, Texas can create an environment in which providers, program administrators, and policy makers can continuously develop new knowledge. The regional network will link programs together through the Texas FEP Consortium, support a culture of measurement-based care, and create a framework for addressing research questions that impact the service delivery system, contribute to the research literature, and reduce the burden of psychosis on young people and their families. Research in persons with FEP has shown that co-occurring substance use is common and can lead to an exacerbation of psychotic symptoms, decreased medication adherence, and poorer long-term outcomes. Research has shown that between 23% and 73% of individuals in FEP programs continue to use substances after 6 to 12 months in care. While CSC models have incorporated practices from brief intervention and treatment models to address substance use, little is known about the use of these strategies in community- based programs or their effectiveness in motivating this group of young people to reduce or stop use. The series of proposed studies will advance an understanding of critical issues for addressing substance use in young people who continue use after entering care. The first study will use a chart review approach to examine whether standard CSC-model interventions are successful at engaging participants in behavior change and the extent to which diverse participants (e.g., African American, Latinx) directly identify reduced substance use as a goal. Qualitative studies will examining the perceptions of CSC participants and CSC peer specialists on the feasibility and acceptability of peer-led interventions for supporting substance use recovery. After partnering with peer specialists and individuals receiving CSC services to develop the intervention, a pilot study will be conducted to examine the feasibility of deployment, study recruitment, retention, and other study procedures. This work will set the stage for a statewide partnership with researchers, decision-makers, providers, young people and their families to become a healthcare system that uses data to continuously learn and transform.
Schizophrenia and related disorders are some of the most burdensome of mental health disorders in terms of years lived with disability. Adolescence and young adulthood provide a critical time to intervene following the development of psychosis and related symptoms. EPINET-TX would allow Coordinated Specialty Care teams in Texas to develop the technology and research infrastructure needed to develop practice-based research and care advancements, addressing the needs of young people with these conditions, their families, treatment providers, and policy makers.
