Although evidence on community-based early detection (ED) programs aimed to reduce prolonged durations of untreated psychosis (DUP) is large and growing, very little is known about the effectiveness of ED services on college campuses in the United States. This gap in the literature is problematic because, with the first symptoms of psychosis being most likely to surface among college age young adults, college campuses are hubs for individuals at an age of increased risk of first episode psychosis (FEP). The long-term goal of our program of research is to improve clinical and functional outcomes among college students with early stages of psychosis by reducing DUP. The objective of our proposed study is to determine the feasibility of an ED program that aims to: (i) identify college students at clinical high risk (CHR) of psychosis or with FEP, and (ii) efficiently link them to coordinated specialty care (CSC) services for a 2nd stage screen, a clinical assessment, and appropriate treatment. We will also provide preliminary estimates of effectiveness with respect to the intervention. Our ED program will include two organizational level changes. First, we will implement universal screening (i.e., the Prodromal Questionnaire Brief) for psychosis among college students who are seeking help at a college counseling center. Second, we will implement a collaborative, person-centered, and rapid referral process (<2 weeks) to CSC. Person-centered elements of the referral process include shared-decision making and a warm handoff. Our central hypotheses are that our multi- level ED program will be feasible, and that preliminary data will show an increase in the number of referrals of college students to CSC. Furthermore, DUP will be shorter and there will be fewer steps and perceived barriers to care among college students referred to CSC through our ED program compared to college students who present to CSC from other referral sources. Our hypotheses will be tested by pursing two specific aims: 1) Identify whether (i) case identification, and (ii) referral-related barriers to CSC are important targets for ED programs on college campuses; and 2) Evaluate the feasibility of our ED program from the perspectives of various stakeholders. The proposed study is significant because it will produce a vertical step in the DUP scientific field by increasing knowledge on the 1) mechanisms of change for DUP among college students, and 2) feasibility of an ED program embedded within a college counseling center in partnership with a CSC program. The study will also elucidate barriers to CSC among an ethnic and racial diverse young adult population. Ultimately, such knowledge has the potential of offering new opportunities to reduce DUP among young adults nationwide.
The proposed research is relevant to public health because it aims to explore the feasibility and preliminary effectiveness of an insufficiently researched way to reduce prolonged duration of untreated psychosis (DUP). Once effective strategies to reduce DUP among high-risk groups for early psychosis are identified ? such as in the proposed study that focuses on college students - there is a potential to alter the adverse consequences associated with prolonged DUP, including hospitalization, suicide, and poor functioning. Thus, the proposed research is relevant to the part of the NIMH?s mission that pertains to paving the way for recovery.
