Client and family experiences with telehealth-delivered early psychosis services.

OBJECTIVE: The COVID-19 pandemic prompted a significant shift to delivering early psychosis services using telehealth. Little is known about the experience of using telehealth in early psychosis services. This quality improvement qualitative project investigated the experiences of program participants and family members with telehealth services in OnTrackNY, an early intervention program for psychosis in New York State during the COVID-19 pandemic. METHODS: The project team conducted individual interviews and focus groups. Data analyses used a matrix approach. RESULTS: Nineteen OnTrackNY program participants and nine family members participated in five focus groups and nine individual interviews. Data were organized into five themes (a) accessibility: most individuals had a device and internet access and challenges were related to connectivity, such as image freezing and sound breaking; (b) convenience/flexibility: benefits included the reduced commute and costs; (c) levels of comfort/privacy with telehealth: program participants felt less judged and less anxiety leading up to in-person appointments while also expressing privacy concerns; (d) sense of connectedness: in-person social connections were deemed important and not replaceable by telehealth; and (e) suggestions: program participants expressed a preference for in-person group activities and suggested hybrid options, highlighting the importance of in-person visits to establish rapport at the beginning of treatment before transitioning to telehealth. CONCLUSIONS: Telehealth services were generally well accepted. Suggestions for future service delivery include offering a combination of telehealth and in-person services based on program participants' preferences and prioritizing in-person services during the early phase of treatment.

Leveraging Instagram to Engage Adolescents With Depression: The Use of Evidence-Based Brief Video Interventions.

The Surgeon General's Advisory (2023)1 has underscored the importance of research into the impact of social media content on adolescents' mental health. Social media platforms such as Instagram are increasingly used by adolescents to seek mental health services and support, highlighting the positive role that these platforms can play in facilitating access to resources and community support.1 Studies suggest that social media platforms can promote help-seeking behaviors among youth, potentially serving as access points to mental health care.2 With social media becoming the primary source of mental health information for adolescents, especially post-pandemic, various digital strategies have emerged to engage youth. This trend is significant, considering that roughly 50% of all mental health issues begin by age 14 years.3 Moreover, social media offer access to vital information, social support, and avenues for self-expression. This is especially important for marginalized groups such as people of color and transgender and gender diverse (TGD) individuals, who often face challenges and barriers in accessing mental health resources because of factors such as stigma, discrimination, and lack of culturally competent care.4.

Functioning and quality of life among treatment-engaged adults with psychotic disorders in urban Tanzania: Baseline results from the KUPAA clinical trial.

BACKGROUND: There is a treatment gap for those living with severe mental illnesses in low- and middle-income countries, yet not enough is known about those who are currently accessing clinical services. A better understanding of potentially modifiable factors associated with functioning and quality of life will help inform policies and programming. AIMS: To describe the functioning and quality of life for a psychiatric treatment-engaged population living with psychotic disorders in two urban areas of Tanzania, and to explore their respective correlates. METHODS: This study analyzed cross-sectional data from 66 individuals enrolled in the Kuwezeshana Kupata Uzima (KUPAA) pilot clinical trial who had a diagnosis of schizophrenia or schizoaffective disorder, recent relapse, and who were receiving outpatient treatment. Baseline functioning (WHO Disability Assessment Schedule 2.0) and quality of life (WHO Quality of Life BREF scale) were measured. Univariable and multivariable regression analyses were conducted to determine correlates of functioning and quality of life. RESULTS: Adjusted analyses indicated that higher disability was associated with higher food insecurity, more symptomatology, more self-stigma, less instrumental support, less hope, lower self-efficacy, and/or lower levels of family functioning. Higher quality of life was associated with higher levels of self-efficacy, more hopefulness, more instrumental support, less self-stigma, and better family functioning. CONCLUSIONS: Identification of factors associated with disability and quality of life can help clinicians and policymakers, as well as consumers of mental health services, to better co-design and target psychosocial interventions to optimize their impact in low-resource settings. TRIAL REGISTRATION: Trial registration: ClinicalTrials.gov # NCT04013932, July 10, 2019.

An open pilot trial of a behavioural intervention to reduce violence by young adults with early psychosis receiving treatment in an early intervention services setting: A protocol.

AIMS: Despite the public health impact of violence among young adults with psychosis, behavioural interventions to reduce the risk of engaging in violence remain rare. For young adults with early psychosis, cognitive behavioural therapy (CBT)-based psychotherapy has efficacy in reducing impairment and improving functioning. However, no CBT-based intervention to reduce violence has been formally adapted for young adults with early psychosis. This protocol outlines the first clinical trial of a behavioural intervention to reduce violence for young adults with early psychosis. This study is set in an early intervention services (EIS) setting and seeks to adapt and pilot Psychological Intervention for Complex PTSD and Schizophrenia-Spectrum Disorder (PICASSO), a CBT-based intervention, through an iterative process utilizing mixed-methods assessments. METHODS: All research will occur at OnTrackNY, the largest EIS program in the United States. This study will consist of an open pilot trial, with four EIS clinicians delivering the intervention to one to two EIS participants per round. In this mixed-methods study, both quantitative measures (acceptability, feasibility and hypothesized mediators of target outcome collected on a weekly basis) and qualitative interviews (with EIS clinicians at weeks 4, 8 and 12) will be conducted. Transcripts will be analyzed using thematic content analysis. Two to three rounds of iterative modifications are anticipated (n = 10-16 EIS participants total). RESULTS: Recruitment began in February 2024 and is expected to continue over a 9-12-month period. CONCLUSIONS: Because violent behaviour causes interpersonal disruptions such as incarceration and increased caregiver burden, an innovative intervention to reduce violence risk could have broader health impact for this vulnerable population. Adapting the PICASSO intervention to the EIS setting will optimize its acceptability and feasibility by the intended target population.

Comparing brief video interventions to reduce public and self-stigma: Randomized control trial.

AIM: Stigma is a major mental healthcare barrier. This study compares the efficacy of two types of brief video interventions, targeting public and self-stigma, in reducing public stigma towards people living with psychosis. We hypothesized both interventions would similarly reduce public stigma and outperform the control group. As a secondary analysis, we explored the effect of familiarity with a person living with serious mental illness (SMI). METHODS: Participants (N = 1215) aged 18-35 recruited through crowdsourcing were assessed pre- and post-intervention and at 30-day follow-up regarding five public stigma domains: social distance, stereotyping, separateness, social restriction and perceived recovery. Both videos present individual narratives using different approaches: the self-stigma video was created through focus groups, while the public stigma video portrays a single person's journey. RESULTS: A 3 × 3 analysis of variance (ANOVA) revealed a significant group-by-time interaction across all five stigma-related domains (p's < .001). Effect sizes (Cohen's d) ranged from 0.29 to 0.52 (baseline to post-intervention), and 0.18 to 0.45 (baseline to 30-day follow-up). The two video interventions did not significantly differ. Linear mixed modelling showed a significant difference between participants familiar and unfamiliar with people living with SMI for the public stigma video, with greater stigma reductions for unfamiliar participants. CONCLUSIONS: This study corroborates previous findings on the positive influence of social contact-based interventions on youth mental health perceptions. Results provide insights into the relationship between public and self-stigma and the impact that familiarity with SMI may have on the efficacy of stigma reduction efforts further validation in diverse groups is needed.

Reimbursement for a Broader Array of Services in Coordinated Specialty Care for Early Psychosis.

Despite the growing evidence supporting the benefits of coordinated specialty care (CSC) for early psychosis, access to this multimodal, evidence-based program in the United States has been hindered by a lack of funding for core CSC services and activities. The recent approval of team-based reimbursement codes by the Centers for Medicare and Medicaid Services has the potential to fund substantially more CSC services for clients with insurance coverage that accepts the new team-based billing codes. This streamlined and more inclusive billing strategy may reduce administrative burden and support the financial viability of CSC programs.

The Need to Adapt the Psychiatric Clinical Assessment to the Digital Age: A Practical Approach.

The use of electronic devices and social media is becoming a ubiquitous part of most people's lives. Although researchers are exploring the sequelae of such use, little attention has been given to the importance of digital media use in routine psychiatric assessments of patients. The nature of technology use is relevant to understanding a patient's lifestyle and activities, the same way that it is important to evaluate the patient's occupation, functioning, and general activities. The authors propose a framework for psychiatric inquiry into digital media use, emphasizing that such inquiry should focus on quality of use, including emotional and behavioral consequences, rather than simply the amount of use.

Usability and Feasibility of the Antipsychotic Medication Decision Aid in a Community Program for First-Episode Psychosis.

OBJECTIVE: Although antipsychotic medications are considered first-line treatment for psychosis, rates of discontinuation and nonadherence are high, and debate persists about their use. This pilot study aimed to explore the usability, feasibility, and potential impact of a shared decision making (SDM) intervention, the Antipsychotic Medication Decision Aid (APM-DA), for decisions about use of antipsychotic medications. METHODS: A pilot randomized controlled trial was conducted with 17 participants in a first-episode psychosis program. Nine participants received the APM-DA, and eight received usual care. RESULTS: After their appointments, intervention group participants had less decisional conflict and greater satisfaction with decisions than control group participants had. Use of the APM-DA did not increase appointment length. Comparison of the intervention outcomes with the control outcomes was limited because of the small sample. CONCLUSIONS: The results support the feasibility and usability of an SDM process via the use of the APM-DA in routine community psychosis care.

Randomized Controlled Trial of a Brief Video Intervention to Reduce Self-Stigma of Mental Illness.

Objective: Self-stigma, a phenomenon wherein individuals internalize self-directed negative stereotypes about mental illness, is associated with negative outcomes related to recovery. This randomized controlled study assessed the efficacy of a brief social contact-based video intervention in reducing self-stigma in a large sample of individuals ages 18-35 endorsing an ongoing mental health condition. We hypothesized that the brief video would reduce self-stigma.Methods: In January and February 2023, we recruited and assigned 1,214 participants to a brief video-based intervention depicting a young individual living with mental illness sharing his personal story or to a non-intervention control. In the 2-minute video, informed by focus groups, a young individual described struggles with mental illness symptoms; this was balanced with descriptions of living a meaningful and productive life. Self-stigma assessments (Stereotype Endorsement, Alienation, Stigma Resistance, Perceived Devaluation Discrimination, Secrecy, and Recovery Assessment Scale) were conducted pre- and post-intervention and at 30-day follow-up.Results: A 2 ✕ 3 group-by-time analysis of variance showed that mean self-stigma scores decreased in the intervention arm relative to control across 5 of 6 self-stigma domains: Stereotype Endorsement (P = .006), Alienation (P < .001), Stigma Resistance (P = .004), Secrecy (P < .001), and Recovery Assessment Scale (P < .001). Cohen d effect sizes ranged from 0.22 to 0.46 for baseline to post-intervention changes. Baseline and 30-day follow-up assessments did not significantly differ.Conclusions: A 2-minute social contact-based video intervention effectively yielded an immediate but not a lasting decrease in self-stigma among young individuals with ongoing mental health conditions. This is the first study to examine the effect of a video intervention on self-stigma. Future trials of self-stigma treatment interventions should explore whether combining existing interventions with brief videos enhances intervention effects.Trial Registration: NCT05878470.

The role of income and emotional engagement in the efficacy of a brief help-seeking video intervention for essential workers.

BACKGROUND: Recently we showed that a brief video-based intervention can improve openness to help-seeking and decrease treatment-related stigma among essential workers, particularly for female and Black individuals viewing demographically matched protagonists. The current randomized controlled trial explored two additional factors which may enhance the efficacy of this intervention: income level, known to be associated with help-seeking, and emotional engagement, which may enhance a person's ability to engage with the intervention. We hypothesized that income level and emotional engagement would correlate with changes in openness to help-seeking ("openness") and stigma. METHODS: Essential workers (N = 1405) randomly viewed a control video or a brief video of an actor portraying an essential worker describing COVID-19-related anxiety and depression and treatment benefits. Openness and stigma were assessed at baseline, post-intervention, and 30-day follow-up, with emotional engagement assessed post-intervention. RESULTS: The brief video intervention demonstrated immediate increases in openness (p < 0.001, Cohen's d = 0.39) and decreases in stigma (p < 0.001, d = 0.14) compared to the control. Reported income level affected neither dependent variable. Participants who scored higher on the emotional engagement scale reported greater change in openness and stigma. LIMITATIONS: Use of a crowdsourcing platform may limit generalizability. CONCLUSIONS: The 3-min video showed modest effect sizes for immediate increased openness and reduced stigma, with greater emotional engagement heightening the effect, suggesting a possible mediator to the intervention. Income level did not affect intervention outcomes. Research should explore the role of income by adding income-related content to the brief-video interventions and assessing whether links to referrals could foster immediate behavioral change. TRIAL REGISTRATION: NCT04964570.

Implementation of Cognitive Health Services in Large Systems of Care: Highlights From Coordinated Specialty Care for First Episode Psychosis.

BACKGROUND AND HYPOTHESIS: With increasing recognition of the importance of cognitive health for recovery in people with psychosis, questions arise as to how to implement cognitive health services in large systems of care. This paper describes the implementation of cognitive health services in OnTrackNY (OTNY), a network of clinics delivering a Coordinated Specialty Care treatment model for early psychosis, with the goal of documenting the processes, challenges, and useful adaptations. STUDY DESIGN: In 2018, OTNY piloted a Cognitive Health Toolkit for implementation across 18 affiliated clinics. The toolkit intended to identify the cognitive health needs of individuals early in the course of psychosis and to integrate cognitive health into the vocabulary of wellness and recovery. Implementation involved creating mechanisms for staff training and support to, in turn, help participants improve how they use cognitive skills in daily life. STUDY RESULTS: The toolkit was disseminated to all 28 OTNY programs throughout New York state by 2023. When simple assessment and decision-making tools were embedded in routine care practices, the majority of participants identified that improving memory, attention, and critical thinking skills would be helpful. Consistently, about 70% of those asked wanted to learn more about how to better their cognitive health. CONCLUSIONS: Cognitive health services can be implemented in large systems of care that provide a multi-level system of implementation supports. Organizational facilitators of implementation include a training program to educate about cognitive health and the delivery of cognitive health interventions, and embedded quality assurance monitoring and improvement activities.

Examining the Effectiveness of a Digital Media Campaign at Reducing the Duration of Untreated Psychosis in New York State: Results From a Stepped-wedge Randomized Controlled Trial.

BACKGROUND AND HYPOTHESIS: Longer duration of untreated psychosis (DUP) predicts worse outcomes in First Episode Psychosis (FEP). Searching online represents one of the first proactive step toward treatment initiation for many, yet few studies have informed how best to support FEP youth as they engage in early online help-seeking steps to care. STUDY DESIGN: Using a stepped-wedge randomized design, this project evaluated the effectiveness of a digital marketing campaign at reducing DUP and raising rates of referrals to FEP services by proactively targeting and engaging prospective patients and their adult allies online. STUDY RESULTS: Throughout the 18-month campaign, 41 372 individuals visited our website, and 371 advanced to remote clinical assessment (median age = 24.4), including 53 allies and 318 youth. Among those assessed (n = 371), 53 individuals (14.3%) reported symptoms consistent with psychotic spectrum disorders (62.2% female, mean age 20.7 years) including 39 (10.5%) reporting symptoms consistent with either Clinical High Risk (ie, attenuated psychotic symptoms; n = 26) or FEP (n = 13). Among those with either suspected CHR or FEP (n = 39), 20 (51.3%) successfully connected with care. The campaign did not result in significant differences in DUP. CONCLUSION: This study highlights the potential to leverage digital media to help identify and engage youth with early psychosis online. However, despite its potential, online education and professional support alone are not yet sufficient to expedite treatment initiation and reduce DUP.

"It's Tough to Be a Black Man with Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma.

BACKGROUND AND HYPOTHESIS: Racial discrimination and public stigma toward Black individuals living with schizophrenia create disparities in treatment-seeking and engagement. Brief, social-contact-based video interventions efficaciously reduce stigma. It remains unclear whether including racial identity experiences in video narrative yields greater stigma reduction. We hypothesized that we would replicate findings showing sustained stigma reduction in video-intervention groups vs control and that Black participants would show greater stigma reduction and emotional engagement than non-Black participants only for a racial-insights video presenting a Black protagonist. STUDY DESIGN: Recruiting using a crowdsourcing platform, we randomized 1351 participants ages 18-30 to (a) brief video-based intervention, (b) racial-insights-focused brief video, or (c) non-intervention control, with baseline, post-intervention, and 30-day follow-up assessments. In 2-minute videos, a young Black protagonist described symptoms, personal struggles, and recovery from schizophrenia, with or without mentioning race-related experiences. STUDY RESULTS: A 3 × 3 ANOVA showed a significant group-by-time interaction for total scores of each of five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery (all P < .001). Linear mixed modeling showed a greater reduction in stigma from baseline to post-intervention among Black than non-Black participants in the racial insights video group for the social distance and social restriction domains. CONCLUSIONS: This randomized controlled trial replicated and expanded previous findings, showing the anti-stigma effects of a brief video tailored to race-related experiences. This underscores the importance of personalized, culturally relevant narratives, especially for marginalized groups who, more attuned to prejudice and discrimination, may particularly value identification and solidarity. Future studies should explore mediators/moderators to improve intervention efficacy.

Community- and Program-Level Predictors of Funding Streams Used by Coordinated Specialty Care Programs.

OBJECTIVE: Although coordinated specialty care (CSC) is an effective service model to address first-episode psychosis, CSC is not widely accessible in the United States, and funding for this service model often remains challenging. The authors examined whether community- or program-level factors predict the use of public and private funding streams in a national sample of 34 CSC programs in 22 U.S. states and territories. METHODS: As part of a larger mixed-methods study, CSC program leaders completed a brief questionnaire regarding funding sources. Statistical modeling was used to examine program- and community-level predictors of the use of funding sources. RESULTS: Most CSC programs (20 of 34, 59%) reported that Mental Health Block Grant (MHBG) set-aside funds accounted for more than half of their total funding, and 11 of these programs reported that these funds contributed to >75% of their funding. Programs ≤5 years old were more likely to rely on MHBG set-aside funds. Programs in Medicaid expansion states were more likely to rely on Medicaid funding than programs in nonexpansion states. Programs in higher-income service catchment areas used more state funds than did those in lower-income areas, and among programs in lower-income service catchment areas, those that were >4 years old were more likely than those ≤4 years old to rely on state funds other than Medicaid. CONCLUSIONS: CSC programs remain largely dependent on MHBG set-aside funding. Some programs have diversified their funding streams, most notably by including more Medicaid and other state funding. A more comprehensive funding approach is needed to reduce reliance on the MHBG set-aside funds.

Evidence-Based Supported Employment for Individuals With Obsessive-Compulsive Disorder.

Individuals with obsessive-compulsive disorder (OCD), a chronic and disabling psychiatric disorder, experience high rates of occupational impairment. OCD symptoms commonly affect individuals' vocational aspirations and result in disability and the need for financial support, problems that are not addressed by current clinical practice guideline recommendations for treating OCD. This Open Forum highlights the need to address occupational impairment caused by OCD and makes the case for formally evaluating whether evidence-based supported employment can help individuals with OCD find and succeed in meaningful work.