Preliminary Evaluation of Washington State's Early Intervention Program for First-Episode Psychosis.

OBJECTIVE: Early intervention programs are designed to address the needs of youths experiencing first-episode psychosis (FEP). Washington State developed New Journeys, a network of coordinated specialty care programs for FEP. In this study, the authors have outlined components of the New Journeys model and preliminary findings since its initial implementation. METHODS: Youths and young adults diagnosed as having psychosis (N=112) completed measures at and after intake on a range of mental health assessments and functional outcomes for the first 12 months of treatment. Administrative data including state-funded emergency department and psychiatric hospitalizations were assessed 24 months before and after intake. Generalized estimating equations were used to assess change over time on multiple measures of mental health status. RESULTS: Compared with their condition at intake, clients had significant decreases in symptoms of anxiety (ß=-2.48, p<0.001), psychotic experiences (ß=-3.37, p<0.05), and clinician-rated psychotic symptoms (ß=-1.47, p<0.05) during treatment. Additionally, quality of life (ß=-5.95, p<0.001) and school attendance (odds ratio=1.42, p<0.05) significantly improved during treatment. Administrative data indicated that postintake, clients were less likely to visit the emergency department for psychiatric reasons (ß=0.22, p<0.05), utilize community psychiatric inpatient services (ß=0.31, p<0.001), and utilize public assistance (ß=0.71, p<0.05) compared with 24 months before intake. CONCLUSIONS: New Journeys clients experienced improved clinical and functional outcomes during their first year of treatment, and rates of state-funded service utilization decreased during their treatment.

Pilot Study of an Integrated Smartphone and Breathalyzer Contingency Management Intervention for Alcohol Use.

INTRODUCTION: Monitoring devices provide a platform for assessing alcohol use and implementing alcohol interventions. This pilot study focused on assessing the early-stage feasibility and usability of a smartphone-based application and breathalyzer used in a contingency management intervention for alcohol use. METHODS: Six nontreatment-seeking participants completed a 9-week ABA within-subjects designed intervention targeting alcohol use. Participants submitted 2 to 8 alcohol breathalyzer samples per day and completed self-report drinking measures and usability assessments. During the A phases (weeks 1-3 and 8-9), participants received reinforces for submitting breathalyzer samples, regardless of their results. During the contingency management, B phase (weeks 4-7), and received reinforcers only when negative breathalyzer samples were submitted. Usability assessment of the application was also conducted during weeks 2 and 9. RESULTS: Participants in the contingent B phase (49%) were more likely to submit alcohol-negative breathalyzer samples compared with the noncontingent A phases (27%; P < 0.001). Usability assessment of the application varied, and participants noted several technical concerns. CONCLUSION: The use of smartphones and breathalyzers may be a practical solution to extend the reach of contingency management during and after treatment.

Harms to Consumers of Inpatient Psychiatric Facilities in the United States: An Analysis of News Articles.

Inpatient psychiatric facilities in the United States lack systematic regulation and monitoring of a variety of patient safety concerns. We conducted a qualitative analysis of 61 news articles to identify common causes and types of harms within inpatient psychiatric facilities, with a focus on physical harm. The news articles reported on patient self-harm, patient-patient violence, and violence between patients and staff, noting that youth, older adults, and veterans were especially vulnerable. Harms occurred throughout the care continuum - at admission, during the inpatient stay, and at discharge - and retaliation towards whistleblowers deterred facility accountability. We recommend 1) addressing staffing shortages, 2) instituting systematic monitoring of critical incidents and the experiences of consumers and staff, 3) improving both inpatient safety and post-discharge community supports, and 4) continued journalistic coverage of harms within inpatient psychiatric facilities.