Design, Implementation, and Assessment of a Public Comprehensive Specialty Care Program for Early Psychosis.

INTRODUCTION: Promising outcomes from early psychosis intervention programs have prompted implementation of early psychosis initiatives nationwide through federal and state funding. The Enhanced Program for Early Psychosis (ePEP) model in north Texas is among the first, if not the first, of these state-funded initiatives to provide detailed reporting of its development and implementation. METHODS: Restrictive inclusion/exclusion criteria with a 1% eligibility rate resulted in a highly disadvantaged, predominantly minority sample with low educational attainment, prevalent mood disorders and substance misuse, and criminal justice involvement. Program progress was assessed over 1 year through structured diagnostic assessments and measures of psychotic symptoms, depression and anxiety symptoms, psychosocial functioning, and service utilization and costs. RESULTS: Implementation challenges included strict income/insurance inclusion and disqualification criteria for program participation, hiring and staff turnover problems, client transportation, and lack of available family to participate in family interventions. Despite these challenges, patients showed reduction in negative psychotic symptoms, hospitalization rates decreased from 29% to 5%, full-time employment improved from 6% to 24%, and probation/parole decreased from 24% to 5%. The mean 1-year per-patient cost was $10,639. Reduced negative symptoms and hospitalizations were associated with service use. DISCUSSION: The development and implementation of this pioneering state-funded early psychosis program, based on the National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative, provide experience and results to inform the implementation of future programs. Its demonstrated success, in spite of many implementation challenges, suggests the potential for future research, including randomized controlled trials to demonstrate substantial benefit and cost-effectiveness of early psychosis programs in real-world settings.

Parent-Reported Child Reactions to the September 11, 2001 World Trade Center Attacks (New York USA) in Relation to Parent Post-Disaster Psychopathology Three Years After the Event.

IntroductionParents are a primary support for children following disasters, even though they face numerous challenges in addressing the physical and social consequences of an event. Parents who are directly exposed to a disaster and those who develop psychiatric disorders post-event are likely to be especially challenged and may be limited in their ability to support their children. This Brief Report describes a pilot study of survivors of the September 11, 2001 World Trade Center (New York USA) attacks who reported their own psychosocial consequences and the reactions of their children three years post-event.HypothesesThe primary hypothesis of the study was that children's September 11th reactions would be associated with their parents' psychiatric status. Secondary hypotheses were that the children's disaster reactions would be associated with direct exposure to the disaster in children and/or their parents, parent-child separation due to the disaster, and disaster-related school absence. METHODS: Approximately three years after the 2001 World Trade Center attacks, 116 parents recruited from disaster-affected or disaster-related organizations were assessed using structured diagnostic interviews and queried about their children's (188 youths, aged three to 17 years at the time of the attacks) posttraumatic stress symptoms and behavioral changes. RESULTS: Almost one-half of the parents had a post-disaster psychiatric disorder, including major depression in 27% and disaster-related posttraumatic stress disorder (PTSD) in 11%. More than three-fourths of the children had at least one disaster-related posttraumatic stress symptom, and more than one-half experienced at least one post-disaster behavior change. A minority of the children were reported to have increased school behavior problems or a decline in their grades. Key correlates of children's disaster-related posttraumatic stress symptoms and post-disaster behavior changes were parent-child separation due to the disaster and parental post-disaster psychiatric disorders. CONCLUSION: Because parents provide primary caretaking and support for children post-disaster, addressing the needs of parents is critical to their ability to assist their children. Reducing parents' symptoms should increase their emotional availability and enhance their ability to address the needs of their children. Given the challenges in providing disaster interventions directly to children, especially when resources are limited, addressing parent psychopathology and distress (even in the absence of focusing on children's symptoms) may benefit children. PfefferbaumB, SimicZ, NorthCS. Parent-reported child reactions to the September 11, 2001, World Trade Center attacks (New York USA) in relation to parent post-disaster psychopathology three years after the event. Prehosp Disaster Med. 2018;33(5):558-564.

Parent-reported behavioral and emotional responses of children to disaster and parental psychopathology.

Child disaster mental health research has been largely limited by investigation of one disaster at a time and inconsistent methods across different studies. This study assessed 160 survivors of 3 disasters with structured diagnostic interviews, asking about the behavioral and emotional disaster reactions their 266 children of ages 3-17. Most children had ≥1 postdisaster behavior change or disaster-related posttraumatic stress symptom. The children's postdisaster behavioral and emotional problems were associated with parental postdisaster psychopathology. The results underscore the importance of asking disaster survivors about their children's disaster reactions and considering parental disaster experiences and reactions in addressing their children's reactions.