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Beyond training providers prior to the roll-out of coordinated specialty care (CSC) for first-episode psychosis in clinical settings, implementation support for data-informed care remains an area that has received very little attention. The current paper describes the development and refinement of implementation support for the data-driven components of care in the New Journeys network, Washington State's CSC model for psychosis, comprised of 14 CSC programs. Using the Evidence-Based System for Innovation Support Logic Model, this paper outlines the individual components for implementation support, tools, training, technical assistance, and quality improvement/evaluation that have been developed for the New Journeys network. We present examples of modifications that have occurred over nine years to address the needs of clients, providers, and state-level network administrators to facilitate the data-driven components of care. We conclude with recommendations based on lessons learned in Washington State aimed at improving implementation of data-driven care in CSC models throughout the USA.
The purpose of this work was to outline the development and strategies used to provide implementation support for the data-driven components of coordinated specialty care programs for early psychosis. We describe the individual use of tools, training, technical assistance, and quality improvement, and how these strategies are used collectively. Based on detailed notes from meetings and correspondence from providers and state-level administrators we present modifications that have occurred to address barriers and needs, essentially using quantitative and qualitative data to inform quality improvement. We then present lessons learned that could be helpful for existing and new coordinated specialty care networks.
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Trastornos Psicóticos , Humanos , WashingtónRESUMEN
Engagement in services is a core element to successful outcomes for service users and programs. In coordinated specialty care (CSC) programs, designed for individuals experiencing first-episode psychosis, engagement has only been measured programmatically and not by service component. This qualitative study sought to explore provider perspectives on service user engagement in service components of CSC. Semistructured interviews were conducted with 20 service providers from five community-based early intervention programs for psychosis in the United States. Interviews were recorded and transcribed verbatim, and thematic analysis was used to analyze the data collected. Provider participants described barriers and facilitators that contribute to disengagement or engagement in four service components within early intervention programs: individual psychotherapy, family education and support, medication management, and vocational services. Barriers identified included substance use, stigma, trauma, and external pressures. Identified barriers to engagement in CSC were both unique to individual components and cut across them. By better understanding the complexity of barriers and their intersections within and across CSC components, there can be more effective policy and program development to reduce disengagement and hopefully increase positive outcomes for service users. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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BACKGROUND: Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. METHODS: The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. DISCUSSION: Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity.
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In recent years, coordinated specialty care (CSC) providers have worked to harmonize and deliver data collection measures across programs so that they can provide data that enable measurement-informed care. However, the strategies that can effectively support the integration of a core assessment battery in clinical care remain unclear. This column presents an evaluation of a multifaceted technical assistance strategy for the delivery and completion of an assessment battery in nine CSC programs (N=247 clients). The findings suggest that a multifaceted technical assistance strategy can effectively support the integration of a comprehensive assessment battery in the care delivered by providers. Similar technical assistance strategies may assist CSC providers as they move toward providing data-driven care in an effort to improve quality of care.
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Pacific Northwest National Laboratory (PNNL) staff developed the Radionuclide Aerosol Sampler Analyzer (RASA) for worldwide aerosol monitoring in the 1990s. Recently, researchers at PNNL and Creare, LLC, have investigated possibilities for how RASA could be improved, based on lessons learned from more than 15 years of continuous operation, including during the Fukushima Daiichi Nuclear Power Plant disaster. Key themes addressed in upgrade possibilities include having a modular approach to additional radionuclide measurements, optimizing the sampling/analyzing times to improve detection location capabilities, and reducing power consumption by using electrostatic collection versus classic filtration collection. These individual efforts have been made in a modular context that might constitute retrofits to the existing RASA, modular components that could improve a manual monitoring approach, or a completely new RASA. Substantial optimization of the detection and location capabilities of an aerosol network is possible and new missions could be addressed by including additional measurements.
