Predictors of Persistent Symptoms in People in Coordinated Specialty Care Services for Early Psychosis in New York State.

OBJECTIVE: This study aimed to determine the prevalence and predictors of persistent transdiagnostic symptoms in the first year of enrollment in OnTrackNY, a coordinated specialty care (CSC) program for individuals with recent-onset nonaffective psychosis. METHODS: Three groups were defined by using the Mental Illness Research, Education, and Clinical Centers Global Assessment of Functioning symptom subscale: persistently symptomatic, intermittent, and improving to moderate. The authors compared groups on baseline demographic characteristics, family and living situation, clinical measures, and pathways to care. RESULTS: Of 1,129 eligible participants, 12% were persistently symptomatic through follow-up. Being medication nonadherent, being homeless, having a diagnosis of schizophrenia, and having a longer duration between symptom onset and program enrollment were predictive of persistent symptoms during the first year of CSC. CONCLUSIONS: Findings suggest that despite intensive treatment, severe symptoms in young people with psychosis may persist because of economic barriers, treatment delays, and lack of stability.

Unmet Opportunity: Intensive Care Transition Intervention for Individuals With Serious Medical-Psychiatric Illnesses.

Individuals with serious mental illnesses and poorly managed medical conditions known as serious medical-psychiatric illnesses (SMPIs) are vulnerable to disruptions in care, resulting in poor outcomes. Intensive integrated care management approaches are indicated when these individuals are hospitalized on medical-surgical inpatient units in order to ensure continuity of medical and psychiatric services. This column describes a manualized intervention for hospitalized individuals with SMPIs that was developed in a National Institute of Mental Health ALACRITY research center. The approach uses a critical time intervention model incorporating motivational interviewing and shared decision making to maximize engagement and continuity of care for individuals with SMPIs.

Recent violence and legal involvement among young adults with early psychosis enrolled in Coordinated Specialty Care.

AIM: Individuals with serious mental illnesses have a small increased risk of engaging in violence or legal involvement compared to the general population. This seems to be particularly true for young adults experiencing early stages of psychosis. This study analysed the prevalence of and risk factors for reports of violence and legal involvement in a sample of young adults receiving Coordinated Specialty Care for early non-affective psychosis. METHODS: A total of 373 young adults (ages 16-30) within 2 years of the onset of non-affective psychosis were enrolled in 10 Coordinated Specialty Care sites in New York State from October 2013 to August 2016. Baseline violent ideation or behaviour and legal involvement was described and predictors identified. RESULTS: Approximately one-quarter of individuals had either recent violent ideation or behaviour at baseline (n = 90, 24.6%); nearly one-tenth of the sample reported recent legal involvement (n = 33, 9.0%). Individuals with violent ideation or behaviour had lower levels of education and were less likely to be working. Those with recent legal involvement were more likely to be male and more likely to have substance use (alcohol, cannabis and other drugs). CONCLUSIONS: The overall rate of recent violent ideation or behaviour is similar to other studies; up to one-third of individuals experiencing a first-episode of psychosis (FEP) report violence. Recent legal involvement was strongly associated with substance use. This study presents insight into violence and legal involvement among individuals with FEP and indicates the need for further research.

Factors Influencing Buprenorphine Prescribing among Physicians in New York State.

BACKGROUND: Increasing access to buprenorphine is an important strategy for curtailing the opioid epidemic. Research is needed to understand what facilitates prescribing among waivered physicians and how to increase the willingness and capacity to prescribe. This study describes prescribing patterns in a sample of buprenorphine-waivered physicians in New York (NY) in 2016 and examines factors influencing prescribing capacity among waivered providers. METHODS: Surveys were mailed to a random sample of 300 physicians with DEA waivers to prescribe buprenorphine in NY which assessed demographics, practice characteristics, buprenorphine prescribing patterns, and barriers/facilitators to prescribing buprenorphine. Analyses include simple logistic regression to calculate the odds ratio, 95% confidence intervals, and p values, respectively, to examine differences in individual predictors among physicians that were actively prescribing buprenorphine and those that were not. RESULTS: 91 physicians responded to the survey, and 65% indicated they were currently prescribing buprenorphine. The mean patient census among physicians waivered to prescribe to 30 patients was 9.6 (SD = 9.7, median = 5), and to 100 patients, it was 60.5 (SD = 38.9, median = 72.5). Common facilitators included access to psychosocial referrals and better reimbursement, while inadequate resources, lack of time, and prior authorizations were the most common barriers. CONCLUSIONS: In addition to increasing the number of waivered physicians, policy-makers should provide enhanced training and implementation support for waivered physicians to start prescribing and facilitate continued and expanded prescribing among those already doing so.

Ending the Opioid Epidemic by Changing the Culture.

The opioid epidemic continues to take thousands of lives each year in the United States, more than motor vehicle accidents and suicides combined. Real solutions, based on science, will require a culture shift in the way that we think about and respond to substance use disorders, in the healthcare system and in our communities. Just more of the same approach will not turn the tide. This article discusses how to better understand the use of psychoactive drugs and how prevention, treatment and policy change can disseminate evidence-based practices, fight stigma, and advance harm reduction; not only as strategies to improve outcomes, but as a social justice movement as well.

Results of a Coordinated Specialty Care Program for Early Psychosis and Predictors of Outcomes.

OBJECTIVE: This study prospectively evaluated outcomes of OnTrackNY, a statewide coordinated specialty care (CSC) program for treatment of early psychosis in community settings, as well as predictors of outcomes. METHODS: The sample included 325 individuals ages 16-30 with recent-onset nonaffective psychosis who were enrolled in OnTrackNY and who had at least one three-month follow-up. Clinicians provided data at baseline and quarterly up to one year. Domains assessed included demographic and clinical characteristics, social and occupational functioning, medications, suicidality and violence, hospitalization, and time to intervention. Primary outcomes included the symptoms, occupational functioning, and social functioning scales of the Global Assessment of Functioning (GAF), as adapted by the U.S. Department of Veterans Affairs Mental Illness Research, Education and Clinical Center; education and employment status; and psychiatric hospitalization rate. RESULTS: Education and employment rates increased from 40% to 80% by six months, hospitalization rates decreased from 70% to 10% by three months, and improvement in GAF scores continued for 12 months. Female gender, non-Hispanic white race-ethnicity, and more education at baseline predicted better education and employment status at follow-up. CONCLUSIONS: Individuals with early psychosis receiving CSC achieved significant improvements in education and employment and experienced a decrease in hospitalization rate. Demographic variables and baseline education predicted education and employment outcomes. CSC teams should make particular effort to support the occupational goals of individuals at increased risk of not engaging in work or school, including male participants and participants from racial and ethnic minority groups.

An update on supported employment for people with severe mental illness.

PURPOSE OF REVIEW: Individual Placement and Support (IPS) is an effective intervention for helping people with severe mental illness obtain competitive employment, yet it has not been widely implemented. This review will examine and summarize the latest research on IPS. RECENT FINDINGS: As the effectiveness of IPS has been well established in the literature, newer research is exploring nonvocational outcomes, such as quality of life and mental health services utilization and expanding the reach of IPS to include different countries and different population groups. There is also a growing literature exploring the cost-effectiveness of IPS compared with traditional vocational services, which has favored IPS. By far, the area of research that has expanded the most is aimed at enhancing IPS outcomes, at both the intervention level and the client level. Researchers are exploring the variance in IPS outcomes as a means of increasing competitive employment rates with IPS. SUMMARY: Although the field of research continues to expand, it is clear that many barriers remain to broad implementation of IPS. The solution goes beyond further research and involves policies and practices that support a recovery oriented mental healthcare system.

Characteristics of complementary and alternative medicine use among adults with current asthma, 2006.

BACKGROUND: Prevalence estimates of complementary and alternative medicine (CAM) use among persons with asthma vary widely; prior studies reported that patients do not discuss CAM use with their physicians. The authors examined the prevalence and characteristics of CAM use among adults with asthma to prepare physicians to discuss CAM use with their patients. METHODS: CAM use among adults with current asthma was analyzed using the 2006 Behavioral Risk Factor Surveillance System (BRFSS) data from a subset of 25 states that completed the follow-up Asthma Callback Survey. CAM use was defined as a "Yes" response to the use of one or more CAM therapies to control asthma during the previous 12 months. Statistics were calculated using SAS v9.2 Proc Surveyfreq to provide weighted estimates and account for complex sample design. RESULTS: The prevalence of CAM use among adults with asthma was 39.6% (95% confidence interval [CI] = 36.9-42.3). There was no significant association with CAM use by sex, race/ethnicity, age, education, or geographic region. After adjusting for demographics and region, CAM use was significantly higher among persons with (1) financial barriers to asthma care (odds ratio [OR] = 2.8, 95% CI = 1.9-4.1); (2) an emergency room (ER) visit due to asthma (OR = 1.7 95% CI = 1.1-2.6); and (3) > or =14 asthma-associated disability days during the previous year (OR = 2.1, 95% CI = 1.4-3.1). CONCLUSIONS: CAM use is common among adults with asthma. It is associated with financial barriers to asthma care and poor asthma control. Physicians should discuss CAM use with their asthma patients.