The History of Coordinated Specialty Care for Early Intervention in Psychosis in the United States: A Review of Effectiveness, Implementation, and Fidelity.

Coordinated Specialty Care (CSC) is a multidisciplinary team approach to providing care for young and emerging adults having their first episode of psychosis. CSC programs have expanded rapidly throughout the United States going from 12 programs in 2008 to over 160 programs a decade later. The purpose of this historical review is to document the process and conditions that led to the accelerated dissemination of these programs across the country. CSC models began in the US in the early 2000s, but nationwide expansion followed the 2008 Recovery After an Initial Schizophrenia Episode trial. As programs have grown, debates have risen about fidelity to CSC models. The challenges facing CSC programs today include lack of evidence on what are the core components of CSC and how fidelity monitoring relates to positive client outcomes.

Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy.

In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is. . ." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.

Exploring Knowledge Translation Concepts in U.S. Occupational Therapy Research: A Content Analysis.

IMPORTANCE: As a new Accreditation Council for Occupational Therapy Education® standard, knowledge translation (KT) is an important concept to occupational therapy. A better understanding of KT in occupational therapy research could inform its relevance to occupational therapy education, research, and practice. OBJECTIVE: To answer the question "To what extent does published U.S.-based occupational therapy research that is explicitly underpinned by a KT theory, model, or framework reflect processes and concepts outlined in the knowledge-to-action (KTA) framework?" DESIGN: A systematic search was conducted to purposively sample U.S.-based occupational therapy research. A content analysis of 11 articles explored concepts of the KTA framework. OUTCOMES AND MEASURES: KTA was used as a conceptual foundation. RESULTS: Multiple sources of data mapped onto concepts in the knowledge creation cycle and each of the first five concepts of the knowledge action cycle. We found that three concepts from the knowledge action cycle-monitor knowledge use, evaluate outcomes, and sustain knowledge use-were not well represented in the sample. CONCLUSIONS AND RELEVANCE: Future research on the monitoring, evaluation, and sustained use of occupational therapy interventions is needed. The adoption of new interventions is important, and the knowledge of how they are sustained in practice will facilitate the clinical integration of future interventions. What This Article Adds: Occupational therapy research that uses KT lacks an emphasis on monitoring and sustaining evidence-informed interventions. Future research on the integration of such interventions into clinical practice is needed so that best practices in occupational therapy can be promoted.

Early Intervention in Mental Health for Adolescents and Young Adults: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to describe the evidence for the effectiveness of early intervention to improve and maintain performance in occupations for youths with or at risk for serious mental illness (SMI). METHOD: Titles and abstracts of 670 articles were reviewed, 234 were retrieved for full review, and 30 met inclusion criteria. RESULTS: Moderate to strong evidence supports cognitive remediation (CR) and mixed evidence supports cognitive-behavioral therapy (CBT) as an adjunct modality to improve general functioning. Moderate to strong evidence supports use of supported employment and supported education (SE/E) to improve social and occupational outcomes in employment and academics. Strong evidence supports family psychoeducation (FPE) to prevent relapse and rehospitalization and improve problem-solving skills and general functioning. CONCLUSION: Occupational therapy practitioners should integrate CR, SE/E, and FPE into early intervention with youth with or at risk for SMI. In addition, CBT is an effective modality for use with this population.

Occupational Therapy: A Potential Solution to the Behavioral Health Workforce Shortage.

Occupational therapy practitioners (OTPs) are clinically prepared to treat patients with behavioral health conditions. Yet, many state and national policies defining qualified behavioral health providers do not include occupational therapy. In this Open Forum, the authors argue that OTPs should be considered qualified to work as behavioral health professionals, especially given the severe behavioral health workforce shortage in the United States. The authors summarize policy barriers preventing OTPs from working on behavioral health teams and the evidence to support their presence. They also propose a policy and advocacy agenda to include and recognize OTPs as members of the behavioral health workforce.

Implementation of occupational therapy within early intervention in psychosis services: Results from a national survey.

AIM: Occupational therapy plays an important role in fostering community participation in areas such as education, employment, leisure, and social relationships, yet its added value within early intervention in psychosis services, especially in the United States, remains poorly understood. The purpose of this research was to conduct a national survey of early intervention in psychosis programs to: (1) understand the role and unique contributions of occupational therapists to early intervention teams, and (2) identify barriers and supports to the implementation of occupational therapy services within these programs. METHODS: Fifty-one senior leaders from U.S.-based early intervention in psychosis programs participated in the national survey. The survey consisted of a series of closed and open-ended questions related to program staffing, the presence of specific services that fall within the occupational therapy scope of practice, and implementation barriers and supports. RESULTS: Despite there being strong interest in employing occupational therapists, a small proportion of programs (31%) reported having them on staff. Occupational therapists supported clients across multiple life areas and were significantly more likely than other team members to promote daily living activities (e.g., cooking) and to address sensory processing needs and challenges. Implementation was influenced by environmental/organizational and staff factors; the primary barrier was funding. CONCLUSIONS: Findings support the role occupational therapists may play in facilitating the community participation of clients of early intervention services, but significant barriers to implementation of occupational therapy services remain. Additional research is needed to further identify the impact of occupational therapy services within the early intervention model.

A pilot study of the Nutrition and Exercise for Wellness and Recovery (NEW-R): A weight loss program for individuals with serious mental illnesses.

OBJECTIVE: This purpose of this study was to evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention. METHOD: Using a pretest/posttest design, 18 participants recruited from a community-based mental health program were assessed at baseline, immediately following the intervention (8 weeks), and at 6-month follow-up. The intervention was delivered by an occupational therapist and occupational therapy graduate students and consisted of 8 weekly sessions lasting 2 hr. Outcomes included changes in weight, and levels of knowledge about nutrition and exercise. RESULTS: Participants lost an average of 3 pounds at immediate postintervention, and lost an average of 10 pounds at the 6-month follow-up. Participants also demonstrated significant increases in their knowledge about nutrition and physical activity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results of this study provide preliminary support for the impact of the NEW-R intervention on weight loss and knowledge about diet and exercise.