Symposia
Health Care System / Public Policy
Emily R. Kline, Ph.D.
Boston University School of Medicine
Boston, Massachusetts
Background: A large body of research supports a consensus that reducing the duration of untreated psychosis (“DUP”) offers patients with psychotic disorders improved odds of meaningful recovery. However, initiatives aimed at reducing individual and population-wide DUP have met with mixed results. This talk will describe two studies utilizing different and potentially complementary strategies for reducing DUP: promoting screening for psychosis and partnering with families to support treatment initiation.
Methods (study 1): In the first study, early psychosis specialists offered generalist clinicians a brief, one-time training on screening for, recognizing, and triaging symptoms of emergent psychosis. Clinicians were assessed before and after the training.
Results (study 1): Clinicians who completed follow-up assessments (n = 36) significantly increased their screening for psychosis and rated themselves as more knowledgeable about how to refer appropriate patients to early psychosis specialty care, relative to their pre-training self-assessments.
Methods (study 2): In the second study, caregivers of individuals with early-course psychotic disorders (n = 70) received coaching in using adapted motivational interviewing skills, with the goal of supporting their child or sibling’s treatment admission and adherence. Caregivers were assessed before and after receiving the motivational interviewing coaching intervention.
Results (study 2): Caregivers found the coaching to be relevant, feasible, and helpful. They were able to learn and demonstrate proficiency using the MI skills. Caregivers’ self-reported stress, expressed emotion, and conflict with their children decreased from pre- to post-intervention, and their self-efficacy improved. Rates of treatment engagement and adherence for their family members – that is, the individuals with early-course psychosis – also improved from pre- to post- intervention.
Conclusions: Brief, strategic training approaches for these two populations - generalist clinicians who may encounter individuals with emergent psychosis, and caregivers who must support patients’ initiation of and engagement with mental health services – represent promising strategies for reducing duration of untreated psychosis and achieving better treatment outcomes.