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EAST helps people with psychosis out west

June 1, 2008
by Tamara Sale, MA
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The program reaches out to people with early symptoms to help them avoid psychosis' devastating consequences

Mid-Valley Behavioral Care Network (MVBCN) is an intergovernmental Medicaid managed healthcare organization responsible for Linn, Marion, Polk, Tillamook, and Yamhill Counties in Oregon. In 1999, MVBCN hired prevention researcher Patricia Mrazek to identify evidence-based mental illness prevention models that MVBCN could implement. Because of concerns about high levels of disability associated with schizophrenia, MVBCN specifically sought prevention models related to psychosis.

Dr. Mrazek recommended MVBCN investigate the work of the Early Psychosis Prevention and Intervention Centre (EPPIC, now named ORYGEN) in Melbourne, Australia. ORYGEN is a leading international center for application of research around early intervention for schizophrenia.

After reviewing EPPIC's research, MVBCN created the Early Assessment and Support Team (EAST) in January 2001. Its goal is to prevent unnecessary trauma and disability associated with psychosis by offering the most effective treatment and support as early as possible. Building on EPPIC's guidelines, clinicians and agency leaders have systematically changed the early experience of individuals with schizophreniform and bipolar spectrum psychosis. EAST has served approximately 400 individuals and families.

Last year EAST began a partnership with The Robert Wood Johnson Foundation's (RWJF) Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP) to advance the work being done for prodromal and early first episode individuals. Also last year, the Oregon state legislature allocated $4.3 million to begin disseminating early psychosis intervention statewide. This past March, new programs began in 12 counties, with EAST taking the lead in technical assistance.

Early psychosis programs such as EPPIC/Orygen are standard practice throughout the British Commonwealth countries and Scandinavia but are virtually unknown in the United States. Early psychosis intervention in the United States has focused primarily on research-based prodromal studies.

RWJF is playing a leadership role in laying the research groundwork to make early psychosis intervention more broadly available through EDIPPP, which is spearheaded by the Maine Medical Center in Portland, Maine, and builds on the Portland Identification and Early Referral (PIER) Program. PIER is similar to EAST's approach, including the use of Assertive Community Treatment and Supported Employment guidelines as well as a strong research component.

Core Elements

EAST's approach includes the following core elements.

Community education. EAST offers community education focused on a positive, realistic understanding of psychosis as a health condition far more common than insulin-dependent diabetes and just as treatable. EAST educates teachers, doctors, parents, and others about the early symptoms. Success stories, and the willingness of numerous program graduates to speak openly, help form the foundation for growing community awareness and acceptance of people with severe mental illnesses.

Proactive outreach and engagement. EAST actively reaches out to individuals with early symptoms to engage them in a positive, voluntary relationship. EAST starts with the person's goals and interests, emphasizing individual success, choice, and self-efficacy. Diverse funding sources allow EAST to provide services regardless of ability to pay.

Shared explanatory model. EAST encourages the person to develop an active, empowered understanding of his/her own condition. EAST works with each individual to find words and shared understanding consistent with his world view, culture, and a belief in a likely positive future. EAST provides medical and scientific information, accounts from people who have recovered, and practical strategies for symptom management and making progress in life.

Partnerships with family members. These are key to EAST. Families are important members of the recovery team and are involved in all phases of assessment, treatment planning, and discharge planning. EAST encourages all families to participate in multifamily psychoeducation, whose core elements are sessions with families and individuals, educational workshops, and structured ongoing sessions focused on problem solving.

Transdisciplinary team. EAST operates through a team approach, in which members of individual disciplines inform each other and routinely cross functions. For example, all members of the team co-facilitate multifamily groups, are involved in medication discussions, and focus on supporting vocational/academic goals.

Counseling. Each individual is assigned a counselor who takes the lead in treatment planning, supportive counseling, and case management. EAST is developing mentor resources to supplement the counseling functions.

Occupational support. Most of EAST's services focus on supporting the person's progress in self-care, community connections, and academic/vocational goals. Occupational therapists help the team understand the person's unique functioning, how he processes cognitive and sensory information, and the types of accommodations he requires. Supported employment/education specialists help clarify and support career/academic goals and interests.