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Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early
John M Kane1, Delbert G Robinson1, Nina R Schooler1
1From the Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, N.Y.; the Departments of Psychiatry and of Molecular Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, and the Department of Mathematics, Hofstra University, Hempstead, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y.; the Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, N.Y.; the Departments of Occupational Therapy, Psychiatry, and Psychology, Center for Psychiatric Rehabilitation, Boston University, Boston; the Departments of Psychology and of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, N.C.; the School of Psychology, Australian Catholic University, Melbourne; the Department of Psychiatry, Yale Medical School, and Yale School of Public Health, New Haven, Conn.; the Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada; the Geisel School of Medicine, Dartmouth College, Lebanon, N.H.; the Bureau of Behavioral Health, New Hampshire Department of Health and Human Services, Concord, N.H.; Nathan Kline Institute, Orangeburg, N.Y.; Minnesota Center for Chemical and Mental Health, School of Social Work, University of Minnesota, St. Paul; the Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles; University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Tex.; and the Division of Services and Intervention Research, NIMH, Rockville, Md.
NAVIGATE, a team-based treatment for first-episode psychosis, improved quality of life and clinical outcomes compared to community care. Early intervention is key, with better results for those with shorter durations of untreated psychosis.
Area of Science:
- Psychiatry
- Mental Health Services Research
- Clinical Psychology
Background:
- First-episode psychosis (FEP) requires effective, accessible treatment strategies.
- The NAVIGATE program offers a comprehensive, multidisciplinary, team-based approach for FEP.
- Implementation in U.S. healthcare systems is crucial for widespread impact.
Purpose of the Study:
- To compare the effectiveness of the NAVIGATE program against standard community care for FEP.
- To assess the impact on quality of life as the primary outcome.
- To evaluate secondary outcomes including psychopathology and functional engagement.
Main Methods:
- A randomized controlled trial involving 34 clinics across 21 states.
- Participants (N=404) with FEP (≤6 months antipsychotic treatment) were followed for ≥2 years.
- Outcomes were assessed remotely by masked raters using validated measures, including the Heinrichs-Carpenter Quality of Life Scale.
Main Results:
- NAVIGATE participants showed longer treatment retention, improved quality of life, and reduced psychopathology compared to community care.
- Greater involvement in work and school was observed in the NAVIGATE group.
- The median duration of untreated psychosis was 74 weeks; shorter durations (<74 weeks) correlated with better outcomes in the NAVIGATE group.
Conclusions:
- Comprehensive, team-based care like NAVIGATE is implementable in U.S. community settings.
- The NAVIGATE program significantly improves functional and clinical outcomes for individuals with FEP.
- Early intervention, indicated by shorter durations of untreated psychosis, amplifies treatment benefits.

