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Fidelity to Common Elements of Coordinated Specialty Care: Outcomes of Clients With First-Episode Psychosis
Abram Rosenblatt1, Preethy George1, Sushmita Shoma Ghose1
1Westat, Rockville, Maryland (Rosenblatt, George, Ghose, Zhu, Ren, Krenzke, Opsomer); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Dixon); School of Medicine, University of Maryland, Baltimore (Goldman).
Objective:
The present study examined whether clients enrolled in coordinated specialty care (CSC) programs for first-episode psychosis (FEP) across 22 states and territories showed improved clinical and functional outcomes and assessed whether program- or client-level predictors were associated with client outcomes. The study included CSC programs that subscribe to a variety of models, including Early Assessment and Support Alliance, OnTrack, and NAVIGATE.
Methods:
Deidentified demographic and outcome data were collected from clients (N=770) receiving CSC services in 36 programs at the time of program entry and every 6 months for up to 18 months. Programs participated in fidelity assessment by using the First-Episode Psychosis Services Fidelity Scale, version 1.0, developed for the study and based on the components of the CSC model defined by NIMH. Additional program-level variables assessed during the study included staff turnover rate and time spent on CSC services.
Results:
Across programs, clients experienced improved symptoms, higher quality of life, and improved social and role functioning. Of note, participants from high-income families had greater improvement in role functioning than participants from low-income families. Higher levels of fidelity predicted reduced symptoms and improved social functioning. Having a CSC team lead with time dedicated to the program was also associated with greater improvements in clients' symptoms and social functioning.
Conclusions:
Clients showed improvements, regardless of program or demographic characteristic. Program-level findings suggest that fidelity to the core components of CSC is important for improving client outcomes across a range of specific program models.
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