Specialized Treatment Early in Psychosis (STEP) (STEP)

Primary Outcome Measures:

• Number of Patients Hospitalized [ Time Frame: 1 year after enrollment ]
  

Secondary Outcome Measures:

• Relapse [ Time Frame: every 6 months ]
  Data was not collected, instead Hospitalization (primary outcome) was used as a proxy
  
  
• Overall Functioning- Global Assessment of Functioning [ Time Frame: 12 months ]

  The Global Assessment of Functioning (GAF) is a numeric scale (1 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. A higher score indicates better functioning.

  The score reported is a change from baseline. The change was calculated as score at 12 months minus score from baseline. A positive score indicates higher functioning.

  
  
• Quality of Life- Heinrich's Quality of Life Scale [ Time Frame: 12 months ]

  The Quality of Life Scale (QLS) is a 21-item scale rated from a semistructured interview providing information on symptoms and functioning during the preceding 4 weeks. Each item is rated on a seven point scale, and a higher score reflects normal or unimpaired functioning. The range is from 0 to 126.

  The score reflected is a change from baseline. Total score at 12 months minus total score at baseline. A positive score indicates better mental health.

  
  
• Vocationally Engaged [ Time Frame: 1 year after enrollment ]
  
• Treatment Satisfaction [ Time Frame: every 6 months ]
  
• Adherence- in Contact With Mental Health Services [ Time Frame: 1 year ]
  Number of participants in contact with mental health services. Collected via self-report.
  
  
• Substance Use [ Time Frame: every 6 months ]
  
• Subjects Who Committed Self-harm and Violence [ Time Frame: 12 months ]
  The number of subjects who committed an act of self-harm or violence. This data was collected at 12 months.
  
  
• Medication (Including Metabolic) Side Effects [ Time Frame: every 6 months ]
  
• Economic Measures Including Service Use, Cost of Care and Forensic Data. [ Time Frame: every 6 months ]
  Total annual cost per patient
  
  

We propose to conduct a clinical trial for first episode psychosis patients not eligible for CMHC services that will compare randomized access to care at CMHC versus the usual procedure of referral to community providers outside CMHC. Patients randomized to access to CMHC services will receive multifaceted, intensive, phase-specific care delivered by a specialized clinical team. This care will include five principal components: antipsychotic prescription, multi-family group therapy, group cognitive behavioral therapy, cognitive remediation and individual case management including supportive, problem solving approaches and a focus on resumption of movement towards educational and/or employment related goals. All consenting subjects will undergo research evaluations every six months for up to five years. Outcomes will be assessed in the domains of re-admission (primary outcome), relapse, symptoms, overall functioning, quality of life, education and employment, treatment satisfaction, adherence, substance use, adverse events (including self-harm) and economic measures including service use, cost of care and forensic data.