Design, implementation, and assessment of a public comprehensive specialty care program for early psychosis

Introduction: Promising outcomes from early psychosis intervention programs have prompted implementation of early psychosis initiatives nationwide through federal and state funding. The Enhanced Program for Early Psychosis (ePEP) model in north Texas is among the first, if not the first, of these state-funded initiatives to provide detailed reporting of its development and implementation. Methods: Restrictive inclusion/exclusion criteria with a 1% eligibility rate resulted in a highly disadvantaged, predominantly minority sample with low educational attainment, prevalent mood disorders and substance misuse, and criminal justice involvement. Program progress was assessed over 1 year through structured diagnostic assessments and measures of psychotic symptoms, depression and anxiety symptoms, psychosocial functioning, and service utilization and costs. Results: Implementation challenges included strict income/insurance inclusion and disqualification criteria for program participation, hiring and staff turnover problems, client transportation, and lack of available family to participate in family interventions. Despite these challenges, patients showed reduction in negative psychotic symptoms, hospitalization rates decreased from 29% to 5%, full-time employment improved from 6% to 24%, and probation/parole decreased from 24% to 5%. The mean 1-year perpatient cost was $10,639. Reduced negative symptoms and hospitalizations were associated with service use. Discussion: The development and implementation of this pioneering state-funded early psychosis program, based on the National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative, provide experience and results to inform the implementation of future programs. Its demonstrated success, in spite of many implementation challenges, suggests the potential for future research, including randomized controlled trials to demonstrate substantial benefit and cost-effectiveness of early psychosis programs in real-world settings.