A CAMH-led collaboration is introducing a new model of psychosis care to improve treatment for adolescents and young adults who experience psychosis.
While early psychosis intervention programs have been widely introduced in Ontario, ongoing work shows there are still challenges in consistently providing all aspects of evidence-based care, particularly those elements of care focused on recovery.
To address these challenges in delivering care, a collaborative team, co-led by patients, family members, researchers and clinicians, will implement a coordinated, multidisciplinary type of care called NAVIGATE. The model is effective in helping young people with early psychosis significantly improve their day-to-day functioning. NAVIGATE standardizes the approach to care, giving frontline clinicians the opportunity to follow evidence-based guidelines in a consistent manner. CAMH’s Slaight Centre was the first to adopt this approach in Canada, beginning in November 2017.
NAVIGATE provides comprehensive care to patients and their families, including medication to reduce symptoms, a family education program, resiliency training to help patients identify and develop strengths, and counselling to help young people pursue their education and employment goals.
To expand the reach of NAVIGATE in Ontario, four early psychosis programs, responsible for covering 45 per cent of Ontario’s geographic area, will partner in its implementation, supported by CAMH’s Provincial System Support Program and Project ECHO Ontario Mental Health, a CAMH-University of Toronto collaboration
Over the four-year project, researchers will evaluate the effectiveness of NAVIGATE compared to standard early psychosis care in terms of improving recovery and functioning in young people with psychosis. The large-scale, community-based research project is supported by a $1.5-million grant from the Canadian Institutes of Health Research Strategy for Patient-Oriented Research (SPOR) initiative, with matching funds from CAMH’s Provincial System Support Program, Project ECHO Ontario Mental Health and CAMH Foundation.
“Accumulating research suggests the sooner young people with psychosis receive treatment, the better their long-term outcomes, yet around 30 per cent drop out of services,” says Dr. Nicole Kozloff, a Slaight Centre child and adolescent psychiatrist. “This study will help identify young people likely to slip through the cracks — and why — so we can ensure all young people with psychosis have access to early and ongoing treatment.”
Dr. Kozloff hopes to determine why young people and their families are disengaging from early psychosis intervention services, with an emphasis on understanding patient- and family-reported reasons. The team will recruit patients through the Slaight Centre and examine demographic, clinical and service use data that is already routinely collected. Patients who become disengaged from care, as well as their families, will also be sent a brief web-based survey.
Dr. Kozloff, also an Assistant Professor of Psychiatry at the University of Toronto, conducts health services research for transition-age youth to improve the delivery effective and appropriate services to young people with serious mental illness. Her particular interest is in marginalized populations, including homeless youth, and she holds operating funding as a NARSAD Young Investigator, awarded by the Brain & Behavior Research Foundation.
Slaight Centre Clinician-Scientist Dr. Laura LaChance is leading a study into how diet and gut microbiome composition affects both mental and physical health in young people with schizophrenia spectrum disorders.
Diet is a major factor in the gut microbiome composition, a key determinant of both mental and metabolic health. Antipsychotic medication is associated with both weight gain and metabolic dysregulation, though exactly how isn’t yet fully understood. This study will explore whether young people with schizophrenia spectrum disorders show differences in diet and gut microbiome composition compared to healthy controls, and whether starting antipsychotics influences either of these variables.
“The next step will be to apply the findings from our study to support future research through a clinical trial of a dietary intervention to target the gut microbiome composition in young people with psychosis,” says Dr. LaChance, also a Lecturer in the Department of Psychiatry at the University of Toronto.
“Ultimately, we aim to influence the gut microbiome through diet and supplements to improve both mental and physical health in young people with psychosis. In the future, we hope nutritional care can become a standard part of treatment as usual for youth with psychosis and we are actively taking steps toward this goal at the Slaight Centre Early Intervention Service.
Engagement with clinical services for youth with early psychosis represents a significant challenge and barrier to recovery — an average of 30 per cent of patients completely disengage from services in the first year of treatment and up to 60 per cent are not fully adherent to treatment plans. Partial and delayed treatment is linked to poorer functional and illness outcomes for this group, making it harder for them to get back to work, school and friends.
Jessica D’Arcey, a Master of Science student at the Institute of Medical Science under the supervision of Dr. George Foussias, is evaluating the efficacy of text messaging as a means of improving clinical engagement in early episode psychosis populations by bridging contact between appointments with weekly check-ins. This new project builds on the work of the SMS strategy piloted in the Slaight Centre last year to enhance service engagement and research retention. These weekly check-ins span the first nine months in treatment and ask patients how they are doing between appointments. If the patient reports significant distress, their care team is notified so it can provide support.
“This study is important because it allows young patients to touch base with their care teams in between appointments in a way that is easy and doesn’t disrupt their day. Texting affords a more flexible and accessible platform while supporting the in-person clinic model,” says D’Arcey.
Early patient-feedback has been positive: 94 per cent of participants have reported the check-ins to be a positive experience and 63 per cent have had additional questions about mental health and wellbeing. The average message return rate is 85 per cent and no one in the study has dropped out or asked to stop the messages. Overall, texting seems to be well-tolerated/accepted by patients and stands to offer a helpful adjunct platform for in-person clinical care.
Led by Dr. Sean Kidd, the Slaight Centre’s Welcome Baskets study is addressing an urgent need to better bridge care from hospital to community through the use of peer supports. This project targets the critical period after people with schizophrenia are discharged from hospital as they transition into the community. Peer support workers— people with lived experience—support patients in the discharge process and in the community.
The Welcome Baskets provide basic living supplies and help people establish a relationship with the community and its resources while supplementing these efforts with strategies for organized and easy daily functioning. The study has already demonstrated positive outcomes, including improved quality of life; increased community functioning and psychological community integration; and patients’ needs being met.
After meeting with the patient, peer support workers design a personalized Welcome Basket that may include basic supplies, plants, coupons and other comfort items. The peer support worker and the patient also confirm a plan for familiarizing the individual with local resources. These services are accompanied by environmental supports, in which calendars, alarm clocks, prompts, lists and other organizational tools are provided in a clear and accessible way.
“Peer support work can be a great way to assist someone in becoming more comfortable and becoming more oriented to their new area and environment,” says George Mihalakakos, Peer Support Worker and Co-Investigator in the study. “The peer support worker can speak to what worked and what didn’t work for them.”
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