1

EASA Introductory Training

Next Two Days:1. Become familiar with how EASA operates: roles, core

activities

2. Introduce useful tools and resources.

3. Form ongoing relationships across the network.

4. Identify areas where more learning is needed.

5. Have fun!!

TS 8:40

2

Our vision: Uniting the strengths and voices of young adults and their allies

to create a thriving community and revolution of hope!

- EASA Young Adult Leadership Council

TS 8:45

Introducing Ourselves

1. Your name, role and where you work

2. Either: How you got your name, or something about your family’s culture and how that affects the way you see the world

MS 9:10

3

Early Assessment and Support Alliance (EASA)

20012008

2010-14

2016-172014

2016

2014-16

TS 9:15

How EASA is Organized

• Oregon Health Authority contracts to local county mental programs (Jean Lasater)

• EASA Center for Excellence (Portland State University/ OHSU)– Website with resources- www.easacommunity.org– Staff

• Director (Tamara)• Clinical Director (Dr. Ryan Melton)• Young Adult Participation Coordinator (Christina Wall)• Rural Services Director (Dr. Katie Hayden-Lewis)• Medical Director (Dr. Craigan Usher, OHSU)• Administrative support (Halley Doherty-Gary)• Contracted experts (Megan, Tania Kneuer-OT, Michael Haines- peer support, young adults)• Iterative practice guidelines (download under professionals section on website)

– Young Adult Leadership Council; forming Family Council– Ongoing training and fidelity review; certification process with continuing ed

credits attached; routine and as needed consultation – Data system through RedCap

TS 9:30

4

Practice guidelines

• Systemic infrastructure, participatory decision making, psychosis-risk syndrome, community education, access and screening, clinical services, transition

• Iterative revisions based on research & experience

• Fidelity (measurement) section

• “Policy for Inclusion in the EASA Network”

• Phases of care & transition checklist

TS 9:40

Participatory decision making (guideline 2)

• Participants, graduates, family members

• Participation on hiring committees

• Feedback in treatment process

• Ideas & concerns encouraged & integrated into programming & organization

• Examples: physical space, groups, community ed, quality improvement

5

Without early psychosis services

• Lengthy delays in accessing services and recovery

• Family isolation

• Push onto disability system

• Lack of appropriate support

• Negative attitudes and outcomes

TS 9:45

Timeline

• EASA- 5 counties 2001• Significant movements in Commonwealth countries and

Scandinavia• Research-based programs in U.S. universities• First dissemination & EDIPPP study 2007• Second rounds 2013, 2016

• RAISE study 2010; results 2014• National EBP: COORDINATED SPECIALTY CARE• Congressional action 2014, 2015, 2016• Programs now in almost every state; national efforts toward

standards and data sharing

• IEPA & PEPPNET: free memberships!http://iepa.org.au/ (Boston 2018!)https://med.stanford.edu/peppnet.html

TS 9:50

6

Are you already serving EASA participants?

Pressing questions that are coming up for you?

MS 10:05

EARLY PSYCHOSIS COORDINATED SPECIALTY CARE TEAMS ADDRESS

Preparing for Adult Transition

Family & social support

Employment & education

Developmental progression

Social skills and

confidence

Medical, health & lifestyle; symptom

management

MS, 10:15

7

Who is on your team?

Shared goals & outcomes; shared

training, supervision,

decision making

Counseling/ coaching Supported

employment & education

Peer support

Occupational therapy

Substance abuse

specialist

Psychiatric

Nursing

MS, 10:30, break

Resident scientist

Health coach & expert

Integrating knowledge, skills

& meaning

Career, job and school

coach

Self-advocacy and

independent living coach

Accommodations and daily

routines coach

Healthy choices & addiction support

BREAK!!

8

Why is early intervention so important?

• It’s effective!!• School success vs. failure &

drop-out• Self advocacy vs. inability to

care for self• Empowerment vs. trauma• Family understanding vs.

conflict• Avoids self medication through

drugs• Reduces suicide risk!• Reduces risk of accidental

death or harm

• Keep identity in life versus forming around psychosis

• Insight still preserved

• Can use lower doses over shorter periods

• Better, faster recovery

• Cut symptom progression short

• Avoid homelessness

• Avoid legal involvement

• Avoid hospitalization

• Increased likelihood of keeping job & being successful adult

TS, 10:50

The mission of EASA is to

Keep young people with the early signs of psychosis on their normal life paths, by:

• Building community awareness and

• offering easily accessible, effective treatment and support

• through a network of educated community members & highly skilled clinicians,

• using the most current evidence-based practices

TS 10:55

9

What causes psychosis?

• Your brain creates its own reality!• Many things can cause psychosis- Just a few of them:

– Becoming blind– Many medical conditions– Infection– Medicines (steroids, stimulants, etc.)– Developmental conditions (epigenetic, in utero, abnormal

pruning)– Sleep disorder– Mood disorders– Schizophrenia (the condition EASA targets)– Trauma

MS, 11

The Core ElementsEASA PROCESS Proactive community education Flexible outreach and engagement Family support and partnership Strengths and person-centered Careful risk assessment Attention to school and work Introduction to others who

have had similar experience Psychoeducation Medical & wellness support Finding meaning, making

sense of experience,developing mastery

Developmental progress Relapse planning Transition

MS, 11:05

10

Help seeking

• Help seeking often determined by level of distress

• Families or outside systems usually involved

• Help seeking/readiness for help often triggered by perceived crisis

TS, 11:08

Sources of delay

• Multiple studies- Over 1 year is typical (NAVIGATE- 74 weeks median)

• Help seeking- not recognizing, not knowing where to go, fear about seeking help

• Referent network- sending people to the wrong place

• Mental health center- delays due to lack of recognition, procedures, insurance restrictions, expectations, language

TS, 11:15

11

Gradual Onset

• Cognitive changes

• Affective changes

• Social withdrawal

• Increasing symptoms

MS,11:20

Learning from experience

https://vimeopro.com/user23094934/voices-of-recovery/video/85740602

TS or K , 11:30

12

Psychosis Cycle: Prodrome

• Prodrome– Often subtle, misunderstood

– Can last for extended period

– Cognitive changes may affect learning and communication

– Suicidality more common

– Family conflict normal

• Acute symptoms

• Recovery (early and late)

TS 11:35

Early Signs & Symptoms

• Performance

• Perceptual

• Behavioral

TS, 11:37

13

Performance Changes to Watch for

• New trouble with:

– reading or understanding complex sentences

– Speaking or understanding what others are saying

– Coordination in sports (passing ball, etc.)

– Attendance or grades

MS, 11:43

Behavior Changes

• Extreme fear for no apparent reason• Uncharacteristic, bizarre actions,

statements or beliefs• Incoherent or bizarre writing• Extreme social withdrawal• Decline in appearance and hygiene• Sleep (sleep reversal, sleeping all the time, not

sleeping)• Dramatic changes in eating

MS, 11:46

14

Perceptual Changes

• Fear others are trying to hurt them• Heightened sensitivity to sights, sounds, smells

or touch• Statements like, “I think I’m going crazy” or

“My brain is playing tricks on me”• Hearing voices or sounds others don’t• Visual changes (wavy lines, distorted faces,

colors more intense)• Feeling like someone else is putting thoughts in

your brain or taking them out

MS, 11:50

What is one thing you can do to help reduce delay?

• PQB screening tool (see handouts)

TS, 11:55

15

Letter from a rural participant (italics added)For quite a long time I didn’t tell anybody what was going on in my head, because I didn’t want people to think I was crazy. That stopped when I became involved with EASA. At first I was skeptical of it all, but my doubts were quickly proven to be wrong.

The beginning was rough for me. But, eventually, I looked forward to talking about what I wanted help with. My time in the EASA program has been life changing. I started out too afraid to talk about psychosis, and now I have a skill set I never knew I could have to help me cope with the problems that come with psychosis itself….

I feel as though I have the right to say I am as dedicated to EASA as it is to me. I have been doing anything and everything I can to utilize the help EASA offers. Do I have to do that? No. Why do I do it? Because EASA works… EASA is worth the work.

Before EASA I was a completely different person. EASA provided me with a valuable set of problem solving skills that makes it easier to live life normally. I am beyond grateful for the EASA program and those who helped me take full advantage of the help it has to offer. I started all of this because I was seeking help for my hallucinations and myself, and I am proud to say EASA was just what I needed.

I strongly encourage anybody living with psychosis to consider joining EASA. EASA changed my life, and I know it can change other people’s lives too.

Vision… from our young adults…

Uniting the strengths and voices of young adults and their allies to create a thriving community and revolution of hope!

TS, video, 2 slides after, noon

16

Planning your Approach:

Priority Audiences

Internal gatekeepers/ referents

Crisis system & hospitalsParents (media)SchoolsPrimary care doctorsClergy…Network of people referred;

Missed opportunitiesFunders/policy makers

UNIQUE

Resources

• Presentation checklist

• Planning sheet (based on Spitfire Strategies Smart Chart, http://smartchart.org/content/smart_chart_3_0.pdf)

17

A bit about psychosis research

• Not just caused by “too much dopamine”

• Bio-psycho-social-developmental dimensions

• Strong evidence linking in utero effects (flu season), late teen/early 20s brain pruning

• Twin studies- clearly genetic not 100% inherited

• Ongoing research- epigenetics, biomarkers, inflammation/immunological responses

• Lots of research showing many approaches which can help; team is most impactful

TS, 1:10

Rapid evolution of knowledge

TS 1:15

TS, 1:15

18

Core values and practices

• Partnership (person & family)

• Education and transparency

• Empowering explanatory model

• No single expert

• Proactive and planful approach

• Strengths and resilience orientation

• Continuity and follow-through

• Feedback & participatory decision making

MS, 1:25

Transdisciplinary teams (guideline #8)

• Ability to provide intensive services (limited overall caseload)

• Everyone serves under and over 18

• Meet weekly to review all people being served

• Cross-training & double-teaming

MS, 1:30

19

Weekly Review Format

Client

Person Family Coun/c

s mgmt

SE/Sed Peer

Support

Medical OT Success/

strengths

Transiti

on date

Ryan Family

invited

to WS

Joinings

complet

e

CBT

with

Nina-

anxiety.

Family

to get id

from

DMV.

Wants to

return to

OSU-

Refer to

John

Meet Wed.

to review

shared

decision

making

materials

Abilify-

5mg some

fatigue.

RN to

obtain

labs

Accommod

ations plan

for school

Completed

FAFSA.

Reaching

out to

friends

again.

12/3/17

Tamara She is

not

intereste

d-join

with

family

alone

MI work

around

THC

use.

Help

with

housing.

John doing

practice

interviews.

Going

together to

self-help

group at

PSU

Establishi

ng PCP.

Team to

help with

exercise

(walking,

check-ins)

Complete

sensory &

cognitive

assessme

nts

Did three

job

interviews.

Thinking

about

becoming a

nurse.

7/1/17

TS, 1:35

Referral process

• Marion County example: http://www.easacommunity.org/PDF/MarionReferralPacketUD.pdf

• Screen-out letter example: http://www.easacommunity.org/resources-for-professionals.php

TS, 1:40

20

Guideline #5: Access and Screening

• Rapid response with strong connection to crisis services

• Direct, flexible access to team; problem solve and strategize

• When screened out continue to provide support & help connect to care

• Follow up with referent

• Educate and partner with family/ referents; reach out to family members who aren’t present

• Rapid access to psychiatry (within 1 week)

• Go to the person, listen, focus on strengths & and be persistent

MS 1:50

Insight

No matter how far into psychosis,

there is always some connection to

reality.

Insight can vary with time.

Gaining insight is a process, not a

state of being.

TS, 1:55

21

Engagement Strategies:

(Xavier Amador: LEAP)

Listen

Empathize

Agree

Partner

“I’m not sick, I don’t need help!”

TS, 2

~convey respect without judgment~

Engage!• Choose a comfortable location.• Try side-by-side. • Acknowledge viewpoint despite what is said.• Be flexible, empathic, active and helpful.• Socialize, focus on interests/strengths, especially those you have in

common. Identify common ground or create it.• Explain procedures & write things down with clear instructions.• Gather assessment information gradually and in the form of storytelling

(aids in memory and identifying negative cognitions and stigma.)• Learn about family and youth culture.

“I would highlight that as far as therapy goes, it’s really non-traditional. Mental health consultants with EASA aren’t going to just sit with you in the office. They’re going to meet you where you need to be met, whether it’s in your home or an easy hike. They do so many amazing things with their clients.” –EASA Participant

MS & TS role play, 2:20, break

22

Collaborative Empiricism

One person acts as “therapist”

Second person chooses a personal belief that you really hold and that others might disagree with

Exercise one:

In a nice way, try to give evidence of an opposing viewpoint and get the other person to see your side of things.

Exercise two:

Ask questions about the belief without trying to change their mind to facilitate shared exploration.

TS, 2:55

Risk Factors to Consider/Mitigate• Health concerns

• Delusional content (perceived threat, focus on water, loss of boundaries)

• Impulsivity

• Social support loss/ family conflict/ potential victimization

• Current or past violence

• Current or past suicidality; exposure to suicide

• Substance use

• High level of distress/ hopelessness

• Recommended: Cross-reference agency risk assessment process with EASA tool; expand what is normally asked.

MS, 3:25

23

Reducing perceived coercion

• Demonstrate sincere respect and valuing of the person

• Create space for the person to be heard and do what you can to support their autonomy and choice

• Never tell falsehoods

(Source: MacArthur coercion studies, http://www.macarthur.virginia.edu/coercion.html)

TS, 3:30

Orientation to Early Psychosis Services

• Address immediate needs and concerns• What to expect (short-term and long-term):

engagement/assessment, phases of treatment• Who is on team & how to access them• What team members do and how they work together

(coordination, assessment, treatment planning, family engagement, harm reduction)

• Basic psychoeducation– Crisis resources– Family guidelines– Relevant illness education: impact of gradual onset, symptoms– Communication and normal family reactions– How relevant system(s) work (HIPAA, FMLA, 504/IEPs/college disability

services, legal, crisis, etc.)

MS, 3:40

24

Orientation resources

• Multnomah/Lane materials

• Family guidelines

• Website:– Family and friend & path to recovery section

– What is psychosis & assessment

– EASA services/phases of treatment

– Crisis handout

• Make sure they have 24 hour crisis line, your number, rapid/routine access to you

MS, 3:45

University of Kansas website:

http://mentalhealth.socwel.ku.edu/tools

STRENGTHS ARE THE FOUNDATION.

MS 3:47

25

Uses of Strengths Assessment

Information• Planning initial engagement; engaging person and family• Helping family and person coach• Identifying social supports• Identifying treatment goals and strategies• Fostering resilience• Identifying relapse prevention methods• Getting ideas for jobs, career development• Teaching the person to identify and use their own strengths• Strengthening motivation and sense of identity

• Benefits of this approach:– Reinforces the person’s sense of self and the positive perceptions of others– Frame the conversation in a helpful rather than pathologizing way– Setting positive tone from first conversation– Engaging family and supporters; reinforcing positive regard for each other– Encouraging and valuing positive coping – Helping find hope

TS, 3:55

University of Kansas Tool: Life Domains

Living Situation Financial/Insurance Vocational/Educational Social Supports/ Relationships Health Leisure/ Recreation Spirituality/ Culture

• What’s worked in the past; what’s working now; what are they interested in/ what do they want in the future

MS, 4:05

26

Strengths Exploration

• What do you dream about?• What music do you listen to?

Websites do you like? What do you like about them?

• What do you like about the place you live?

• What do other people appreciate about you?

• A couple of resources:– www.mitrainingtoday.com

(teen values card sort)– www.cade.uic.edu/moho/resou

rces (interest checklist)

• What makes you resilient and helps you keep going?

• What helps you grow?• What are your skills? In what did

you feel successful in the past?• What do you do for fun? What did

you used to do for fun? What do you like?

• What interests you? What do you enjoy learning? (What used to interest you)?

• Who do you like? Who supports you?

• What places do you go?

MS, 4:10

Review Scenario

• Discussion: What risk factors do you see and what might you do to reduce/address those?

• What strengths might you build on to engage?

MS, 4:40; q&a

27

Introductions; reflections and questions from yesterday

TS, 8:50

Where people sometimes get stuck with strengths assessment

• Stuck on the form itself• Use brainstorming format/nonlinear• Use prompt questions

• When and how to do it• Should be part of comprehensive assessment• Ideal- place for everyone to contribute and continue to update

• Doesn’t as important as crisis• Observation & history• Questions: What helps you/this person feel calmer? What would help? What supports

are available? What strengths will help you and your family get through?

• Grief and sense that can’t do things any more• Reinforce/observe what’s working now• Reinforce the ability to get back into what you have loved/enjoyed where that is desired• Reflect and name/reframe negatives

• Young person can’t think of anything; limited engagement/non-verbal• Observation, use of supporters, written checklists/card sorts, collages/pictures• Include family

TS, 9:00

28

Assessment

• Gradual, in narrative form

• Use multiple sources

– Family/family input form

– Past evaluations

– Observation/conversation

MS, 9:05

Assessment• Symptoms- progression over time

• What changed, when• Precipitants & relieving factors• Pathway to care

• Current medical exam & labs• Developmental history- medical, developmental milestones, head

trauma, other forms of trauma, learning disability, school, family• Co-morbid conditions- substance use, medical conditions, learning

disability• Individual and family culture & explanatory model• Identity issues- gender

• Which of these may be weak/missing in your process? How can you enhance?

MS, 9:15

29

Sharing Additional Assessment Resources

• SCID

• SIPS

• EASA:– Differential diagnosis training

– Family Input form

– Health Assessment

• Trauma assessments (OnTrack and Navigate manuals)

• Cultural Formulation Interview (DSM V)

• Career Information System/ Dartmouth (vocational)

MS 9:25

Nursing and health Functions(Sali video: https://www.youtube.com/watch?v=0R4x8BnkooY

• Health care coordination & education• Primary care and medication assistance• Side effect monitoring and education• Administering shots as needed• Healthy lifestyle support

– Sleep– Exercise– Nutrition– Tobacco cessation– Safe sex

TS, 9:35

30

Health Assessment

• Rule out other causes (examples: lupus, thyroid disorder, Crohn’s Disease, etc.)

• Identify risk factors (blood sugar, heart conditions, high lipid levels, etc.)

• Provide baseline for ongoing assessments

• Medicines can have greater side effects with younger age

TS 9:40

Routine Medical Tests for Psychosis

• CBC with differential• Chemistry panel (with liver enzymes, electrolytes,

BUN, Cr, calcium)• Urine drug screen• Urinalysis, with microscopy• B-12 and folate• Thyroid screen (TSH, T4)• MRI or CT as indicated• Other tests indicated by additional medical

conditions identified

31

Metabolic Syndrome

• Cluster of metabolic risk factors – Insulin resistance, hypertension &

cholesterol abnormalities, increased risk for blood clotting

• Most often overweight or obese• Higher risk for cardiovascular diseases and type

2 diabetes• Sometimes present at entry• Medications can induce this syndrome• Early mortality is huge concern

TS, 9:55

Advice to a New Early Intervention Program from the EASA Young Adult Leadership Council

• Help the person (and family) see beyond the stigma.

• Make the person feel comfortable.

• Help them find hope.

• Let them know they are not alone.

• Listen and offer options.

• Help plan for relapse.

• Let them regain confidence.

• Keep it simple.

• Be flexible and persistent.

MH, 10:05

32

What we are attempting to impact(from Dan Fisher’s “Personal Assistance for Community Existence”):

Empowering beliefs- Hope, belief in the likelihood of a positive future, future

orientation

Maintain and build relationships- people who believe in you and never give up,

who make you feel safe & you can trust. People who have had similar experiences.

People who care, who let you recover at your own pace.

Skills- Forming emotionally meaningful connections, self care, self responsibility,

self forgiveness, setting & achieving personal goals, expressing uncomfortable

feelings.

Identity- Not defined primarily by illness, recalling past successes, overcoming

stigma, becoming whole again

Community- Valued social roles, helping others

MH 10:15

www. Hrweb.mit.edu

MH, 10:20

33

Recovery Process• Is often gradual• Isolation does not mean inactivity; active internal process of

figuring out how the brain is working– Moller’s Post-Psychotic Adjustment process: Common experiences in this

phase- Embarrassment, fear, frustration, overwhelm; hard to go out in public; takes all your energy

– May be more likely to learn from internet

– Group activities and social activities may be hard to sustain; ability to converse may be impacted

– Important to acknowledge the person’s real effort & let family know that it is ok for the person to have space

– Can last 9 mos to a year

MH, 10:25

Common experiences of early and later recovery

• Early recovery– Common experience: Learning to cope, figuring things out; recognizing

limitations; communicating with others

– Often more receptive to reality testing; relapse prevention planning

– Beginning to speak more and check out others’ reactions

• Later recovery– Begin to gain confidence; social anxiety often still an issue– Daily structure, future orientation are important– Often want to give back to others, learn from experience

MH, 10:30, break

34

Shared Goals• What does this person want to accomplish?

– How are symptoms getting in the way and how can team help?

– Goals should be primarily in the person’s words and should be owned by the person

– All members of the team contribute; all team activities relate back to the person’s goals and priorities

– Frequent revisions

• Avoid:

– Controlling the conversation and taking away the person’s voice.

– Pushing the person into things that are outside their comfort zone

Advice from EASA Leadership Council: “What helped in the beginning was… taking things slow. Trying different things. Figuring out the priority of needs and keeping in consistent contact.

MS and next 2, 11

Shared Decision Making

listening for /

eliciting

participants’ and

families’ values

and preferencesbest

research evidence

sound clinical

judgment

35

Figure 1: Things providers and participants need to talk about

Comic by Shane Nelson + Craigan Usher

Peer Support Roles

• Formal and informal positions

• Range of ages and experience

• Roles and training vary

• Community integration

• Facilitating strengths assessment, shared decision making

• Co-facilitating recovery and multi-family groups

• Psychoeducation

MH 11:00-11:10

36

Peer Support Context

• Value and model lived experience as an important source of knowledge

• Create an environment where all staff are encouraged to practice wellness and attend to their own health

• Be aware of microagressions (“us-them” thought processes, “war stories”, negative judgments)

• Actively seek culture of feedback and learning

• Recognize peer support as a career professional role

• Provide supervision and mentoring to young professionals

• Avoid thinking of peer support specialist as transportation or child care if other staff people are not being put in that role

MH to 11:30

Supported Employment & Education (gdln 12)(Individual Placement and Support Principles: Gary Bond video

https://www.youtube.com/watch?v=F1Foxm5lDdE )

• Supported employment/education should be highly visible, easy to access

• Preference, not symptoms, is the guide• Rapid job/school search• Competitive settings based on person’s interests• Focus on benefits• Discussion of disclosure decisions• Follow-along support• Ongoing relationship development with employers and

schools• Specialized focus for one person

MS-Bond video 11:40

37

Succeeding in school

• Same IPS principles• Accommodation supports:

– K-12: Section 504 and Individual Educational Plans (IEPs)

– Higher education: All colleges & universities have a Disabilities Services Office.

• Kevin & Michael: In your experience, what helps with making it through school? How can EASA help with that?

K & M, to noon; lunch

Psychiatry

• Appointment available within 1 week

• Psychiatrist integrated team member/shared appointments.

• Weekly in the beginning; never less than monthly

• Half hour appointments

• Ongoing even if not interested in meds.

TS, 1:05

38

Medication prescribing

• Conservative: start low and go slow with consideration of titration.

• Avoid polypharmacy.

• Careful attention to side effects!!

• Careful consideration of tapering after extended remission

TS, 1:10

Choosing medicine

“Medication can be very empowering if the decision is truly made by the individual. Pressure can be subtle. The information can be stacked to make it look like the only option. If one option isn't working it's important to explore others that might." We will make decisions that others disagree with, and it is important for us to be able to be honest and discuss our decisions without feeling shamed, blamed, or threatened.

(YALC article in Focal Point)

TS, discussion, 1:20

39

Guideline #11: Occupational Therapy

• “Achieving health, well-being, and participation in life through engagement in occupation”1

Occupations encompass:

Meaning, purpose, and utility

Context and temporality

Client factors (e.g. values, beliefs, and spirituality; body functions [mental, sensory, etc.]; body structures)

Performance skills (e.g. motor, process)

Performance patterns (e.g. habits, routines, rituals, roles)

https://www.youtube.com/watch?v=UbZ1lFvDzsE

TS, plus next 2, 1:35

What if you don’t have an OT?

• Seek additional team training and consultation

• Recommendations in EASA OT manual:

http://www.easacommunity.org/PDF/OT-Manual.pdf

40

Counseling/ clinical case management

• In vivo/ in settings relevant to the person

• Engagement, assessment, psychoeducation, motivational interviewing, dual diagnosis treatment, evidence-based CBT, tailored approach

• Transdisciplinary

Guideline # 7: Family Partnership

• From first contact

• Reach out to include all family members (exception abuse)• Where person won’t allow contact, explore reasons

• Explore family understanding and needs

• Transparency and shared decision making

• Critical source of information and support

• Review strengths, needs, goals, and progress routinely

(in beginning, every 90 days); involve in transition planning

(Kevin & Michael reflection- How does involving families make a difference and why is it important?)

MS, 1:40

41

Psychoeducation

• Information and exploration of new relevant knowledge

• Integrates techniques to help process new knowledge; core knowledge & clinical skills for all team members– Cognitive Behavioral Therapy

– Motivational Interviewing

– Structured problem solving

– Planning/homework, practice, rehearsal

– Feedback informed treatment

TS, 1:45

Psychoeducation stages

• Joining (2-3 sessions)

• Education (intensive workshop or series of meetings)

• Forming (if group)- strengths, experience with condition

• Ongoing structured problem solving & targeted education

TS, 1:50

42

Family Psychoeducation

• Revisiting strengths and coping mechanisms• Reviewing goals the family has for the person• Understanding the symptoms , causes, onset process and

treatment of psychosis• Understanding normal family reactions (cyclical grief, confusion

conflict)• Learn and practice communication skills for dealing with

psychosis• Introduce and review family guidelines (Good to provide these

from day 1)• Teach and practice problem solving process

TS, 2

Individual Psychoeducation• Individualized based on the person’s strengths and goals• Goal is to introduce ideas come to shared understanding• Psychosis and other relevant conditions- symptoms, diagnosis, causes,

prodrome/ cyclical nature• Basic understanding of treatment & options • Adolescent/young adult developmental tasks• What other people have found helpful & what the person may find helpful• Normal emotional and interpersonal impact of psychosis (grief, confusion,

conflict)• Success stories• Skills for coping with psychosis & managing stress

– Mindfulness– CBT skills

• Healthy lifestyles (nutrition, sleep, social network, exercise, etc.)• Relapse planning• Impact of substance use• Rights, resources

MS, 2:10

43

PSYCHOEDUCATION RESOURCES

Conversation

• (From scenario): Identify two goals that might be relevant for this individual

MS q 1 2:10-2:20

44

• What role would you play in carrying out those goals?

• What role might other members of the team play?

MS q2 & 3, 2:20-2:30; break 2:30-2:45

BREAK!!

45

Feedback

Critical to success

• Can usually predict drop-out within first three sessions

MS w/next slide, 2:55

ORS/SRSwww.scottdmiller.com

46

TS w/next 2, 3:05SERIES: http://www.easacommunity.org/national-

resources.php

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Talking About Diagnosis• Goal: Shared explanatory model which helps the person move

forward

• Transparency: Always explain how you are making decisions and involve the person (i.e. introduce to DSM-5, etc.)

• Focus on specific symptoms that interfere with goals vs. overarching label; diagnostic uncertainty in beginning

• Different cultural beliefs

• Internalized stigma and real discrimination

• Diagnosis can be helpful or harmful; tool for knowledge

• May be helpful to put in historical and cultural context

MH, 3:15

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Structured Problem Solving

• Always start and end with socialization/strengths

• Understanding/empathizing with each person’s unique perspective

• Problem definition• Brainstorm/ review options• Pros/cons• Preferences (multiple parties may rank)• Clarify areas of agreement/disagreement• Negotiate goals

• Provide time for deliberation and reflectionMS, 3:25

Relapse Prevention• Relapse signature- unique content, timing/sequence, intensity

• Review what changed during prodromal period

• Use checklist of common early signs to cue the person

• Identify day-to-day preventive strategies

• Identify early and later strategies

• Make sure the plan is shared

• Rehearse the plan

• Review and revise as needed

TS, 3:35

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Substance Use

• Common developmentally

• Addressed within the team

• Harm reduction

• Motivational interviewing

• If refer out for more intensive care it is helpful to educate the other provider and assess whether messages are consistent.

MS 3:45

Substance abuse assessment and treatment resources

• NAVIGATE Individual Resiliency &OnTrack New York modules

• Dual Diagnosis Capability Resource:• Self-assessment:

http://www.centerforebp.case.edu/client-files/pdf/ddcmhtindex.pdf

• Follow-up and training resources:

http://www.centerforebp.case.edu/client-files/pdf/ddcmhttoolkit.pdf

TS, 3:50

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Guideline #16: Transition Planning

• Successful treatment is not defined by what a person does in EPI, but after they leave.

• Use transition check-list; focus on all domains from the beginning

• Starts at first conversation- reinforcing existing resources, understanding where person is headed and what they will need

• Problem-solve and engage after they leaveTS, K, MH 4:10

The System, We Are

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Unprecedented opportunities for connection and learning

• Prodrome and Early Psychosis Network (PEPNET): http://med.stanford.edu/peppnet/whoweare.html

• International Early Psychosis Association: www.iepa.org.au

• National Association of State Mental Health Program Directors portal: http://www.nasmhpd.org/content/early-intervention-psychosis-eip

• NAMI National: https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Psychosis/First-Episode-Psychosis

• National Council on Behavioral Health: http://www.thenationalcouncil.org/topics/first-episode-psychosis/

• Partners 4 Strong Minds (national education effort): http://partners4strongminds.org/

TS, 4:20; q&a

Some Technical Assistance Resources

• RAISE study resources: http://www.nimh.nih.gov/health/topics/schizophrenia/raise/coordinated-specialty-care-for-first-episode-psychosis-resources.shtml

• Navigate (RAISE Early Tx Program manuals & consultation): www.navigateconsultants.org

• RAISE Connections/ OnTrack USA (implementation and treatment manuals & consultation): http://practiceinnovations.org/OnTrackUSA/tabid/253/Default.aspx

• EASA (practice guidelines, training materials, psychoeducation resources, consultation): www.easacommunity.org

• Commonwealth programs: Orygen (formerly EPPIC) https://orygen.org.au/Campus, IRIS http://www.iris-initiative.org.uk/

• PIER Training Institute (EDIPPP lead): http://www.piertraining.com/

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Follow us online!

• Website: www.easacommunity.org• Facebook: www.facebook.com/easacommunity• Twitter: www.twitter.com/EASACommunityOR

Contact Us!easac4e@pdx.edu

Tamara Sale, tsale@pdx.edu

Megan Sage, msage@pdx.edu

Michael Haines, mhaines@pdx.edu

Christina Wall, cwall@pdx.edu

Ryan Melton, rymelton@pdx.edu

Katie Hayden-Lewis, kah@pdx.edu

Dr. Craigan Usher, ushercr@ohsu.edu