Active Studies
EPICAL: Early Psychosis Intervention in California
EPICAL: Early Psychosis Intervention in California
Based on an average incidence of psychotic illness of 272 per 100,000 people each year, approximately 107,000 California residents are estimated to experience a first psychotic episode each year. California currently has 30 active programs providing Early Psychosis (EP) services across 26 counties. However, these programs are not identical. They offer different services, follow different treatment models, and measure treatment impact differently.
EPI-CAL aims to improve the quality of services and measure the impact of treatment. To do this, we (UCSF, UCD, and Stanford) created a learning health care network (LHCN) of California EP programs. The goal of this network is to standardize practice and support knowledge-sharing. To make evaluation of these different EP programs possible, network members have agreed to gather the same information across the same timeframe. Clients, families, and providers will provide information by answering surveys at regular intervals throughout treatment. Surveys will be offered in 13 different languages to meet the needs the diverse communities represented in the LHCN. Surveys will ask about how clients are doing at work or school, how their social life is, and how they feel about their future.
The technology used by the LHCN will bring the information provided by clients and families back into their care. The providers will have access to their clients’ data to use as part of their regular appointments with clients and families. This may empower clients to use their own data in care decisions.
EPI-CAL will also allow programs to learn from their own data and from each other. Program management will have access to all of the survey data from their program. They can compare their whole clinic to the network as a whole. They can use this group data to evaluate the impact of program services and look for areas of strength or for improvement.
EPI-CAL started as a collaboration between California counties (Los Angeles, San Diego, Orange, Solano, and Napa) and One Mind to develop a Learning Health Care Network for the EP programs of those counties. A grant from NIH brought the California LHCN into the national network of EP programs, EPINET. This grant also made it possible to add additional county and university EP programs into the LHCN. Being a part of EPINET gives clients and programs the opportunity to contribute to the national conversation on how to inform and improve care for individuals with early psychosis across the US.
Duration of Untreated Psychosis (DUP)
Our team is working on developing and validating a novel DUP measure for use in community settings. We hypothesize this new measure will demonstrate inter-rater reliability (IRR) between coordinated specialty care (CSC) providers and a central assessor, with an intra-class coefficient (ICC) of at least .80 for days from initial assessment to DUP start point, days from assessment to DUP end point, and days from start point to end point DUP (total DUP). Additionally, we hypothesize predictive validity, defined by significant relationships between shorter DUP and greater improvements in functioning and quality of life at six months, as well as feasibility and acceptability to early psychosis (EP) providers and clients, with a mean administration time of less than 40 minutes.
The measure is currently being piloted at six sites, where we are actively collecting data to assess its reliability, validity, and feasibility in real-world settings.
County Data
Our aim is to conduct preliminary evaluation of cost-effectiveness and impact of Early Psychosis (EP) program participation in community settings. The goal of this study is to produce a multi-county integrated analysis including data from both the early psychosis programs compared to regular outpatient treatment as usual for clients in the following counties: San Diego, Los Angeles, Solano, Orange, Napa, and Stanislaus. [We hypothesize that cost of care for individuals enrolled in EP programs will be lower than CG program participants, and participation in EP program services will be positively associated with improved outcomes.]
The proposed analysis is based on pilot work conducted in Sacramento County, scaled to multiple counties (Niendam et al., 2016). It focuses on consumer-level data related to program service utilization, other outpatient services utilization, crisis/ED utilization, and psychiatric hospitalization and costs associated with these utilization domains during the time period of January 1st, 2017-June 30th, 2022.
Training and Technical Assistance (TTA)
The Early Psychosis Training and Technical Assistance Center (TTA) was developed by UC Davis in collaboration with UC San Francisco and Stanford University to support the implementation and sustainability of EP programs across California. Our goal is to support the provision of high quality early psychosis care to all Californians and to promote recovery and better outcomes through a learning healthcare network approach.
As part of our program, we provide a suite of training modules designed to aid programs in developing or sustaining their EP programs in accordance with the Coordinated Specialty Care (CSC) model. Participating EP programs are offered ongoing consultation with TTA staff to provide program management guidance, connect programs with resources needed to reach fidelity, track training progress, and troubleshoot obstacles toward TTA goals.
As the TTA Assessment Training team leads, our UCSF team supports the TTA by carrying out fidelity assessments, providing consultation in evidence-based assessment, and developing assessment training materials. Group and individual consultation is provided in the use of gold standard, trauma-informed evaluation of psychosis, common diagnostic differential considerations, and the integration of brief, low-burden screening tools for community based settings to enhance efficiency of service delivery.
Past Studies
COTES: Community-Based Cognitive Training in Early Schizophrenia
ENRS: Equity in Narrative Recovery Stories
PART: Clinical and Neurocognitive Assessment in Adolescents and Young Adults at Risk for Serious Psychiatric Disorders
PQ-B: Prodromal Questionnaire
STANLEY: Randomized clinical trial of intensive computer-based cognitive remeditation in recent-onset schizophrenia