Identification of Early Psychosis By Community Social Workers: A Proposed Randomized Trial with Survey Evidence of Feasibility

Background and Purpose: Efforts to identify and treat individuals with first-episode psychosis (FEP) have supported the efficacy of specialized early intervention services. Delays in accessing such services, also known as prolonged duration of untreated psychosis (DUP), are associated with disruption in areas of function and poor clinical outcomes, meaning that timely entry into treatment is critical to maximize the benefits of such specialized services. Two recently published meta-analyses revealed that the international average DUP was approximately 2-years, falling far short of a 3-month World Health Organization goal. Previous approaches to reducing DUP have focused on training general practitioners and mental health workers to identify the onset of psychotic symptoms. Such approaches have been hindered by practitioner-level (e.g., uncertainty regarding the appropriateness of referrals) and systems-level (e.g., youth with psychosis not seeing general practitioners) factors. In response to this unmet need to reduce DUP, the University of Maryland School of Social Work and the Maryland Early Intervention Program are developing a training program for social workers to identify first episode psychosis in community settings. In this study, we present survey data assessing the perception of the utility of such a training program among social workers in Maryland.

Methods:Practicing social workers were recruited through an advertisement in the alumni e-mail newsletter of the University of Maryland School of Social Work. Participants (n=97) were social workers practicing in Maryland, that self-reported working with at least some adolescents or young adults (age 12-30) in their employment settings. Surveys were distributed online through Qualtrics and consisted of self-administered items assessing demographics and opinions on the need for training to assess for early psychosis.

Results:Despite most respondents endorsing working with people who they believed to be in the early stages of schizophrenia (62.5% responded “definitely,” 21.9% “I think so”), only slightly over half, 51%, felt “definitely” prepared to make an appropriate referral. Despite this slight majority feeling prepared, only 33% were familiar with specialty early psychosis clinics in the region. Most participants endorsed that it would be useful to have access to brief screening tools (definitely: 77.1%) and direct referral information (definitely: 82.3%). When specifically told that there is currently a 2-year DUP in the US, on average, they were then asked if they would be interested in specific training in this area. 57.7% said definitely, 35.1% somewhat, 7.2% said not interested.

Conclusions and Implications: Practicing social workers endorsed a high rate of clients that appeared to meet criteria for early psychotic disorder, with moderate confidence in their ability to make referrals. However, most were not knowledgeable of the specialty services in their area, and reported interest in (1) screening tools to reliably identify early psychosis; (2) direct access to specialty services; and (3) trainings to identify and refer youth with first-episode psychosis. Based on these survey results, training social workers to identify youth with first episode psychosis and to make appropriate and valid referrals to specialty clinics may be an effective approach to reduce DUP in the United States.