Coordinated Specialty Care for Individuals with Recent Onset of Psychotic Symptoms: The Ontrackny Initiative

Background and Purpose:In the last 25 years, research has shown that young people experiencing a recent onset of psychotic symptoms, or first episode of psychosis (FEP), can achieve clinical and functional recovery when provided with evidence-based, specialized early intervention treatments including cognitive and behavioral therapies, supported education and employment, family psycho-education and support, and/or low dose atypical antipsychotic medication. Bundled together and delivered by a multi-disciplinary team that emphasizes assertive outreach and engagement, and recovery, this coordinated specialty care (CSC) model has the potential to reduce rates of disability in these young individuals who have recently developed primary psychotic disorders. In the US, following the positive findings of the NIMH funded Recovery After Initial Schizophrenia Episode (RAISE) studies, in 2014, Congress enacted legislation for a 5% set-aside of mental health block grant monies specifically for FEP services.  In 2016, this set-aside was increased to 10%.  Since the passage of the legislation, CSC programs have proliferated throughout the US. In New York, beginning in 2013 with funding from the New York State Office of Mental Health and continuing with new federal monies, the OnTrackNY initiative has grown to 14 CSC teams throughout New York State, with more teams to be added.  This paper describes the OnTrackNY CSC model, and presents preliminary data about client demographic and clinical characteristics, the services they used, and their clinical, social and occupational functioning.

Methods: Between 2013 to early 2016, 11 OnTrackNY CSC teams were implemented throughout New York State. Teams enrolled 298 individuals between the ages of 16 to 30, with primary psychosis, and with onset of psychotic symptoms greater than one week but less than two years.  Data regarding client demographic and clinical characteristics were collected upon admission.  Clinical characteristics, service utilization within and outside of the CSC model, and clinical, social and occupational functioning as measured by the MIRECC GAF, were collected every three months. The average age of participants is 21 and 18% of the sample is under 18. Seventy percent is male, 30% female; and 43% self-identified as White, 39% Black, and 10% Asian. Forty percent have private insurance, 50% Medicaid, and 10% other.

Results: Rates of participation in school and/or work increased over time from 43% at admission to 73% at 15 months.  Participants also made steady gains in clinical, social and occupational functioning over time: average MIRECC GAF symptom scores went from 35 (sd=16) at admission to 55 (sd=18) at 15 months; for social functioning, from 55 (sd=18) to 71 (sd=14); and for occupational functioning, from 36 (sd=20) to 58 (sd=25).  Participants remained engaged in treatment (76% at month 15) and rates of inpatient and emergency room utilization dramatically dropped after admission and stayed stable over time.

Conclusions and Implications: Young people experiencing FEP, who receive CSC services, can engage in work and school and achieve higher clinical, social and occupational functioning.  Through policy changes such as the mental health block grant set-asides, more CSC services can be implemented and reductions in disability may be achieved.