Functional Outcomes from Implementing the Navigate Treatment Model in Urban Healthcare Systems

Background and Purpose:

First episode psychosis, or early psychosis, has historically resulted in limited functional recoveries for people receiving non-integrated treatment methods in typical mental healthcare settings. NAVIGATE is a comprehensive coordinated specialty care (CSC) treatment model that was established as an evidenced-based approach in the Recovery After an Initial Schizophrenia Episode treatment project (RAISE-ETP). NAVIGATE utilizes an integrated multimodal treatment approach aimed at improving outcomes for adolescents and young adults experiencing FEP. Two metropolitan sites in Minnesota implemented the NAVIGATE model and were formally assessed for fidelity to the model. The aim of this study was to evaluate the functional outcomes for NAVIGATE program participants in Minnesota.

Methods:

Functional outcomes for NAVIGATE participants were reviewed and analyzed at baseline (n = 232), 6-months (n = 116), and 12-months (n = 67). There were some differences observed in demographic variables between the two sites, which may be due to one site being located in downtown Minneapolis and the other being located in a first-tier suburb of Minneapolis.

Individuals were assessed using both clinician and self-report ratings that were collected at baseline, every six months in treatment, and discharge. Data was collected on functioning regarding hospitalizations, engagement in work and school, symptom severity, substance and tobacco use, legal status, medication use and adherence, and social supports. Standardized scales were also used to capture clinical data on functioning, symptom presentation and severity, and recovery.

Data was analyzed using repeated measures analysis of variance with post-hoc honest significant difference testing. Additional data analysis utilized McNemar’s test, a repeated measures test using counts and a chi-square distribution.

Results:

The teams at each site achieved fidelity to the NAVIGATE model on all items assessed.

Overall, there were no significant improvements in antipsychotic medication use, substance use, or criminal justice system involvement between baseline and 6-months of NAVIGATE participation, which was sustained at 12-months. There were inconsistent effects observed between the two sites for employment and education outcomes.

Participants reported significant improvements in met needs, symptom severity, occupational and social functioning, and recovery between baseline and 6-months. Significant improvements in met needs, symptom severity, occupational and social functioning, and recovery were not observed between 6- and 12-months respectively; however, the observed improvements at 6-months were sustained at 12-months.

Conclusions and Implications:

Broadly, functional outcomes associated with met needs, symptom severity, occupational and social functioning, and recovery outcomes improved for NAVIGATE participants from baseline to 6-months, with no additional gains observed from 6-months to 12-months at both metropolitan locations. The observed improvements from were stable from 6-months to 12-months at both locations. Overall, psychosis symptoms were significantly reduced, while significant gains were achieved in social, occupational, and recovery domains between two sites with high fidelity to the NAVIGATE model. No significant changes were observed for substance use, antipsychotic medication adherence, self-help, or the involvement of others in the treatment process. A major limitation of this study is the reduction in sample size between each assessment timepoint, which resulted primarily from planned and unplanned discharges from treatment.