Research and practice have increasingly focused on early intervention for psychosis to optimize functional outcomes and minimize symptom distress. Current best practices take a recovery-focused approach, typically employing social workers as team leaders or in other prominent roles. Previous research has found that training programs for community providers are generally successful in increasing provider knowledge of early intervention services, but has not explored providers’ decision-making processes to refer clients for early intervention. The present study aims to understand 1) the decision-making process of, and impact of training on, social workers who participated in an online early identification of psychosis training by the Maryland Early Intervention Program (MEIP) and subsequently contacted the referral line and 2) the experience of MEIP referral or consultation.
A qualitative, multiple case study methodology was used to understand providers’ decision-making processes and referral experiences. Semi-structured interviews were conducted with clinical social workers (n=3) who contacted the MEIP after participating in a randomized clinical trial study testing the efficacy of a web-based training program focused on identifying early warning signs of psychosis and making referrals. Interviews were recorded and transcribed via Webex. Transcripts were analyzed with the “Sort and Sift, Think and Shift” method.
Social workers’ decision-making processes varied based on service contexts, and clients’ symptoms and sociocultural backgrounds. Case 1 emphasized the use of the Prime Screen (a screening measure for psychosis-risk) in facilitating their decision to call the MEIP, and that learning about MEIP resources was a “huge relief.” For Case 2, there were linguistic barriers to their client connecting with the MEIP; however, they consulted with MEIP staff about appropriate course of treatment and psychiatric referral. Additionally, the training increased their comfort working with adolescents experiencing psychosis and prompted them to seek additional resources to continue working with that client. Case 3 emphasized the training’s impact on their understanding of early psychosis with varying levels of functioning, which helped them identify potential psychosis in their own client. Across the three social workers, themes emerged around 1) decision-making confidence and knowledge of identifying “red flags” of psychosis, 2) benefits of consultation with MEIP, and 3) sharing of training knowledge with colleagues who did not participate in the study. All offered recommendations for improving the training and referral processes and access to resources for providers whose clients could benefit from early intervention.
Findings suggest that conducting online trainings for clinical social workers around early psychosis identification and referral may be a valuable strategy for increasing providers’ ability to make informed decisions about treatment and referral for psychosis. Additionally, the training had an impact on providers who did not receive the training through sharing of resources by those who participated. Social workers noted the convenience of a web-based training for busy clinical settings. Conversely, social workers highlighted barriers to client access to early psychosis services, (i.e., language, transportation, finances). Further work is needed to refine and adapt early psychosis training and services to reduce barriers for diverse client and provider populations.