This Month’s Highlights

Special Section on RAISE and Other EarlyIntervention Services

Four articles, two brief reports, and three columns in this issuefocus on coordinated specialty care programs for individualsexperiencing early psychosis. Such programs, which seek tochange the trajectory and prognosis of schizophrenia throughcomprehensive and aggressive treatment in the earliest stagesof illness, have been widely implemented in other countries,but not in the United States. In 2008, the National Institute ofMental Health (NIMH) announced the RAISE project (Re-covery After an Initial Schizophrenia Episode), later awardingcontracts to two research groups to develop and test potentialinterventions. The special section features reports from bothgroups. In Taking Issue, Amy B. Goldstein, Ph.D., and herNIMH colleagues describe the ways in which each report inthe special section addresses implementation challengesidentified when RAISE was launched (page 665). In thelead article, Kim T.Mueser, Ph.D., and colleagues from one ofthe NIMH-funded groups describe the intervention they de-veloped, known as the NAVIGATE program. Core servicesinclude family education, individual resiliency training, sup-ported employment and education, and individualized medi-cation treatment (page 681). In the second article, Lisa B.Dixon, M.D., M.P.H., principal investigator for the otherNIMH-funded group, and her colleagues provide an overviewof services included in the intervention they developed—theRAISE Connection Program. These authors also present out-come data on functioning, symptoms, and remission amongclients who received services for up to two years at Connec-tion sites in Baltimore and New York City (page 692). Be-cause engagement is critical to the effectiveness of theseprograms, researchers at the Baltimore and New York sitesexamined data from semistructured interviews with clients—both those who were well engaged and those who were not.As Alicia Lucksted, Ph.D., and colleagues report, Connection’sfocus on life goals was a central factor in engaging clients.Most interviewees were under age 25, and their engagementhinged substantially on Connection’s nonclinical services,such as supported education and employment (page 700).In a third article, Vinod H. Srihari, M.D., and colleaguespresent findings from a controlled trial of STEP (SpecializedTreatment Early in Psychosis). STEP, which is not part of theRAISE initiative, was established in 2006 by the ConnecticutMental Health Center. After one year, STEP participants hadsignificantly fewer and shorter hospital stays than those in

usual treatment and demonstrated better vocational en-gagement (page 706). Of the three columns in the specialsection, two are from RAISE researchers associated with theConnection Program. In Research & Services Partnerships,Susan M. Essock, Ph.D., and coauthors describe the Connec-tion Program as a partnership involving researchers and statemental health authorities. The authors explain why statesare interested in first-episode services and describe the de-velopment of the partnership,financingmechanisms, and plansto add teams in Maryland and New York (page 672). As theseprograms are implemented more widely, new teams’ fidelity tothe intervention is essential. In the Best Practices column,Dr. Essock and colleagues present a practical approach to fi-delity monitoring that they developed for the ConnectionProgram—one that uses routinely available administrative dataas well as information from client interviews (page 675). Wide-spread dissemination will also require a funding mechanismthat not only is compatible with approaches already used bypayers but also generates incentives for providers. In Eco-nomic Grand Rounds, RichardG. Frank, Ph.D., and colleaguespropose a fundingmodelwith three components and describehow such a model might be implemented (page 678). Twobrief reports complete the special section. The first, by JeanAddington, Ph.D., and others associated with the NAVIGATEprogram, presents findings from a study that examined durationof untreated psychosis (DUP) among community mental healthcenter clients. Median DUP was 74 weeks, and two-thirds ofparticipants had DUP of greater than six months (page 754).Finally, in a two-year study of patients receiving first-episodeservices in Montreal, Clairélaine Ouellet-Plamondon, M.D.,F.R.C.P.C., and colleagues found high rates of disengagementamong immigrants, even though their medication adherencewas similar to that of nonimmigrants (page 758).

Briefly Noted

• As Medicaid programs transition from branded second-generation antipsychotics to generics, expenditures forthese drugs could decrease by more than 75%, accordingto a forecasting study based on analyses of 2008–2011Medicaid data (page 719).

• This month’s Open Forum describes SAMHSA’s Recoveryto Practice project, a workforce collaborative to increaseclinicians’ skills in delivering evidence-based, recovery-oriented services (page 751).

Psychiatric Services 66:7, July 2015 ps.psychiatryonline.org 667

HIGHLIGHTS