Early Detection and Intervention for the Prevention of Psychosis in Adolescents and Young Adults

An RWJF national program replicates the Portland Identification and Early Referral (PIER) Program

The Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP) was a national effort to identify, intervene early, and treat young people between ages 12 and 25 at risk for a psychotic episode.

“When you develop schizophrenia, you drive off a cliff. So imagine you could stop the process already underway.”—William R. McFarlane, MD, EDIPPP Program Director

Dates of Program: August 2006–May 2013

Description: Psychotic disorders, which most often appear in the late teenage years or early adulthood, devastate families and constitute a major public health burden, affecting some 2–3 percent of the adult population. Over a lifetime, a single psychotic individual can cost society in excess of $10 million. Recent evidence suggests that early intervention may delay or prevent some mental illness.

The program, managed by the Maine Medical Center, had three components:

  • Community outreach, focused on educating individuals who interact regularly with young people and may be in a position to observe prodromal (early) symptoms. These include school employees, social workers, doctors, nurses, students, parents, clergy, and law enforcement personnel.
  • Research in which a specialized multidisciplinary clinical team assessed the risk of psychosis and the functioning level of individuals referred for treatment and assigned them to one of three study groups based on their symptoms (lower risk, higher risk, or early in their first episode of psychosis), and tracked their progress.
  • Clinical treatment geared towards the needs of young adults (between the ages of 12 and 25) at risk for a psychotic episode. The clinical program was built around family-aided assertive community treatment, which is based on the idea that family involvement is essential to preventing psychosis.

What were the results?

  • Despite their diverse characteristics, all five EDIPPP sites generated a stream of appropriate referrals, completing 539 outreach activities that reached approximately 23,315 potential referrers from 2008 to 2010. A total of 1,221 young people were referred for intervention during this period.

“These kids were not hard to identify… These are the kids that are excelling and then suddenly taking a nosedive—being isolated, withdrawn, not doing well in school. It became very clear you could train people to identify these young people correctly.”—Jane Isaacs Lowe, PhD, RWJF Senior Adviser for Program Development

  • Family-aided assertive community treatment was more effective in managing many symptoms than standard community care.
  • Negative symptoms decreased in the higher-risk and early first-episode psychosis groups, compared with the lower-risk group.
  • California and Oregon are incorporating early identification and intervention for psychosis into mental health systems statewide. EDIPPP teams are playing a key role in the launch of the programs.

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