About Early Detection and Intervention for the Prevention of Psychosis
The Robert Wood Johnson Foundation's (RWJF) initiative funded from 2006 to 2013—National Demonstration of Early Detection, Intervention and Prevention of Psychosis in Adolescents and Young Adults (EDIPPP)—was designed to replicate the Portland Identification and Early Referral (PIER) Program that used evidence-based psychosocial and pharmacologic interventions in the early identification and treatment of adolescents and young adults with severe mental illness. Recognizing that the community can play an important role in prevention, EDIPPP reached out to adults who had regular interaction with young people (teachers, social workers, doctors, nurses, police officers, parents,) and educated them on early signs of psychotic illness so that they could identify those at risk.
EDIPPP worked primarily with young people ages 12 to 25 who showed early symptoms but did not yet have the disease and provided them with treatment plans based on their level of need. By leveraging early referral programs, EDIPPP’s aim was to redefine mental health services and redirect the course of treatment to prevent psychotic illness in young people.
RWJF contracted with the University of Southern Maine’s (USM) Muskie School from August 15, 2007 through November 30, 2011 to evaluate the community outreach and training efforts of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). A key component of the program was educating communities about psychosis and informing community members how they could access EDIPPP services. Led by Brenda Joly, PhD, University of Southern Maine, Edmund S. Muskie School of Public Service, the four-year evaluation focused on the community outreach and education activities and included an assessment of three major areas: 1) implementation of the PEI education and community outreach strategies; 2) contextual factors that may influence the implementation and impact of this initiative; and 3) specific outcomes related to the PEI education and outreach efforts.
Over the life of this evaluation (2007–2011), the evaluation grantee provided 13 cross-site and grantee-specific evaluation reports, detailing the evaluation framework, methodology, major data collection tools limitations, and outreach findings. This final report focuses on the major outcome of interest—program referrals. The report summarizes findings based on a series of key informant interviews across all sites with individuals who made a referral to EDIPPP.
Process and outcome measures were used to obtain qualitative and quantitative data. Data were collected from focus groups, interviews, and a survey.
In the spring/summer of 2011, Muskie School researchers conducted a series of key informant interviews (n=29) among professional referrers (59% women) from each of the five EDIPPP sites, using a semistructured interview protocol. Outreach staff at each site assisted in recruiting referrers who had made one or more referrals to EDIPPP between March 2008 and March 2010. Sites were asked to provide contact information for professionals who had made: A single appropriate referral; a single referral that was not deemed appropriate; more than one referral, with the first referral being deemed inappropriate; and more than one referral (appropriate or inappropriate).
The outreach evaluation sought to measure several short-term outcomes, including an increase in knowledge and intentions to refer. However, the main outcome of interest was centered on referrals and evaluators who sought to better understand the experiences, perceptions and knowledge of individuals who made a referral to EDIPPP. This report addresses the following evaluation questions:
1. Which outreach efforts had professional referrers been exposed to? 2. According to professional referrers, what messages were communicated in EDIPPP education sessions? In the views of the referrers, were outreach efforts satisfactory? Could they be improved? 3. How does the referral process work? Was the process satisfactory to referrers? 4. What are the pathways that lead to referrals to EDIPPP? What are the barriers?
Key Evaluation Findings
- Approximately 1,221 referrals were recorded by EDIPPP staff between March 1, 2008 and March 31, 2010.
- Referrers tended to be highly educated women; many with a post-graduate degree.
- Nearly one-in-four individuals who made a referral first heard about the program through a training session.
- In general, referrers either had known the client they were referring for more than five years or less than one month.
- Significant differences existed between professional and nonprofessional referrers.
- Most referrers who made contact with EDIPPP during the evaluation were first-time callers, however, a significant subset (27%) had made multiple referrals to EDIPPP.
Lessons learned from this evaluation suggests the importance to successful outreach of:
- identifying and targeting outreach to priority populations likely to come into contact with those in need of prevention or treatment services;
- developing and disseminating consistent core messages that referrers need to know, e.g., how to identify a person at risk, how to make a referral; and
- ensuring the credibility of educators and trainers involved in outreach.
The results from RWJF’s four-year evaluation revealed that community outreach can be an effective strategy for identifying those at risk of mental illness and ensuring their referral to appropriate treatment programs. Evidence from this evaluation demonstrates that outreach efforts can reach priority groups, shape perceptions and create local networks that may result in referrals for specialty programs and clinical research. Results also show that relatively brief community engagement efforts can significantly increase the knowledge and awareness of the public of complex mental health issues.
For more in-depth findings and discussion, please refer to the final report.