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The Coalition of Behavioral Health Agencies, Inc. Coalition Briefs
An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery

Elizabeth Saenger, PhD, Editor and Writer
No. 115-2, May 2015

The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.


The Power of Psychosocial Services

Elizabeth Saenger, PhD

The American Psychiatric Association's annual May convention is a hubbub of presentations, poster sessions, exhibits, and receptions. Sometimes it is hard to separate the wheat from the chaff. However, I had a tip from a respected psychiatrist: attend the NAVIGATE presentations.

NAVIGATE, a part of the Recovery After an Initial Schizophrenia Episode (RAISE) Early Treatment Program, was funded by the National Institute of Mental Health. It strives to identify first episode psychosis, and optimize, and personalize, early treatment.

Quality of Life

Psychiatric rehabilitation experts Kim Mueser, PhD, Lisa Dixon, MD, and their colleagues decided to look abroad for inspiration in designing NAVIGATE. Drawing on research in Europe, Canada, and Australia, where unified health care systems specialize in particular problems and situations, they assembled a set of evidence-based treatments specifically for people who had just had a psychotic episode.  These therapies include medication, psychosocial therapies, rehabilitation services, family education, and supported employment and education to reduce symptoms and improve functioning.

The NAVIGATE package of interventions focuses on individuals during the critical two years following the first episode, and provides extra, but less intensive, care for up to five years thereafter. This strategy is consonant with research showing that people usually need the most intensive services during the first two years, but require more than treatment as usual for the next five years to retain the gains they have made.

How do the comprehensive, tailored psychosocial services of NAVIGATE compare with treatment as usual? As measured by the Heinrichs-Carpenter scale, patients clearly have a higher quality of life with NAVIGATE.

Take Advantage of NAVIGATE for Free

Individual clinicians and agencies can adapt aspects of NAVIGATE using nuts-and-bolts guides online. A step-by-step director’s manual summarizes key tasks, such as outreach; forming the interdisciplinary treatment team; and engaging patients and families. A section on supervising clinicians recommends what to look for, what questions to ask, and what to reinforce with different team members. In the process, the manual covers a variety of issues, such as avoiding stigmatizing language.

Guides directed at other team members include information focused specifically on the treatment of first episode (vs multiple episode) patients. The psychopharmacology manual notes that there are relatively few first episode individuals presenting for treatment. Consequently, physicians are often unfamiliar with ideal treatment, unaware that these patients need only 50-60% the usual dose of antipsychotics used with chronic schizophrenia patients. Prescribers may also miss other aspects of the clinical picture with first episode patients, such as the heightened risk of suicide in the years right after diagnosis.

The comprehensive Individual Resiliency Training (IRT) manual  is designed for work with first episode clients. For example, since these clients are often depressed, IRT teaches them how to focus on the positive. Clients are asked to "Find Good Things Each Day." This exercise, and others, form part of the "broaden and build" approach. Early data suggest "broaden and build" helps clients feel more positive emotions, and this benefit improves functioning and quality of life. IRT also selectively incorporates parts of additional techniques, such as cognitive therapy.

Other guides include the SEE (Supported Employment and Education) manual, family manual, and team manual.

Conclusions

NAVIGATE is a flexible, strengths-based, interdisciplinary treatment with shared decision-making, psychoeducation, and other components common in recovery-oriented care. The manuals make it easy to spot techniques to try with clients, or administrative issues to address.

It may not be possible to deliver a full-blown version of NAVIGATE. However, most programs can enrich care by adapting parts of the model for use with first episode clients. In addition, NAVIGATE may inspire programs to become more comfortable with a specialty focus in treatment, and improve outcomes by tailoring care to patients at different stages of a disorder, or in common circumstances.

Supported Employment: Facts and Figures from the Bazelon Center

Elizabeth Saenger, PhD

Why is expanding supported employment for people with a diagnosis of mental illness a great idea? Find out with Getting to Work: Promoting Employment of People with Mental Illness, a new publication from the Judge David L. Bazelon Center for Mental Health Law. Or look at three Bazelon Center fact sheets which present some highlights of this effective, evidence-based treatment and social policy.

  • Supported Employment Works! describes how the Individual Placement and Support (IPS) model, supported by eleven randomized controlled trials, plays a critical role in improving quality of life and client outcomes.
  • Supported Employment Saves Money! shows how states may save money by providing supported employment because individuals receiving this help use fewer healthcare services. These services include hospitalizations, which are a major cost in the system.
  • Supported Employment and Olmstead explains how supported employment fits in with the Americans with Disabilities Act, and subsequent Court decisions, holding that people with disabilities should be allowed to live, work, and receive services in the most integrated setting appropriate to their needs.

Families in Recovery: A Mixed Blessing

Elizabeth Saenger, PhD

How do families affect recovery when a member has a serious mental illness? A study in Montreal identified six factors at work in the way families both facilitate and hinder recovery. Families are a blessing in that they provide moral support, practical support, and even motivation. On the other hand, they may act as a stressor, stigmatize the identified patient, and force hospitalization, all of which can slow recovery.

The very different effects families can have on recovery underscore the potential of family psychoeducation. More than a hundred controlled experiments have shown that this intervention provides useful information about mental illness, helps members improve their communication and problem-solving abilities, reduces the burden of care on families, and more.

Clearly, to turn a mixed blessing into a powerful force for recovery, family psychoeducation may be the answer.

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The opinions expressed in RECOVERe-works do not necessarily reflect the views of the Coalition of Behavioral Health Agencies.

To subscribe or unsubscribe to RECOVERe-works, a free publication of the Center for Rehabilitation and Recovery at the Coalition, please email esaenger@coalitionny.org.

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