Essential Components of First-Episode Psychosis Services

A study published in May 1st, 2013 Psychiatric Services identified essential evidence-based components of first-episode psychosis services. The research took place in two stages. First a systematic literature review, then, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential.

This two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form a foundation for developing a fidelity scale for such services. It may also be helpful to funders and providers as a summary of essential services.

The study yielded an interesting group of essential services and approaches divided by domain and component. For example:

Population-level interventions and access
– this domain stressed public and healthcare provider education, communication among providers and availability of treatment for comorbid conditions
Comprehensive assessments and care plan
– highlighted the importance of individual-centered assessments, suicide assessment, psychosocial care plans, etc.
Individual-level interventions
– this domain included pharmacotherapy including medication choices, low dosing, metabolic monitoring, etc
-also included is psychoeducation, addiction treatment, vocational and educational planning
Group-level interventions
– including multi-family and group therapies
Service system and models of intervention
– this stressed team approaches, staff supervision, outreach programs, crisis intervention services
Evaluation and quality improvement
– continual evaluation and outcome measures

The researchers concluded that “our review found an adequate corpus of research on first-episode psychosis services to inform a panel of experts in identifying evidence-based components. The Delphi was successful in reducing evidence-based components to 32 essential components. Pharmacological components generally had the highest level of supportive evidence, although psychosocial components, such as family psychoeducation or multifamily group psychoeducation and supported employment, both had level A evidence. The lack of evidence for a number of organizational components reflects the lack of attention paid to these issues in the research literature.”

Psychiatric Services 2013;64:452–457