114.2 Scaling Early Psychosis Treatment in New York State: Challenges and Outcomes

Abstract

Background: OnTrackNY is a novel coordinated specialty care (CSC) program designed to treat individuals within 2 years of the onset of nonaffective psychosis in New York State. OnTrackNY is funded by New York’s mental health authority, the Office of Mental Health (OMH), which supports service delivery, training and evaluation. Starting with four CSC teams in 2013, OnTrackNY will have 21 teams scattered throughout the state in diverse care settings by 12/16. In order to create an adapting learning health-care system with dynamic real-time improvement cycles, person- and program-level data on care outcomes and processes are collected and reported to teams, while teams offer feedback on their experiences and challenges in program implementation in the context of training activities. This process creates an evolving program model that is anchored in evidence and experience. Little is known about outcomes of CSC programs in the United States. This study describes OnTrackNY program outcomes to 8/16. Methods: The Center for Practice Innovations (CPI), a training and implementation center located at the New York State Psychiatric Institute, oversees training and quality improvement activities for OnTrackNY. CPI works with the Performance Measurement and Evaluation Unit of OMH to monitor referral patterns and enrollment, baseline characteristics and follow-up outcomes, and fidelity. All teams supply quarterly information about team structure and staffing and regarding client status including use of acute services and participation in education and employment. Clinicians are also trained to score client symptom, occupational, and social functioning, using the Mental Illness Research Education and Clinical Center (MIRECC) Global Assessment of Functioning (GAF) scales, adapted for early psychosis. Mechanisms for gathering client self-report and follow-up after discharge are being developed. Results: As of August 2016, a total of 403 individuals have been enrolled in OnTrackNY; 71% male and have a mean age of 21. A total of 15% are less than 18 years old. Forty-two percent are Caucasian, 41% are African American, 10% are Asian, and 23% are Hispanic. Fifty percent are insured by Medicaid, and 40% have private insurance. Client retention in treatment was 82% at 1 year. Mixed model multivariate regression analyses reveal improvements from baseline to 3 months, 9 months, and 1 year (all P < .001) on all MIRECC GAF scales as well as increased odds of participating in work or school and decreased odds of hospitalization. Few differences by individual programs were observed. Being male (all MIRECC GAF scores, education/employment) and having violent ideation or behavior at baseline (all MIRECC GAF scores, hospitalization) was associated with poorer outcomes. Conclusion: OnTrackNY serves as an example of how to scale up early psychosis services across a large state that is supported by resources for services, training, and monitoring of outcomes and fidelity. Limitations include reliance on clinician report. Striving to improve the model and transition and discharge are key future issues that need further exploration.