STEP’s First-Episode Service (FES)
STEP’s interdisciplinary team provides free, comprehensive clinical care, with the aim to transform the capabilities of young people with recent-onset schizophrenia spectrum disorders or ‘first-episode psychosis’ (FEP). STEP’s care pathway includes a specialty team-based first-episode service (FES), the STEP Clinic. This FES has been recognized as a model for Coordinated Specialty Care (CSC) by the National Institute of Mental Health (NIMH).
STEP’s FES is comprised of six main elements, all tailored to the individual based on their presentation, individual preferences, goals, and phase of recovery (engagement, stabilization, recovery).
Phases of Recovery:
- Engagement: entering or re-entering care after an interruption
- Stabilization: impairments related to symptoms have been minimized
- Recovery: patient is working on social, educational, work-related goals; is learning coping strategies for self-management of illness.
- It is not uncommon for patients to move in and out of these phases or cycle through them several times before getting to a more sustained recovery phase
Upon admission to STEP’s First-Episode Service (FES), the STEP clinic, patients are assigned a primary clinician and a psychiatrist to work collaboratively on managing their symptoms and achieving their goals. The primary clinician will help each patient and their family navigate the various elements of care.
Continuing Treatment in Coordinated Specialty Care
Individual therapy is a key element of STEP’s FES. Patients will meet with their primary clinician usually on a weekly basis at an agreed upon time. The patient and the clinician will work to develop a safe and trusting relationship and collaborate to identify goals and targets of treatment. STEP clinicians utilize a variety of evidence-based psychotherapies to support the following:
- Understanding and reducing symptoms
- Identifying early warning signs/relapse prevention
- Stress management and relaxation
- School and/or work goals
- Promoting skills (e.g., coping, distress tolerance, reality testing, changing relationship to internal experiences, problem-solving, communication)
- Addressing co-occurring issues (e.g., anxiety, trauma)
- Physical health and wellness
- Managing and reducing substance use
- Other topics of interest (e.g., relationships, identity, processing past episodes, navigating disclosure)
Pharmacotherapy and Health Promotion
- Injectable Medications: For individuals who prefer not to take medications by mouth or who struggle to take daily medications, we offer long-acting injectable (LAI) forms of medications. Many young people find LAIs to be a more convenient option that also helps with medication consistency.
Family Support and Education
Family support and education is an important part of early psychosis care and is recommended for all families and support people. Engaging in family support and education can have a variety of benefits including fewer symptoms and hospitalizations, improvements in overall functioning, more effective family communication, and decreased caregiver stress.
STEP offers a variety of supportive and educational opportunities for family/support people, based on an individual family’s needs, interest, and the young person’s preference. Such opportunities include:
- Education about psychosis, treatment, recovery, and other important topics
- Communication, problem-solving, and crisis-management skills
- Connection to local and virtual resources
- General support
Family Support and Education Workshops
STEP Family Orientation Workshops
As part of STEP family services offerings, the clinic hosts regular group orientation workshops for families (and interested clients). The STEP Family Orientation Workshop will help families become familiar with services and team at STEP, common symptoms of psychosis and how to support your young person’s recovery. All families and support people of recent STEP enrollees are encouraged to attend!
Please email Laura Yoviene Sykes, PhD, for Zoom info.
STEP Family Orientation Workshop - Wednesday October 12th 5-6pm (Note: This workshop is ONLY for STEP families/support people)
The STEP program hosts periodic educational workshops aiming to bring in experts to discuss topics relevant to the young people we serve and their families. Workshops are open to STEP clients, their families and support system, as well as the general public. RSVP required.
If you are interested in presenting at a STEP Family Workshop, please email Nina Levine.
Navigating Mental Health Crises in the Community Among Young People with Psychosis – Panel and Discussion -
Please join us on Tuesday, September 13th, 5pm-6:30pm(Note: This workshop is open to the public)
This workshop is open to any Connecticut family or community member interested in learning how to navigate mental health crisis in the community among young people with recent onset psychosis.
Expert panel will include:
- Wandra Jofre, LCSW – CMHC CIT Clinician
- Lt. Michael Fumiatti, MS – Crisis Intervention Team (CIT) Officer – New Haven
- Louise Pyers, MS, BCETS – Founder and COO of CABLE (CT Alliance to Benefit Law Enforcement)
Presentation will be followed by question & answer session.
Coordination with Community Supports
With your permission, your STEP team will coordinate with other providers and supports in your community, such as: Primary care providers (PCPs), school counselors, and advisors
Your STEP team will also provide assistance with day-to-day needs, such as:
- obtaining financial support (e.g., SNAP benefits, SSI/SSDI)
- liaising around legal issues
- gaining assistance with housing
Support for Employment and Education
STEP strives to support young people’s (re)engagement with important “instrumental” and “expressive” roles (e.g., school and work)
STEP patients have the option of meeting with dedicated staff to support their engagement with various vocational and educational pursuits. Support is individualized and may include a wide range of activities such as: resume building, job applications, interview skills and etiquette, college applications, and class selection
STEP also supports and encourages young people in fostering healthy relationships, including connecting with peer support networks and organizations
Many distinct disorders can cause psychotic symptoms, and while laboratory tests and imaging can sometimes help, repeated assessments by trained clinicians over several months (‘longitudinal evaluation’) is often the best way to determine an appropriate diagnosis and to not miss known medical disorders (e.g. epilepsy) that require separate treatment. Thus longitudinal evaluation is a core element of STEP care, and is first initiated in Module A, through rapid assessment of eligibility for STEP services by the STEP outreach and admissions coordinator. Evaluation and initiation of treatment (Module B), includes learning as much as we can about a patient as quickly as possible through in-depth evaluation, case formulation, establishing working diagnoses, and treatment plan. While mostly completed during evaluation phase (Module B), evaluation remains an active task of Continuing Treatment in Coordinated Specialty Care (Module C) given the need for longitudinal follow-up to sometimes fully evaluate diagnostic possibilities.
Thus, throughout STEP care, regular outcomes assessments take place (~ every 6 months), as well as continuous updating of clinical formulation as more information is gathered through working with the patient.