STEP reopens, offering early intervention for psychosis

STEP, the program for Specialized Treatment in Early Psychosis, has reopened its clinical service to new admissions, addressing a critical public health gap by offering first-class care to individuals ages 16-35 in the early stages of psychotic illness.

Psychosis often strikes during the "young adult" years, but after experiencing a full-fledged episode of psychosis, young people in the U.S. often wait for months, even years, to receive mental health care. They and their loved ones face a fragmented health care system that sends mixed messages about early psychosis and its treatment. To add to those challenges, stigma may prevent people from seeking help, and psychotic disease causes significant distress and confusion for virtually everyone it touches. Fortunately, early intervention can change things dramatically for the better.

The STEP Program, based at Connecticut Mental Health Center, pursues early intervention through its three-part mission in clinical care, research, and education. STEP's clinical service provides empirically based, developmentally appropriate care for young people with recent onset psychosis and their families. Thanks to renewed support from the Connecticut Department of Mental Health & Addiction Services, STEP's clinical staff has expanded, led by its new director Jessica Pollard, PhD, and the clinic is now accepting new referrals and self-referrals.

Commitment to early intervention

"Timely and effective treatment for young adults experiencing early psychosis is an important component on the path to recovery," said DMHAS Commissioner Pat Rehmer. "DMHAS is dedicated to early intervention, and the increased funding to the STEP clinic for new referrals demonstrates this commitment."

"We are grateful for the visionary support of the leadership at DMHAS and CMHC, which is consistent with their established commitment to those with chronic mental illnesses," says Vinod Srihari, MD, principal investigator of STEP research, founding director of the STEP Program, and associate professor of psychiatry at the Yale School of Medicine.

"Since its opening in 2006, STEP has grown and developed because of the work of a talented team of clinical and medical staff, as well as researchers," Dr. Srihari explains. "We are poised to have a greater impact than ever as we expand to care for new clients, conduct new research, and train new leaders in the field of mental health care." (For more about the history and expansion of STEP, click here.)

How to seek treatment

The STEP clinic is available to qualified individuals regardless of insurance status. If you would like to learn more about treatment options available at STEP, please contact the Referral Line (203) 785-2100, or Dr. Jessica Pollard, Clinical Director, (203) 974-7345, jessica.pollard@yale.edu.

From research to expanded practice

In 2012, STEP completed a five-year study funded by The Donaghue Foundation and the National Institutes of Health to establish the effectiveness of its service model in improving vocational and social outcomes and reducing hospitalization rates, compared to usual models of care in the community. This was the first U.S.-based randomized controlled trial of such an early intervention service, and STEP patients did significantly better than the "usual care" group. (Read more about that study, and STEP's approach, here.)

In response to data demonstrating the effectiveness of the clinical service, DMHAS allocated increased support to hire dedicated STEP staff and to increase the impact of this early intervention model in the State of Connecticut.

Dr. Srihari says that the investment made by DMHAS and CMHC makes sense from a public health perspective. "Without early intervention," he explains, "many individuals will go on to develop chronic illnesses with unnecessary degrees of suffering and disability that can be mitigated with thoughtfully delivered treatments that are already available to us."

Next round of research

Although clients do not need to participate in research in order to receive treatment, the STEP Program is now conducting a study to support its vision of improving outcomes for early psychosis across Connecticut. In September 2013, the clinic received a second grant from the NIH to test a strategy to reduce the duration of untreated psychosis (DUP) in the State. The DUP is a measure of how long it takes for individuals to enter effective care after the onset of full-fledged psychosis.

"In usual U.S. systems of care," notes Dr. Srihari, "the DUP has been estimated to be more than one year. This represents an unacceptable delay that adds considerably to the distress and burden of these illnesses."

A team of clinicians and researchers at Yale, the University of Connecticut, and Harvard, led by Dr. Srihari, will implement a campaign targeting barriers to care. The campaign will launch in 2015 and target individuals who have yet to benefit from early intervention in a geographic zone within feasible access to CMHC. The campaign will use media outlets and professional outreach to improve identification of psychotic symptoms, convey knowledge of the effectiveness of treatment, and enable quick access to STEP from the towns of Bethany, East Haven, Hamden, New Haven, North Haven, Orange, West Haven and Woodbridge. The strategy is modeled after the TIPS Project, a successful public information campaign in Norway that was co-led by Thomas H. McGlashan, MD, a co-investigator in this study. The study will test whether such a campaign can work in the U.S. by piloting it in southern Connecticut, and comparing the impact of this work to a control site in Boston.

Educational mission and further research

The STEP Program has, since its inception, expanded to undertake a wide variety of research projects. It also serves as an important training site for budding clinicians in psychology, psychiatry, and social work, as well as for clinical investigators. By design STEP is interdisciplinary, with its missions in clinical care, research, and education wholly dependent upon one another.

In October 2013 the Connecticut Mental Health Center Foundation awarded Gerrit Van Schalkwyk, MD a small grant for his study aimed at identifying factors that influence treatment engagement in early psychosis. Dr. Van Schalkwyk will conduct and evaluate a series of qualitative interviews with STEP research participants. Dr. Van Schalkwyk is a resident in the CMHC Psychiatry Residents Program. His project will be supervised by Dr. Srihari and Larry Davidson, PhD, Director of the Yale Program for Recovery and Community Health. This grant award launches a new CMHC Foundation initiative to build relationships with CMHC medical residents and support their research while at CMHC.

"STEP's mission in clinical care, research, and education reflects the overall mission of CMHC," says Michael J. Sernyak, MD, CEO of Connecticut Mental Health Center. "STEP represents the best of what we can accomplish in the field of mental health services, when we set out together to improve the lives of people with serious mental illness."

This article was submitted by Shane Seger on February 18, 2014.

Vinod Srihari, MD
Jessica Pollard, PhD

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Jessica Pollard

Assistant Professor of Psychiatry

Vinod Srihari

Associate Professor of Psychiatry