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Research at STEP

See below for a list of STEP’s recent publications.

Annotated Bibliography:

Overviews and practical reviews:

Srihari, V. H., Jani, A. & Gray, M. Early Intervention for Psychotic Disorders: Building Population Health Systems. JAMA Psychiatry 73, 1–3 (2016). Brief outline of STEP’s Population Health informed approach to building local systems of care for schizophrenia.

Srihari, V. H. & Cahill, J. D. Early Intervention for Schizophrenia: Building Systems of Care for Knowledge Translation. in (eds. Wood, S. J., Uhlhaas, P J & Lupp, J.) vol. 28 (2019). Detailed description of STEP’s vision for dissemination of early intervention services within the Institute of Medicine’s Learning Health Systems (or Network) concept.

Dixon, L. B., Goldman, H., Srihari, V. H. & Kane, J. M. Transforming the Treatment of Schizophrenia in the United States: The RAISE Initiative. Clinical Psychology 14, annurev-clinpsy-050817-084934 (2018). A historical overview of the (delayed!) development of coordinated specialty care services in the U.S.

Srihari, V. H. & Kane, J. M. Early Intervention Services 2.0: Designing Systems for the Next Generation of Work. Biol Psychiat 88, 291–293 (2020). Viewpoint on how emerging research on pre-psychosis or prodromal populations can be incorporated into the EIS paradigm to intervene earlier in the disease course.

Ferrara, M., Mathis, W. S., Mathis, Cahill, J. D. & Srihari, V. H. Early Detection of the Schizophrenia(s): A Population Health approach. in (eds. Hardy, K. V. et al.) (American Psychiatric Publishing, 2019). A description of STEP’s approach to reducing delays in access or the Duration of Untreated Psychosis.

Pollard, J. M., Cahill, J. D. & Srihari, V. H. Building early intervention services for psychotic disorders: A primer for early adopters in the U.S. current psychiatry reviews 12, 350–356 (2016). Written for novice sites but highlights the importance of culture and incentives in building or refining early intervention services.

Ferrara, M. & Srihari, V. H. Early Intervention for Psychosis in the United States: Tailoring Services to Improve Care for Women. Psychiatr Serv (2020). Women may be underserved by extant CSCs and this paper offers proposals for improvement.

Weiss A, Chaudhry S, Cahill J, Srihari VH. Establishing the Early Psychosis Intervention Clinic, New Orleans (EPIC-NOLA): Sustainability Challenges Threaten Clinical Success. Journal of Health Care for the Poor and Underserved 2021. Empirical report from a clinic in New Orleans established in consultation with STEP.

Selected papers reporting outcomes from the STEP Program:

Srihari, V. H. et al. First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial. Psychiatr Serv 66, 705–712 (2015). First U.S. experimental demonstration of CSC success with care models adapted from U.K, Australia and Denmark but for implementation in U.S. public sector.

Murphy, S. M...Srihari VH. An Economic Evaluation of Coordinated Specialty Care (CSC) Services for First-Episode Psychosis in the U.S. Public Sector. J Ment Heal Policy Econ 21, 123–130 (2018). Detailed report on an economic cost-benefit analysis of STEP’s coordinated specialty care service.

Srihari, V.H. et al. Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial. Schizophrenia Bulletin Open 3(1), 1-9 (2022). First U.S. demonstration of early detection of FEP, detailing the halving of DUP across a 10-town region.

Gallagher, K. et al. Taking the next step: Improving care transitions from a first-episode psychosis service. Early Interv Psychia (2021). This paper reports the results of a quality improvement (QI) intervention to improve successful transfers to community care after 2 years of specialty care at STEP.

Ferrara, M. et al. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psych Psych Epid 56, 1359–1369 (2021). Individuals with FEP who sought help before the onset of full-blown psychosis were more likely to have exercised their own choice vs those who were brought into care by family/others after psychosis onset.

Pollard, J. M. et al. Analysis of Early Intervention Services on Adult Judicial Outcomes. Jama Psychiat 77, 871–872 (2020). Individuals who received STEP (vs usual care) were less likely to suffer interactions with the criminal justice system over several years after discharge.

Kline, E. R. et al. Timing of cannabis exposure relative to prodrome and psychosis onset in a community-based first episode psychosis sample. J Psychiatr Res 147, 248–253 (2022). This paper characterizes cannabis use in our FEP sample – mostly before psychosis onset, rising historical trends and associated with more adverse outcomes.

Mathis, W. S., Woods, S. & Srihari, V. Blind Spots: Spatial analytics can identify nonrandom geographic variation in first episode psychosis program enrollments. Early intervention in psychiatry 10, 1217 (2018). Uses novel geographic methodology to identify gaps in referrals of FEP from primary care providers to our service based on expected incidence of cases.

Mathis, WS, et al. Marginal Delay: A Quantitative Method for Assessing Delay along Pathways to Care to Reduce the Duration of Untreated Psychosis. (2022, In Press). Uses a novel methodological approach (network analysis) to assess delay along pathways to care for first episode psychosis. Delay in initial help-seeking after psychosis onset was the largest contributor to overall delay in getting to STEP (vs delay after initial contact with a referring healthcare provider).