EDIPPP Intake Procedures

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EDIPPP Intake Procedures

• From referral to clinical visits

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Referral Intake Process

• First call
• Phone screen form and PRIME screen are completed
  by clinician.
• A score of 1 is required on the Prime Screen on
  at least one P scale in order to proceed.
• Clinician records call on phone log.

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EDIPPP Initial Phone Screening

• Evidence of psychosis
• hallucinations      
• delusions      
• unusual thought content      
• disorganized speech      

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EDIPPP Initial Phone Screening

• PRODROMAL SYMPTOMS
• Difficulties in thinking (attention,
  concentration, memory, organization)
• Difficulties in speaking or writing
• Anxiety     
• Drop in functioning (work, school, self-care,
  activities)      
• Perceptual disturbances/sensitivities      

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EDIPPP Initial Phone Screening

• PRODROMAL SYMPTOMS (contd)
• Suspiciousness, ideas of persecution      
• Grandiosity      
• Social isolation or withdrawal      
• Decreased emotional expressiveness or sense of
  loss of emotions and self      
• Odd/bizarre behavior or appearance      
• Disturbances of sleep      
• mood      
• motor functioning      
• appetite/nutrition

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The PRIME Screen Pt. . __________________
Date _____/_____/_____ Office ID
_________ Please read the attached information
sheet before completing this questionnaire. The
following screen asks about your personal
experiences. We ask about your sensory,
psychological, emotional, and social
experiences. Some of these questions may seem to
relate directly to your experiences and others
may not. Please answer all questions.
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(No Transcript)
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Deciding whether to assess

• Clinician reviews case with team leader (TL), who
  determines whether case meets other intake
  criteria for assessment ( per exclusion criteria
  list).
• In some situations, the team may need to hear the
  case to assist with making a determination.
• If the decision is made to assess the referral,
  the TL gives phone screen form to secretary.

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Screened out calls

• Phone screen forms of referrals not being
  assessed are kept in either the potential or
  not to be assessed files in the clinical area.
• Keep these forms in the event there is a future
  call about the same individual.

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Starting the assessment process

• Secretary assigns ID from the database and
  starts a manila folder with name and ID.
• Folder includes phone screen form and pertinent
  notes.
• Manila folder stays in locked file cabinet in an
  area marked Assessments.
• Clinician assigned to work with family should
  call to make orientation appointmentideally,
  this would be the person who took the referral
  call.

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Research becomes involved

• Secretary gives research coordinator (RC) a copy
  of phone screen form (ID at top).
• RC gives secretary Family Questionnaire packets
  to give to clinician.
• Secretary assembles orientation packet for
  clinician.

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Components of the Orientation Session
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Informed Consent Checklist

• Introduction Symptoms / Early
• Intervention
• Purpose of Informed Consent Process
• Mild level of symptoms very common in this age
  group early intervention is the only known way
  to prevent or delay the onset of mental illnesses
• Assessment to determine eligibility

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Informed Consent Checklist

• General information
• Research Study
• Purpose
• 2 years
• Voluntary
• Alternative treatments
• Risks and benefits
• Participant Stipend (6 months __
• 1 year __ 2 years __)

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Informed Consent Checklist

• Assessment
• 2 3 sessions
• Family involvement
• Questionnaires and MFG survey

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Informed Consent Checklist

• Study Design
• Assignment to group on basis of need
• Counseling w / medication (med based on need and
  consultation, not experimental)
• Major research assessments at 6, 12, and 24
  months
• Research blind
• Differences / similarities between the groups

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Informed Consent Checklist

• Treatment Group
• MFG family education
• Crisis intervention
• Medication management
• Supported education and employment
• Functional assessments/support

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Informed Consent Checklist

• Comparison Group
• Light case management monitoring
• Assistance as needed

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Informed Consent Checklist

• HIPAA / Confidentiality
• Confidentiality and exceptions
• Release of information
• Type of Information collected

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Confirming Consent ask questions if necessary
to verify appropriate level of understanding!
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Orientation session

• Clinician meets with family and potential client
  prior to the assessment process.
• Joining starts during interview.
• Use informed consent checklist and orientation
  protocol.
• IRB consent forms, Family Questionnaires and
  Family FPE Survey are completed, along with other
  necessary forms.

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Orientation session (contd)

• Review appointment timeline with family.
• Offer research assessment times to family if they
  choose to proceed.
• Appointments for research assessments and
  feedback sessions are given at this time by
  secretary.

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ORIENTATION

• Client, Parents, Siblings (12 up)
• 3 Hours with a Clinician
• Orientation to Program Research
• Face-to-face mental status
• Sign informed consent document Contract to
  Participate
• Complete family questionnaires
• Schedule with Research

DAY ONE
Client Parents with a Researcher 1
Hour Complete Client Health and Treatment History
Parents 3 Hours with a Researcher Complete
client family history interviews, review of
client functioning (PAS, Family History,
Heinrichs QLS, GAF/SR)
Client 3 Hours with a Researcher Complete
clinical research interviews (SIPS, PANSS,
SCID/K-SCID)
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DAY TWO
Client Cognitive Testing 1.5 Hours with a
Researcher Complete substance use survey
social role functioning scales (T-ASI
Heinrichs QLS, PAS) 2.0 Hours
Family Complete review of client mental health
symptoms (K-SCID) 1.5 Hours with a
Researcher Complete any outstanding
questionnaires (Burden Scale, MFG Survey, Subject
Locator Form) 30 minutes
DAY THREE
Client Parent Assessment Feedback with EDIPPP
Clinician
Treatment Assignment

• COMPARISON GROUP
• Client Parents
• Urgent Assessment Tool Kit Review of Contract
  to Participate
• Schedule appointments

• TREATMENT GROUP
• Client Parents
• Learn about services Complete clinic paperwork
• Review Contract to Participate

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Research Visits
Clinical Visits for Treatment Condition

• MONTH 6
• Client
• 3 HOURS
• 1 YEAR
• Client
• 7 8 HOURS
• Parent(s)
• 4 HOURS
• Client Family
• 1 ½ HOUR
• 2 YEARS
• Client
• 7 8 HOURS
• Parent(s)
• 4 HOURS
• Client Family
• 1 ½ HOUR

MEDICATION MANAGEMENT Client and Parent(s) 1
HOUR At least once a month MULTI FAMILY
GROUP Client Family 1 HOUR 30 MINUTES Groups
meet twice a month (bi-weekly) PSYCHOEDUCATION
WORKSHOP Client and Family 6 - 7 HOURS INITIAL
JOINING SESSIONS (2 Sessions) Client Family 1
HOUR (per session)
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Research assessments

• Researchers administer all intake assessments,
  including neuropsych testing.
• If an individual is considered psychotic, the
  team MD and TL will be consulted re rapid
  treatment access.
• In this situation, some research assessments may
  need to be postponed in order to begin treatment.
  The P scales should at least be administered.

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Following the assessment process

• Following research assessments, RC scores SIPS
  and gives scores to research director (RD), along
  with research checklist and copy of SIPS. RD then
  determines whether the client meets criteria for
  treatment or control.
• RD gives outcome information to secretary and TL.
  
• Those who meet treatment criteria have a chart
  made according to each EDIPPP sites regulations.
  
• Information on individuals who decline
  participation at any stage should be kept in
  appropriate areas (research or clinic).

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Components of the Feedback Session
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Feedback session

• Assigned clinician first reviews SIPS information
  and research checklist to better understand the
  clients symptoms and level of illness.
• Clinician then meets with family (client
  included) for feedback session.
• Clinician should follow EDIPPP feedback session
  protocol.

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Feedback session (contd)

• Discuss assessments
• SIPShow client rated on P scales
• Use clients own language to review his/her level
  of distress
• Emphasize that while worrisome, symptoms may only
  be an indicator of potential future problems

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If the client meets EDIPPP criteria

• Discuss what EDIPPP can offer family
• Knowledge about mental illness, family support
  through education, preventative psychosocial
  interventions, etc.
• Frequent medication and symptom monitoring, so if
  any changes arise, it will be noticed far sooner
  than if treated in another outpatient setting

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If the client meets EDIPPP criteria (contd)

• Give the family
• welcome letter from the P.I.
• welcome gift package.
• Discuss the importance of the familys
  involvement with on-going research and review
  future research appointments (give them a copy of
  the engagement flow-chart if that would help),
  especially the longer assessments at 6, 12, 24
  months

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If the client meets EDIPPP criteria (contd)

• Begin initial psychoeducation informational
  session and joining with family if theres time
• Introduce other team members casually or formally
  if appropriate at this session
• Schedule future psychoeducation sessions

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If client does NOT meet criteria

• Discuss why they were not offered the
  experimental treatment
• Use this as a time to join or engage with the
  family
• Reassure family that you will help find
  resources/other providers that would be more
  suitable to their needs

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If client does NOT meet criteria (contd)

• Discuss the importance of familys involvement
  with on-going research and review future research
  appointments
• Ask familys permission to be contacted
  periodically (every few months) by a case manager
  who will inquire about their well-being and offer
  any needed assistance. Obtain 5 different
  contacts.

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Psychoeducational sessions

• Plan for 2 or more, 1 ½ hour sessions with family
• Include MD/RN as indicated
• Review presenting symptoms and present level of
  distress and impairment
• Reassure everyone about level of symptoms and
  treatment options, including medications
• Review research components and emphasize their
  importance
• Offer basic information about prodrome or first
  episode and repeat as often as necessary
• Work with client and family to start treatment
  planning