To examine: i) changes in key outcome measures over time in treatment in a representative first-episode psychosis treatment cohort and ii) baseline predictors of service disengagement.
Baseline characteristics of 236 patients were examined for associations with outcomes over time using generalized estimating equation models. The data on disengagement were analysed using logistic regression.
After controlling for admission scores, patients showed consistently improved outcomes while in treatment on functional recovery (unemployment, P < 0.01; HoNOS, P < 0.001; the Quality of Life Scale, P < 0.001; GAF, P < 0.05) but not symptomatology (as assessed by the PANSS and substance abuse). The 64 (33%) who disengaged were more likely to be unemployed (P < 0.01) and have higher HoNOS (P < 0.01) and GAF (P < 0.05) scores at baseline.
This evaluation has shown significant improvements in psychosocial functioning but not psychopathology during treatment at an Early Intervention for Psychosis Service. Despite attempts to retain patients, there is a high rate of treatment discontinuation.
"There are currently two main models of transition between CAMHS and AMHS in the UK; (1) Using a "transition team" that operates independently from CAMHS and AMHS to bridge the gap, or (2) the use of shared care protocols during which CAMHS and AMHS interlock and facilitate a gradual transfer of care. There is precedent for the independent transition service model as this has been implemented in early intervention in psychosis, albeit with mixed success [25,26]. One disadvantage of this model is the introduction of additional and unnecessary divides within the system. "
[Show abstract][Hide abstract] ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood. However, in the UK, there is a paucity of adult services available for the increasing number of young people with ADHD who are now graduating from child services. Furthermore, there is limited research investigating the transition of young people with ADHD from child to adult services and a lack of guidance on how to achieve this effectively. This paper reviews the difficulties of young people with ADHD and their families who are transitioning between services; we review transition from the child and adult health teams' perspectives and identify barriers to the transition process. We conclude with recommendations on how to develop transition services for young people with ADHD.
"Kelly, Wellman, and Sin (2009) reported a 57% education and employment rate 18 months after contact with an early intervention team and Fowler et al. (2009) found that 52% of young people made a full or partial vocational recovery under a comprehensive early intervention team compared with 15% under a community mental health team. Whilst Turner et al. (2009) found a statistically significant decrease in unemployment (those on governmental benefits (except a student loan) and excludes full and part-time employment, parenting and studying) over the treatment period of 24 months. There has been considerable research looking at the duration of untreated psychosis (DUP) and the impact on outcomes. "
[Show abstract][Hide abstract] ABSTRACT: Despite considerable growth in treatments, interventions, services and research of young people with a first episode of psychosis, little attention has been given to the priorities of these young people, in particular, gaining employment. A literature review was undertaken with the aim of investigating: 1) whether young people with a first episode of psychosis want to work, 2) what challenges they experience regarding work, 3) what is understood about employment outcomes, 4) what the most effective interventions to enable them to gain employment may be, and 5) what the associated costs may be. The review found that these young people appear to want to work yet face a range of psychological and social challenges to achieving this. Typically by the time they first come into contact with mental health services a proportion are already falling out of education and employment, and this decline continues with contact with services. However, there are specific interventions that can support them to gain employment. The Individual Placement and Support approach, adapted to include support to fulfil educational goals, has demonstrated that a mean of 69% of young people with a first episode of psychosis can gain education and employment compared to 35% of controls.
International Review of Psychiatry 01/2010; 22(2):148-62. DOI:10.3109/09540261003661825 · 1.80 Impact Factor
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