Prevention and Recovery in Early Psychosis (PREP) Partnership
It takes, on average, 17 years, for the fruits of academic research to be implemented in a field's best practices, and longer for them to reach communities in need. PREP is proposing an approach that will expedite the implementation of the new discoveries in the treatment of early onset psychosis.
About You
Section 1: About You
First Name
Greg
Last Name
McCombs
Website URL
Country
United States
Section 2: About Your Organization
Organization Name
Family Service Agency of San Francisco
Organization Website
Organization Phone
415-474-7310
Organization Address
1010 Gough St., SF, CA, 94109
Organization Country
United States
Is your organization a
Non‐profit/NGO/citizen sector organization
Your idea
Name Your Project
Prevention and Recovery in Early Psychosis (PREP) Partnership
Country your work focuses on
United States
Describe Your Idea
It takes, on average, 17 years, for the fruits of academic research to be implemented in a field's best practices, and longer for them to reach communities in need. PREP is proposing an approach that will expedite the implementation of the new discoveries in the treatment of early onset psychosis.
Innovation
What makes your idea unique?
The Individuals with early psychosis are not well served by the existing mental health system. This program seeks to decrease the traditional delays in diagnosis and treat¬ment, profoundly improve outcomes for young people with early onset psychosis, and bring untold financial and human savings to public health and social service systems. The PREP model is a transformative reconceptualization of how treatment of serious mental illness should be provided. The proposed model brings together a broad array of effective evidence based ap-proaches with the goal of trans¬forming treatment outcomes for youth and young adults with psychosis. The multi-faceted treatment model proposed by PREP includes: individualized case management, family psycho-education and family counseling, supported education/ employment, medical services, crisis intervention and stabilization, counseling, substance abuse counseling, cognitive interventions, stress reduction and complementary healing practices, creative therapies, and peer support.
PREP’s multi-faceted treatment model builds on the most important work being done globally on this issue: It is similar to UCLA’s Aftercare Research Project in that it offers a number of complementary treatment modalities as well as a rigorous, embedded evaluation design, but it differs in that it is not a research project, so treatments are assigned according to client needs and strengths rather than randomization. It is more similar to the EAST model developed out of Portland, although PREP adds ground-breaking computerized cognitive rehabilitation techniques that are lacking from the EAST model. Like no other program globally, it brings together “everything that works” to help transform treatment in early psychosis.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
With first onset usually occurring in the mid-teens to early twenties, schizophrenia is characterized by hallucinations, delusions, thought disorders, bizarre behavior, paranoia, and/or depression.
The chances that an individual would receive the spectrum of services that constitute the state of the art in psychosis treatment are vanishingly small—but now there is an opportunity to change that. After two years of planning in San Francisco and a year of piloting the program using the inkind resources of partners and the general fund contributions of the lead agency, the PREP Partnership was awarded the City of San Francisco’s funding for Prevention and Early Intervention services in fall 2009 and has a proposal pending to Alameda County for similar services. The PREP Partnership is targeted to serve youth and adults ages 16-24, including work with their families using multi-family groups. Again, research has shown that much treatment does not effectively involve the family, but treatment that does successfully engage family members has been shown to have excellent outcomes for the consumer. Securing these two contracts, in partnership with UCSF which offers the region’s first and only clinic for prodromal assessment of clients experiencing, or at risk of experiencing, their first major psychotic break, has been a significant step in positioning us to operate at a scale that can demonstrate impact. At the end of this year, we will begin producing measurements of PREP’s impact, although several years will be needed to demonstrate and evaluate all of the selected indicators or measures.
Problem
In developing medical treatments for many chronic medical illnesses (such as heart disease, diabetes, and cancer), early detection and preventive intervention efforts have revolutionized standard protocols, resulting in improvements in patient longevity and quality of life, and reductions in the costs of care. In contrast, efforts to develop preventive identification and treatment for serious mental illnesses have lagged behind. Research shows that the average individual does not get a correct diagnosis of his/her condition until two years after the first break. Those first two years are critical, as delayed intervention is a significant predictor of poor outcomes. Once diagnosed, the standard of care is often inadequate. Few psychosis sufferers will ever receive an evidence-based non-pharmacological treatment, even though these are showing great promise in university settings. Few will receive rigorous medication management or cognitive rehabilitation services.
Actions
The PREP Partnership was formed by the Family Service Agency of San Francisco (FSA), the Mental Health Association of Alameda and San Francisco Counties and the UCSF Prodromal Assessment, Research, and Treatment Program (UCSF) to launch the Prevention and Recovery in Early Psychosis (PREP) Partnership in San Francisco County and with additional lead partner East Bay Community Recovery Project (EBCRP) to launch the program in Alameda County. The proposed model brings together a broad array of effective evidence based ap¬proaches with the goal of trans¬forming treatment outcomes for youth and young adults with psychosis. PREP’s 2 major components are 1) a public outreach and education (O & E) campaign, and 2) a comprehensive, rigorous, and client/family-centered array of services designed to reduce and control symptoms, restore cognitive capacity damaged by the disease, and promote community reintegration, including state of the art multi-family groups and medication management protocols.
Results
Although there is no known cure for psychosis, our goal is stable remission that will allow the individual to live a normal, prosperous, and fulfilling life. Additionally, the financial and social benefits to society are enormous and our project will include tracking and documentation of that: The current system of mental health treatment relies heavily on crisis intervention and hospitalization –the most expensive resources. A transformed mental health system will result in savings in these areas to society, as well as in lost work time, lost jobs and curtailment of education, and lost child support, and in decreased arrests and divorce. Intervention outcomes will be assessed from client, family and clinician perspectives using established measures that have been piloted by UCSF and FSA.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Over the next three years we want PREP to become the leading model for early psychosis intervention, which relies equally on both the evidence-based treatment model that brings together the latest advances, and also the outreach and education model which coordinates with all of the other on-the-ground resources. This outreach and education to those working with youth, to family members and community members needs to break through misinformation and stigma to get the word out that mental illness is treatable and people can live with it and manage it. It is not a death sentence, and a diagnosis doesn’t mean what we always thought it meant -- there can be positive outcomes.
We will produce research showing the efficacy of our work. This will provide the evidence needed for the model to continue to be replicated in more and more communities. It will include data on the cost savings to society inherent in this work. For our program costs less than the current way of operating, and should generate significant savings in emergency room visits and ambulance rides, so that counties could significantly fund the program from those savings. Demonstrating these savings and benefits will be instrumental to the program’s success.
Finally, to continue to replicate the project with fidelity to the model is critical, ensuring that all the selected program elements are there -- that is what it will take to make our project successful.
What would prevent your project from being a success?
Lack of or limited funding is certainly one factor that would prevent our project from being a success. Through specific evaluation and data analysis, we propose to show that the cost of the program can be covered through the savings in emergency room visits and ambulance rides that are realized once the program is implemented.
A second factor that could prevent our project from being a success is encountering local preferences or perspectives that could be barriers to being able to replicate the program in new communities. Again, we hope that our growing track record of replication, coupled with the latest research and findings about our work, will help overcome the barrier of local preferences, but we think that overcoming this resistance is best understood as part of the work, part of the educating we will need to do.
How many people will your project serve annually?
101‐1000
What is the average monthly household income in your target community, in US Dollars?
$100 ‐ 1000
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for 1‐5 years
In what country?
United States
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
Family Service Agency of San Francisco
How long has this organization been operating?
More than 5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have any non-monetary partnerships with NGOs?
Yes
Does your organization have any non-monetary partnerships with businesses?
Yes
Does your organization have any non-monetary partnerships with government?
Yes
Please tell us more about how these partnerships are critical to the success of your innovation.
The entire project is founded on the essential partnership between three NGOs -- academic institution, community based mental health agency and mental health outreach organization and this partnership is critical to the success of our innovation. We are directly addressing the delay that exists in transferring academic research into clinical action by bringing the cultures of academia and community-based nonprofit together in this partnership to work together to address this social problem. FSA also has partnerships with the businesses Salesforce.com and The Gap, Inc. – both have contributed significant expertise through ongoing partnerships with us to support this project. We partner with many government agencies to effect client referrals and utilization of services, which are critical to maintaining and providing a seamless and comprehensive continuum of care.
What are the three most important actions needed to grow your initiative or organization?
The three most important actions needed to grow our initiative are research, replication and continued steam behind the consumer-driven movement for stigma and discrimination of reduction. First, as discussed earlier, research that evaluates our program will provide the fuel that will feed our program’s expansion. It will demonstrate this in client outcomes, family outcomes, project outcomes and societal benefits/cost savings. Both the improved client outcomes and the reduction and the better triaging of resources to client needs can be demonstrated. Second, continued successful replication of the model will provide the outcomes that will be the basis of the needed research – we need to ensure that the replications continue to stay true to the integrity of the model – that program fidelity is maintained, so that the research is valid. Finally, and this is a larger action that involves the community and change agents like Ashoka’s Changemakers and Robert Wood Johnson Foundation as well, we need to foster and sustain the momentum and enthusiasm in involving consumers in their own treatment, much of which has grown out of the passage of the Mental Health Services Act (MHSA) in California. The MHSA has really pushed for the utilization t evidence-based practices, and consumer-driven, community-based services. The movement’s momentum will be integral to the maximal success of stigma reduction in our communities.
The Story
What was the defining moment that led you to this innovation?
Several years ago, FSA’s CEO Robert Bennett had the opportunity to meet Dr. Sophia Vinogradov, UCSF professor of psychiatry, and to learn about her work taking the cognitive therapies developed for the victims of brain damage from car accidents, etc. and subsequently popularized on PBS for use in the general aging population by her colleague who pioneered them Dr. Michael Merzenick, and applying them to work with the mentally ill, specifically psychosis, to dramatically restore cognitive functioning that had often been left to languish due to over- or undermedication and a lack of focus on maximal restoration and functioning of those with mental illnesses. As the leader of San Francisco’s largest, nonreligous social services agency with a history of innovating in social services (our agency’s founder created the modern foster care system, secured the first social services contract with the state of California, and oversaw the 1906 relief efforts, among many, many other firsts), Robert Bennett had an “aha” moment, seeing first-hand that “the system” lacked the mechanism to reliably and timely incorporate these evidence-based advances, and that this lack was critically linked to discrimination and stigma, so that any state-of-the-art innovative project that proposed system change would also need to have a rigorous outreach and education component of equal importance to educate both medical professionals and those working on the frontlines with youth, as well as to family members, neighbors and other community members. Given the scope of FSA’s services, as the leading private nonprofit provider of mental health services in the city, and our legacy and mission, it was logical that our work would move in this direction, so that as an agency, we are engaged in systems change and the implementation of evidence-based practice and innovation in all of our practice and program areas across our agency.
Tell us about the social innovator behind this idea.
Robert Bennett, the CEO of Family Service Agency is donating his time as an in-kind contribution to the project, personally ensuring that the FSA developed components of the multi-faceted treatment approach are applied with fidelity and integrity. For twenty years, Mr. Bennett was CEO of Resource Develop¬ment Associates, a strategic planning and evaluation consulting firm devoted to strengthening com¬munity based social services in low-income communities and communities of color. While at RDA, Bennett led the development of major initiatives in public health, urban revitalization, juvenile justice, infant mortality, perinatal substance abuse, school-linked family support services, homelessness, mental health, children’s systems of care, and independent living services. He has also been active in the arenas of juvenile and criminal justice reform, homelessness, and community develop¬ment, and now is helping to transform the treatment of psychosis through the complementary suite of evidence-based therapies that comprise the foundation of the PREP Partnership approach. Bennett has also served as a frequent consultant to Federal and State agencies, and is author of over two dozen major evaluations, 12 published papers, and numerous invited conference presentations. He is the co-author of “Vision/Reality,” HUD’s guide to comprehensive community planning. Bennett holds a Bachelor of Arts degree in philosophy, summa cum laude, from the University of Michigan at Ann Arbor, and a Master of Arts degree in history, with highest honors, from the University of California at Berkeley.
How did you first hear about Changemakers?
Email from Changemakers
If through another, please provide the name of the organization or company
 | 191 weeks ago Kaylena Bray updated this Competition Entry. |
| 191 weeks ago Greg McCombs submitted this idea. |
