Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagement

Reducing Duration of Untreated Psychosis (DUP) is a primary goal for improving long-term
outcomes in young people with a first episode of psychosis (FEP). The "standard of FEP care"
within the US focuses on targeted provider education regarding signs and symptoms of early
psychosis to motivate patient referrals to FEP services, followed by initiation of services
within largely clinic-based settings Experience at the Early Diagnosis and Preventive
Treatment (EDAPT) FEP specialty program at U.C. Davis in Sacramento has identified two
important bottlenecks to reducing DUP, consistent with reports in the literature from other
FEP clinics. These are 1) delays in the identification of psychotic symptoms by referral
sources, and 2) delays or disruptions of patient engagement in specialty FEP care. Building
upon a comprehensive and established referral network of 20 sites across the Sacramento area
(schools/universities, ER/inpatient hospitals, outpatient mental health, primary care), the
investigators will address delays in patient identification and engagement using a two-phase,
cluster randomized design. The investigators will consecutively test the impact of two
interventions to reduce DUP, defined in this RFA as time from first onset of psychotic
symptoms to engagement in FEP specialty care. To address identification delays, the
investigators will examine the use of standard targeted provider education plus novel
technology-enhanced screening compared to standard targeted provider education alone, testing
the hypothesis that the education plus technology-enhanced screening will identify more
patients, earlier in their illness. To address engagement delays, the investigators will
compare the use of a mobile community-based, telepsychiatry-enhanced engagement team to
standard clinic-based procedures for intake, engagement and initiation of treatment, to test
the hypothesis that the mobile approach facilitates earlier and more stable engagement,
thereby reducing DUP. The proposed work will provide new specific evidence-based practices
for reducing DUP and improving outcomes through specialty care of individuals with a first
episode of psychosis.