Sessions Descriptions

Coordinated Specialty Care (CSC) represents a groundbreaking public health approach to early intervention for people with psychosis. The federal block grant has helped to create almost 300 programs nationally; yet even this crucial funding is potentially fragile. This session will discuss how we can ensure coordinated specialty care programs can be sustained. We will review practical strategies to facilitate the creation of private and public funding streams that could promote sustainability.

• Describe the history of the growth of CSC and the future need for licensing or certification.
• Summarize other models that can offer day rate payment.
• Describe the elements of private pay services that foster third party payment.

• Financially sustaining Coordinated Specialty Care (CSC)
• COVID-19 and underrepresented communities
• COVID-19 and Serious Mental Illness (SMI)

Introductory; Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

Inspired by the growing recognition that early intervention leads to better outcomes among people along a continuum for psychosis, efforts to identify people at clinical high-risk (CHR) for psychosis have seen exponential growth in the past decade. Gains in identification and assessment have been propelled by advanced statistically derived formulas based on large samples. Although this macro-level process has been productive for many, this approach has focused primarily on white people, evolving from a mental health system grounded in white supremacy. For example, typical CHR interview practices such as those employed with the Structured Interview for Prodromal Syndromes (SIPS) may in some cases not fully honor individual differences of those being evaluated. As a result, existing practices can both fail to identify some individuals from marginalized communities who are at risk for psychosis, while at the same time misdiagnose others. Evidence suggests that conditions associated with marginalized identities such as the stress of immigrant status, being "othered" as an ethnic/racial minority, and exposure to neighborhood crime and trauma increase risk for developing psychosis-spectrum disorders. Simultaneously, contextual or environmental factors can lead to endorsing items – particularly those related to suspiciousness – on CHR assessment tools when the underlying mechanism is unrelated to psychosis. Whether potentiating the development of psychosis, or creating a context where confounds lead to errors of measurement and subsequent over/mis-pathologizing, or both, accurate conceptualization of a person's situation through the use of psychometrically valid strategies across diverse populations is critical.

After briefly describing the field's racially imbued historical context, this talk grapples with contemporary factors related to the disparate assessment of psychosis across racial/ethnic groups, discussing how responses to discrimination, crime, and/or trauma may be causally or concurrently (or concurrently that leads to causality) linked to psychosis risk symptoms. The validity of common assessment measures is described among Black people, and in the context of high-crime neighborhoods, with findings suggesting a need for focused attention towards intercultural and contextual responsivity. Further, assumptions inherent in certain risk assessment questions are scrutinized to assess if behaviors or beliefs considered problematic if observed among white people are equally predictive among minority groups (e.g., belief in superstitions, déjà vu, having special talents, religious convictions). Ultimately, this talk asserts that a lack of cultural/contextual consideration, as well as a lack of validated measures in marginalized groups, can lead to diagnostic confusion, false-positives, and large-scale health disparities, especially in the context of federal funding that is actively encouraging growth to scale in this area. The talk concludes with steps clinicians, researchers, and leaders can take to challenge the status quo in the service of making assessment of risk more inclusive and accurate.

Action recommendations include more explicitly infusing cultural humility into risk assessment training (e.g., the role of clinician bias, considering socially mediated stress as a dynamic factor when establishing risk), increasing access for people of color to become both professionals and leaders in the field, rebuilding trust that has been violated through the marginalization of communities in and outside of the mental health care system, and using structured tools such as the Cultural Formulation Interview to garner a clearer perspective of a given individual's circumstances. Collectively, these steps may help reduce the risk of misdiagnosis as well as enhance detection in those who may be at risk for psychosis.

• Identify signs of psychosis-risk symptoms through exposure to risk assessment tools.
• Demonstrate awareness of psychosis-risk screening and assessment strategies, and recognize how attention to cultural and contextual factors inform these strategies.
• Describe actions that can be taken to change the status quo with respect to potential biases and health disparities in this field.

• Psychosis risk symptoms, screening, and assessment
• Social and cultural factors impact on screening and assessment
• Addressing potential biases and health disparities

Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

Initiated in 2019 and sponsored by the National Institute of Mental Health (NIMH), the Early Psychosis Intervention Network (EPINET) is a national learning health care system for early psychosis. EPINET is designed to support practice-based research to improve early identification, diagnosis, clinical assessment, intervention effectiveness, service delivery, and health outcomes in clinics offering evidence-based coordinated specialty care to persons in the early stages of psychotic illness. EPINET includes regional Hubs, first episode psychosis clinics, and the EPINET National Data Coordinating Center (ENDCC). EPINET links clinics that work with individuals with early psychosis through (1) standardized clinical measures, (2) uniform data collection methods, and (3) integration of client-level data across service users and clinics. The session will focus on the EPINET Core Assessment Battery (CAB) that was developed through a consensus process by the EPINET Steering Committee. The Steering Committee is composed of principal investigators from each of the eight regional scientific hubs and the ENDCC. The CAB includes standardized measures and individual items that assess key domains of early psychosis psychopathology, recovery, contextual factors, and treatment that can reasonably be included in the data collection efforts within first episode psychosis programs. The CAB serves as the basis for common data collection across all EPINET clinics. Data aggregated across EPINET clinics will be used to establish a national repository of early psychosis common data elements that will facilitate research to improve early psychosis identification, clinical assessment, intervention effectiveness, and recovery outcomes among individuals experiencing early psychosis. As the database grows, the national repository will be open for analyses to researchers outside of EPINET.

• Describe research domains important to assessment in early psychosis treatment programs.
• Explain how the EPINET Core Assessment Battery can be used by EPINET and non-EPINET clinics and researchers.
• Summarize how EPINET, as a learning health care system, can advance first episode psychosis research and clinical practice.

• Assessment in early psychosis treatment programs.
• EPINET Core Assessment Battery.
• Data and a Learning Healthcare System.
• QA measures with a recovery focus.

Introductory

Psychologists, Social Workers, Other Mental Health Professionals

Effective teamwork is the cornerstone of the development and promotion of interprofessional collaboration. When teams come together, their ability to work toward health and wellness for service participants, families, and communities are stronger than any individual efforts. Supervision can further optimize the work of the team. COVID-19 and the ensuing social unrest brought to light the long-standing inequity in access and treatment across all health and behavioral health providers demonstrating all too clearly that BIPOC communities had many more deaths from COVID-19 than white communities. While there is growing interest in understanding how social factors drive poor health outcomes, behavioral health providers responsible for defining and responding to how this impact community of BIPOC, identification of structural racism as a root cause of racial health inequities have largely been neglected.

Clinicians are often trained in treatment models and systems steeped in a long history of white supremacy. Moreover, supervisors along with team members are not exempt from enactments of racial and social injustice, prejudice, power and privilege embedded in our social environment and institutions. Negative consequences impede learning not only between the supervisee and supervisor but also the exchange among team members. As such it can affect clinical understanding of service participant and perpetuate injustice based on power and social locations. Thus, is not an easy task to shift cultural norms entrenched across individual, organizational and institutions and move towards an antiracist practice. During this unpresented time, having difficult and at times uncomfortable conversation presents unique challenges when this dialog have to take place on online platforms.

This presentation will discuss ways in which teams and supervisors can develop brave spaces both physically or online for dialog and critical analysis to identify and alter dynamics of power, privilege, and social oppression. We will present models for constructing facilitated team discussions and supervision dialog, Critical Conversations (CC), to unpack discriminatory beliefs, values, and distribution of resources associated with social, behavioral, and economic outcomes for individuals receiving services. Lessons learned from the ACT Institutes work will be presented.

• Identify current social justice issues impacting our work today.
• Explain challenges and opportunities for teams and in supervision when addressing white supremacy and white privilege.
• Describe how critical conversations (CC) model provides a framework to illuminate and examine power dynamics in order to produce change with parallel insight and action—across teams, supervisee, supervisor—towards an anti-racist practice.

• Current social justice issues impacting our work
• Interprofessional team: Establishing a vision
• Creating safe spaces: Keeping it real
• Transforming our programs/agencies

Introductory; Intermediate; Advanced

Psychologists, Social Workers, Other Mental Health Professionals

Coordinated specialty care services are critical for people with first episode psychosis (FEP), but for historically underserved racial and ethnic minority communities much greater attention is needed to overcome the multiple barriers to receiving these services. Given the barriers that underserved communities face when seeking care for early psychosis, this session will emphasize the importance of understanding individuals and family member experiences. In this session, we will begin by examining the pathways to care for a diverse group of individuals from the onset of a FEP to their entry into coordinated specialty care. We will explore how help seeking decisions were influenced by the misattribution of symptoms, stigma and self-reliance, and how contacts with the health care system was a critical juncture in the pathway to care that expedited or delayed entry into care. We will describe and present data on the experiences of several Black families and their points of contact prior to coordinated specialty care and how that can influence individual outcomes, such as quality of life. We will then review the importance of community outreach and campaigns to promote coordinated specialty care, like the campaign designed for the Spanish-speaking Latinx community in California.

• Demonstrate ways of exploring individual's and their family's experiences prior to coordinated specialty care.
• Describe the importance of family involvement and how family member experiences prior to coordinated specialty care can impact individual outcomes.
• Describe how community outreach and campaigns can be used to reduce the duration of untreated psychosis and encourage people with FEP and their families to seek timely mental health care.

• Reducing duration of untreated psychosis.
• Experience and utilization of coordinated specialty care by racial and ethnic minority families.
• Effective messaging to underserved communities.

Introductory

Psychologists, Social Workers, Other Mental Health Professionals

Due to the COVID-19 pandemic, services for those experiencing new onset of mental health concerns and psychiatric crises have rapidly shifted to be conducted almost entirely remotely through telehealth. Coordinated Specialty Care (CSC) for early psychosis is a team-based, evidence-based treatment approach for those in the early phases of psychotic disorders, a population associated with increased incidence of emergency service utilization. The CSC approach includes evidence-based assessment and crisis services among other elements. We will present an overview of best practices for early psychosis assessment and crisis services. We will then describe past practices and present recommendations for transitioning to telehealth using examples and data from a well-established and thriving early psychosis clinic: the SacEdapt Clinic in Sacramento, CA. The impact of remote work and the Covid-19 pandemic on these components of CSC care will be discussed in the context of systemic issues in mental health services including early detection, inter-system care coordination, and racial and cultural inequities.

• List two evidence-based assessment measures for early psychosis.
• Describe two recommended adaptations from in-person to remote assessment.
• Identify two approaches for addressing system issues that have impacted remote assessment and crisis services during the COVID-19 pandemic.

• Coordinated Specialty Care (CSC) crisis management.
• Crisis management and telehealth adaptations in the era of COVID-19.
• Cultural and remote considerations for assessment and screening of early psychosis.

Introductory; Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

With the significant expansion of early intervention programs for psychosis in the United States has come a demand for a workforce to deliver Coordinated Specialty Care (CSC), particularly in the context of broader workforce challenges in behavioral health. This session will describe core competencies for CSC identified through key informant interviews with early psychosis leaders from around the country. Recruitment, selection, orientation, training, professional development, and retention strategies; and supervision recommendations will be presented.

While many CSC Programs have staff with extensive knowledge of psychosis and experienced in managing risk of violence, they may be less experienced in interacting with the criminal justice system and unfamiliar with the sequential intercept model. Individuals in the early stages of psychosis are at heightened risk of violence and disproportionately likely to experience criminal justice involvement compared to their peers. It is crucial that CSC workforce are aware of opportunities to intervene at the intersection of the mental health and criminal justice systems. Developing these competencies can help reduce the risk of further violence or criminal justice entanglement and thereby optimize long-term outcomes for those in the early stages of psychosis. Transition age youth of color are also disproportionately over-represented in the criminal justice system, representing one third of the youth population in the US but two thirds of incarcerated youth. Workforce of CSC programs will need to be acutely aware of the potential for criminal justice involvement among the individuals they serve with the added layer of racial and ethnic disparities for clients of color and be adept at navigating and advocating within these systems.

This session will review the evidence for heightened risk of criminal justice involvement, racial and ethnic disparities among justice involved youth, and recommendations for intervening effectively.

• Describe competencies for Coordinated Specialty Care workforce and recruitment, professional development, and retention strategies.
• Identify opportunities for intervention within the criminal justice system.
• Summarize the evidence regarding disproportionate justice involvement among youth people with psychosis, including racial and ethnic disparities.

• Workforce development considerations in Coordinated Specialty Care (CSC).
• Core competencies in CSC.
• Knowledge and skills related to criminal justice involvement.
• Intersection with race and ethnicity.

Introductory; Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

Across the U.S., Coordinated Specialty Care (CSC) for a recent onset of psychosis providers are increasingly integrating Peer Support (SAMHSA, 2019). This trend is promising for improving care experiences and outcomes among those with a recent onset of psychosis– and providing meaningful employment opportunities for those in recovery from an onset of psychosis. Peers importantly bring a non-clinical, alternative perspective that disrupts team language, practice, and systems rooted in the more traditional medical model (Deegan, 2017). However, recent research summarized empirically established peer workforce issues in community mental health (e.g., Jones et al., 2020; Mancini, 2018). These include on-the-job stigma and discrimination, low pay and no benefits, isolation, unclear work roles, burnout, limited professional development opportunities, and high turnover. With the proliferation of Peer Support integration into CSC, providers are becoming acquainted with these challenges in building and sustaining a peer workforce. Our presentation compares: (1) the vision for peer support integration into CSC with the (2) current reality facing peers on CSC teams. We propose innovative solutions from CSC Models OnTrackNY and EASA as well as emerging approaches from across the country that target organizational and systemic reforms to improve peer workforce experiences and outcomes.

The Vision: Peer Specialists will work successfully within multidisciplinary teams, support service engagement, influence team culture to be more responsive to young person lived experiences, strategically share their story, document services, maintain wellness and professionalism, role model and coach, provide community support, host groups and social activities and build strong working alliances with CSC participants.

The Reality: The dominant narrative within CSC, and where CSC is implemented, is clinical and does not embrace (and arguably rejects) core Peer Support principles, including mutuality and "nothing about us without us." Most CSC teams operate within adult community mental health or university-based clinics, not peer-run or youth-centric organizations. Other disciplines on CSC teams (e.g., psychiatrists, social workers) are taught to limit self-disclosure and use evidence-based methods that inherently reject alternative illness and healing narratives. Compared to other CSC team members, peers tend to be lower paid, younger, and individuals of color. In a recent study with 25 CSC teams with peers, 84% had only one peer and most were part-time (SAMHSA, 2019). Thus, peers, who are the lowest paid and who have the least power (and presence) on CSC teams, must educate colleagues on the value of their role, challenge the dominant clinical narrative, and speak up "appropriately" when colleagues make discriminatory, racist, sexist, classist, and/or ablest remarks. Peers are subject to tokenism, microaggressions, being ignored, and feeling pressured to advocate or answer uncomfortable questions – and later regretting their responses. Particularly during COVID-19, peers have been leveraged as self-care and virtual technologist experts – educating their colleagues on how to maintain health and wellness when stressed and facing adversity as well as how to best use smartphones and computers to engage CSC participants creatively through video chat platforms.

The Solution: Peers need equitable roles on CSC teams in regards to pay, benefits, responsibilities, support and professional growth opportunities. Peers cannot be solely responsible to be the culture carriers and engagement specialists on CSC teams. CSC Models must value and centralize peer support principles and practices to the extent that they do other treatment modalities. CSC teams must support peers in connecting to national and local peer networks, and professional development opportunities. Team-, program-, and system-level strategies aiming to build and retain peers in CSC must be evaluated.

• Describe aims and promise of effective, sustained peer support integration into CSC teams.
• Explain the reality of on-the-ground peer support experiences in CSC and community mental health settings.
• Identify innovative and practical solutions emerging nationally within and beyond CSC to improve CSC workforce experiences, professional development, and impact.

• Peer support principles and practices
• Current challenges faced by peer support on CSC teams
• Solutions for improving team integration, influencing team culture, sustaining professionalism

Introductory

Psychologists, Social Workers, Other Mental Health Professionals

The emerging science and practice of Compassion-Focused Therapy (CFT; Gilbert, 2009; 2010), with its roots in evolutionary psychology, attachment theory, and neuroscience, may offer a useful framework for approaching some of the challenges of working in early psychosis services, at each of the personal, professional, and organizational levels. In this presentation, we will start with an understanding of why compassion is important. The reality is that we just find ourselves here, in the flow of life, with a "tricky brain" that can cause all sorts of problems for ourselves, our colleagues and our systems. A lot of what happens in our minds is not our fault, but it is still up to us what we want to do about it. In this presentation, we will explore how our evolved minds can be orientated in certain ways depending on our social motives, and we will consider how orientating our minds towards compassion for self and others can bring a variety of positive benefits for mental health and well-being. We will learn some techniques and practices to help us cultivate compassion in our personal and professional lives, particularly for when things get tough around the issues we face with grief, isolation and loss.

• Describe the concept of 'multiple selves.''
• List the qualities of the 'compassionate self.''
• Summarize the techniques for directing compassion to parts of us that are struggling.

• The compassionate self
• Compassion and healthcare staff
• Compassion across the healthcare system

Introductory

Psychologists, Social Workers, Other Mental Health Professionals

The U.S. population is changing. Due to the population aging, the proportion of older adults is increasing. Meanwhile, the population is diversifying; while the population of non-Hispanic Whites is projected to decrease over the next four decades, the population of Hispanics of any race, African Americans, Asian Americans, and multiracial individuals is projected to grow.

While historically underrepresented groups have witnessed population growth since the 1970s, mental health needs have been unattended. Data compiled by the Office of Minority Health (2018) show that historically underrepresented groups are disproportionately affected by mental health needs across the lifespan, but receive mental health treatment with less frequency compared to non-Hispanic Whites. A host of cultural and systemic barriers to accessing care have been identified in the extant literature, while noting the crucial role of mental health service providers in facilitating access to care (Alegria, 2014; Alegria et al., 2016; Surgeon General, 2001).

Social workers represent a large proportion of the behavioral health workforce. In the U.S., there are more than 680,000 social workers, and the Bureau of Labor Statistics (2018) projects the profession to grow 16% from 2016 to 2026. A recent survey of new social work graduates showed 92% of new MSW graduates go into direct practice with individuals, families, and groups, but only 27% reported finding a job primarily addressing issues in mental health or substance abuse (Salzberg, Quigley, Aquaviva, Wyche, & Sliwa, 2018). Challenges to a diverse workforce remain: whereas 60,122 students were enrolled in social work master's degree programs nationally in 2015, only 38.7% of full-time students and 42.3% of part-time students come from historically underrepresented groups (CSWE, 2015).

The smaller number of racial and ethnic master's level social work students available for the behavioral health pipeline is especially significant as the populations most at need for mental health services are often racial/ethnic minority clients. Disparities in access to and use of behavioral health services underline the need for diverse and culturally competent service providers. Since the 1970's, one of the ways that the Council on Social Work Education (CSWE) has addressed the behavioral health needs across the U.S. is through the Minority Fellowship Program (MFP), which targets, but does not limit, recruitment to American Indian/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, African Americans, and Hispanics/Latinos. These racial and ethnic groups are historically underrepresented in the delivery of behavioral health services (Substance Abuse and Mental Health Services Administration, 2014; Russell, 2010).

This session reviews the National Academies (2016) framework for educating on social determinants of health. Results from MFP evaluations will be used to highlight successful strategies to engage and support the professional development of masters and doctoral students committed to addressing the behavioral health needs of historically underrepresented groups. Implications and recommendations for behavioral health workforce recruitment and development will be discussed.

• Identify at least one recommendation to implement in behavioral health training that addresses social determinants of health.
• Describe the 3 key features of the Council on Social Work Education (CSWE) Minority Fellowship Program (MFP) that have supported masters and doctoral fellows.
• Identify at least one strategy to engage students from historically underrepresented groups to address disparities in behavioral health.

• Behavioral Health Inequities
• Social Determinants of Health
• Minority Fellowship Program
• Workforce Development

Introductory; Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

Coordinated Specialty Care teams have a unique ability to deliver specialized care for early psychosis utilizing tools that underscore and facilitate client and family engagement. Teams are able to deliver services in a flexible, person-centered, cohesive and culturally competent manner. Typically teams are able to meet with clients and families in the office, their homes, communities and school. The level of coordination across team members to have discussions regarding service delivery, provide joint meetings with several providers, and share information about client interactions that affect treatment decisions, is a fundamental component of the CSC approach.

However, the emergence of COVID-19 led to a rapid shift to the use of telehealth as a primary method for service delivery and technology became the primary vehicle for team communication. Activities that were normally performed in person had to be rapidly adapted to be delivered online and via telephone. Furthermore, the negative social, health and economic impact of COVID-19 on team members and services recipients added another dimension of collective uncertainty, trauma and loss. Team leaders had to grapple with how these issues impacted their team members, and how they impacted the ways in which the team related to program participants. The negative impacts were exponential in communities of color and added a focus on explicitly considering the effects of racism and culture on individual's lives. In parallel, team functioning changed dramatically. Team members had to develop new ways to communicate and coordinate with each other remotely and brainstorm mechanisms for engaging participants and families. Specifically, team meetings, supervision and other forms of team integration were also performed remotely with little preparation or training.

This talk will examine the concrete changes that teams underwent when shifting from in-person to remote service delivery and factors that team leaders had to consider for effectively supporting and promoting a positive team dynamic and effective team functioning. We will describe specific strategies that team leaders implemented to: 1) boost team morale, 2) emphasize self-care and reduce compassion fatigue, 3) facilitate dialogue within the team about trauma, grief and considerations of racial inequities, 4) manage and encourage team communication and cohesion, and 5) supervise role functioning to ensure fidelity to the CSC model during a stressful and rapidly changing environment.

• Describe changes in team functioning associated with 1) the use of technology, 2) managing the impacts of COVID-19, and 3) integrating explicit discussion on race and culture.
• Identify strategies that team leaders can employ to 1) support team members as they try to deliver coordinated services via telehealth, 2) facilitate dialogue within the team on the impacts of COVID-19, trauma, culture and 3) oversee that team members are utilizing principles of cultural humility when delivering services.
• Explain supervisory strategies that can help with team building and team cohesion during times of uncertainty and stress.

• Challenges and context of team functioning during COVID-19
• Building team cohesion and support around stress, grief, and trauma
• Cultural humility in Coordinated Specialty Care (CSC) teams

Advanced

Psychologists, Social Workers, Other Mental Health Professionals

Sustained social and vocational recovery is the ultimate goal of specialist first episode psychosis (FEP) services and the most valued outcome by young people and their families. Yet, follow-up studies have indicated that treatment benefits of early psychosis services are not sustained and therefore functional and social recovery is often not fully realised.

The recognition of these limitations has brought about a renewed focus on treatment approaches focused on improving long-term recovery from early psychosis. Along with studies evaluating psychosocial interventions focused on preventing relapse and fostering social and vocational recovery, three recent clinical trials have evaluated the effects of extending the duration of specialist support (by one to three years) compared with the typical timeframe of early intervention services (i.e., 2 years), with mixed findings.

Recent psychological models have proposed self-efficacy, intrinsic motivation and positive emotions as important targets to promote social functioning in psychosis. Strengths- and mindfulness-based interventions have been put forward as key interventions to increase self-efficacy and positive emotions, respectively, with preliminary studies supporting their potential to improve social functioning in psychosis. Similarly, self-determination theory posits that interventions addressing the basic psychological needs of competence, autonomy and relatedness will increase engagement with the intervention and improve overall functioning through increased intrinsic motivation.

A promising and potentially cost-effective alternative to extending the duration of specialist FEP services is to provide lower intensity, maintenance treatment following the initial 2 years of specialist support. Online, mobile and social media-based interventions provide a novel avenue to offer young people lower intensity, effective, sustainable and scalable support beyond discharge from specialist FEP services.

Drawing on our previous interventions in preventing relapse and improving vocational attainment in FEP, combined with novel approaches to social recovery (strengths and mindfulness-based approaches) and the principles of self-determination theory, our team developed a world-first digital intervention (Horyzons) designed to foster long-term recovery in FEP. Horyzons blends evidence-based models of social functioning, relapse prevention and vocational recovery in a wrap-around social media therapeutic environment supported by peer workers as well as clinical and vocational professionals. The effectiveness of Horyzons has now been examined via a single-blind randomised controlled trial (RCT) designed to test whether treatment with both Horyzons and treatment as usual (TAU) for 18 months was more effective than TAU alone.

While we did not find evidence that Horyzons improved social functioning as measured by the Personal and Social Performance Scale (PSP) compared with TAU (social functioning remained high and stable in both groups from baseline to 18-months follow-up), Horyzons was effective in fostering vocational and educational attainment -key aspects of functional recovery- and reducing utilization of emergency services in young people with FEP over 18-month follow-up. Horyzons was also appealing for young people, with almost 50% of participants logging on for at least 9 months.

The implications for the field will be presented and discussed in this session. Horyzons and the MOST platform are now being evaluated and disseminated across Australia and internationally.

• Summarize the state of the early psychosis field in terms of effective interventions/services promoting long-term recovery.
• Describe new models of digital interventions designed to be linked to clinical services.
• Identify the pitfalls of existing online mental health interventions.

• Transforming face-to-face interventions
• Integrative digital approach to youth mental health services
• Moderated Online Social Therapy (MOST): Digitally enhanced youth mental health care

Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

Coordinated Specialty Care (CSC) is an evidence-based practice that has been demonstrated to be effective in successfully engaging and serving individuals experiencing a first episode of psychosis. It involves the use of a multidisciplinary team that actively engages and serves clients and their families using a consumer-centered approach with shared decision making. However, the approach requires a certain amount of service flexibility that does not fit neatly into public or private insurance fee-for-service payment models. In this presentation, we will document the problems with current reimbursement methods and suggest strategies that can be used to address them.

The first strategy involves advancing an argument based on legally required parity in insurance coverage. In 2008, Congress passed and President George W. Bush signed the Mental Health Parity and Addiction Equity Act. This Act prohibits discrimination in insurance coverage for behavioral health services, requiring insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer. The inability to fully cover the costs of CSC services by both commercial insurance and Medicaid / CHIP is arguably a violation of the Federal Parity Law. In this presentation, we will present this argument and suggest strategies and resources that advocates can use to push for equitable insurance coverage.

A second strategy for assuring equitable access to CSC services involves mandating that a bundled service model and reimbursement rate be used for CSC services in both public/Medicaid and commercial insurance. This is the strategy that Illinois successfully pursued. While Illinois' law excludes commercial insurance coverage of supported education and employment, the law requires that the CSC services be provided with fidelity (meaning providers must use public funds for education and employment components of the model). In this part of the panel, we will both discuss the multi-year process that was involved in the development of the enabling legislation and summarize the implementation process that has been ongoing this year.

Workgroups convened by the Illinois Department of Insurance including treatment providers, insurance companies and advocates have developed program eligibility requirements, continuing treatment and discharge guidelines. Work is underway to choose a reimbursement code and reimbursement rate for the program. Cost-based, bundled reimbursement will be available January 1, 2021. Presenters will also discuss how the Commercial and Medicaid legislation includes mandates for young adult team services beyond CSC, so that young people have services to transition to, and from, during their services journey based on their mental health needs. We will also discuss the challenges of supported employment and education inclusion in the legislation.

Finally, we will review some of the existing approaches that can be used in Medicaid to fully cover the cost of these services We will present data regarding cost effectiveness of CSC services as well as the potential for large public savings if CSC services are properly reimbursed, including significant reductions in severity of illness, physical health care costs, disability, unemployment, homelessness, and early mortality. Not only is coverage the right thing to do to enable access to treatment, but we will also demonstrate that full coverage of every incident case would result in negligible increases in insurance premiums using New York state population data and incidence estimates for both commercial and Medicaid populations.

• Describe the major features of the federal Mental Health Parity and Addiction Equity Act and how the law can be used to seek equitable coverage for CSC services.
• Explain the process of developing and implementing legislation that requires coverage for CSC services in both public and private insurance.
• Effectively argue that CSC services are affordable relative to other commonly reimbursed medical procedures and meet conventional standards for cost effectiveness.

• Mental Health Parity and Addiction Equity Law
• Cost based, bundled rates for CSC services
• Medicaid strategies to fund CSC services

Intermediate

Psychologists, Other Mental Health Professionals

In response to the COVID-19 pandemic, CSC programs have had to modify their services to meet the overwhelming needs of participants and family members. This presentation will provide information, strategies, and suggestions for CSC programs using telehealth during the COVID-19 pandemic focusing on three key areas: (1) common challenges that CSC teams have reported during the COVID-19 pandemic; (2) innovative strategies and solutions from CSC programs to enhance engagement in treatment and telehealth; and (3) suggested telehealth modifications and cultural adaptations to respond to the needs of racially and ethnically diverse populations.

Since the COVID-19 pandemic began, CSC programs have experienced challenges associated with the shift to telehealth and the increased and changing needs of participants. These challenges include difficulties maintaining engagement, participant experiences of increased loneliness and boredom, reports of increases in symptoms and case management needs, and new procedures and protocols to provide ongoing CSC treatment. CSC teams across the world have shared their perspectives on how the COVID-19 pandemic has impacted their ability to provide treatment, and the ongoing concerns of adapting CSC evidence-based interventions from an in-person to a telehealth format.

In response to the pandemic, CSC programs both nationally and internationally have developed strategies to use telehealth in the delivery of treatment. This presentation will focus on providing suggestions, adaptations, and considerations for implementing the CSC treatment model using telehealth delivery methods. Suggestions will include specific strategies for individual therapy, family education, psychopharmacological treatment, peer support, and case management. Many programs have developed innovative solutions to address the unique needs of participants returning to work or school, managing symptoms, engaging and integrating family members in treatment, and avoiding relapses. This presentation will describe strategies CSC teams have used to minimize disruptions in care and expand the use of telehealth services including zoom groups, skills demonstration and practice, integrating family members in treatment, and using interactive materials.

Finally, the presentation will focus on improving engagement using telehealth services for persons from racially and ethnically diverse backgrounds. Suggestions will include strategies to adapt interventions for a telehealth delivery format and considerations to culturally tailor an intervention.

• Describe the common challenges associated with delivering telehealth services in a CSC program.
• Identify strategies that can be integrated into CSC interventions to improve engagement in telehealth services.
• List some telehealth modifications and cultural adaptation suggestions to improve engagement with persons from diverse backgrounds.

• Impact of pandemic on core CSC services
• Suggested strategies to address challenges
• Improving approaches to telehealth
• Addressing the telehealth needs of diverse communities and individuals

Introductory; Intermediate

Psychologists, Social Workers, Other Mental Health Professionals

Coordinated Specialty Care (CSC) is a treatment program for individuals in the early stages of psychotic illness that focuses on recovery, shared decision making, and employs a team of specialty care providers who work with the client to create and implement and personalized treatment plan. Fueled by Mental Health Block Grant set aside funds, CSC programs have proliferated in the U.S.; a national survey in 2018 found that approximately seventy percent of programs started serving clients in 2014 or later (Westat, 2019). As many of these CSC programs mature, teams are increasingly faced with key decisions, including determining optimal program length, what can be done to facilitate a transition when clients leave the program, and what may be the most appropriate services for ongoing care. In addition, research from outside the U.S. has noted the challenge of sustaining gains achieved in early intervention programs once clients are no longer receiving intensive services.

In response to these issues, some programs have established post-CSC programs, usually at a reduced level of intensity of services or have expanded the duration of CSC services. These "step-down" programs and extended-length models are all designed to provide continuity of care and ease the transition into community-based services, though they vary in many aspects. This session will provide four presentations representing federal and local perspectives on continuity of care following CSC services:

Kristina West will discuss the findings of a research project that examined approaches to continuity of care in nine CSC programs, either through use of a step-down model or an extended length of service. Ms. West will review the scope and structure of programs, integration within larger health systems at local and state level, and policy challenges and opportunities in providing continuing care after CSC.

Michael Birnbaum, MD will discuss the development and implementation of the BOOST program at The Zucker Hillside Hospital. The BOOST program was specifically designed to maintain and enhance gains achieved through early intervention at The Early Treatment Program (ETP), Northwell Health's early psychosis intervention clinic. Dr. Birnbaum will also discuss plans to deploy and study an online CSC step-down program developed by collaborators in Australia.

David Penn, PhD will discuss the implementation of Horyzons, a digital intervention, for first episode psychosis. Horyzons was developed in Melbourne, Australia, by Drs. Mario Alvarez (Orygen) and John Gleeson (Australia Catholic University). It comprises user-friendly therapeutic content and a social network and is moderated by clinicians and peer support specialists. Dr. Penn will review the adaptation of Horyzons for CSC in the US, present preliminary feasibility data, and discuss ongoing efforts to integrate it into CSC.

Nicholas Buekea, PhD will discuss his experience as a CSC client and transitioning out of CSC services in the EASA program. Dr. Buekea participates in the Youth Adult Leadership Council (YALC) where former EASA clients can help guide and support EASA's work. YALC seeks to educate the public on the phenomenon of psychosis and to develop better ways in keeping community members engaged.

• Analyze the problems associated with continuity of care for CSC programs.
• Compare strategies to address continuity of care across nine CSC programs for early psychosis.
• Summarize future directions for implementing continuity of care for CSC programs.

• Continuity of care post-coordinated specialty care (CSC).
• Models of successful transitions.
• Effective community engagement.

Introductory

Psychologists, Social Workers, Other Mental Health Professionals

This session will focus on psychopharmacology management of early psychosis in the COVID-19 era. The changes brought by the pandemic almost overnight had a profound effect on society and psychiatry, including in early psychosis care. We will begin with an overview of the impacts of the COVID-19 pandemic and mitigation efforts on society in general. We will review the potential for elevated psychopathology in the general population and emerging data in this regard. Topics include anxiety, depression, substance use, and suicide and these are all relevant to the early psychosis population as well as other segments of society. We will also review how COVID-19 infection alters pharmacokinetics and pharmacodynamics in the body and what these changes might mean for psychopharmacology management in people with psychotic disorders. We will discuss the possibility of early psychosis patients developing COVID-disease – this has been a relatively minor problem thus far.

Greater concerns have been expressed about isolation, loss of education and employment opportunities, uncertainty regarding health insurance and other impacts from the COVID-19 mitigation efforts on people with early psychosis. We will review the experience thus far in relation to these issues which present formidable challenges for clinicians. Data on outcomes in the early psychosis population in the COVID-19 era are relatively sparse but urgently needed. We will also discuss the impact of rapid conversion to virtual care (access to internet connectivity, trust, and privacy). We will then review recommendations for prescribing in early psychosis clinics during the COVID-19 pandemic.

The basic tenets of psychopharmacology have not changed with COVID-19 but certain topics require more attention and a high level of vigilance is needed to avoid compounding medical problems in patients who become infected. Finally, we will look into the future as screening and vaccination efforts become widespread. People with early psychosis may be at higher risk of refusing preventive care, or unable to access it. A concerted effort will be needed to remove barriers so people in our clinics can receive the care they need and deserve.

• Describe COVID-related changes in physiology and psychopathology that may be seen in people with early psychosis.
• Outline principles for managing psychopharmacology in early psychosis.
• Describe potential access and health disparities impacting people with early psychosis in the COVID era.

• COVID-related changes in those with first episode psychosis
• Psychopharmacology and first episode psychosis
• Access and health disparities in the COVID era

Advanced

Psychologists, Social Workers, Other Mental Health Professionals