The Program
Coordinated Specialty Care (CSC) for First Episode Psychosis (FEP) is an evidence-based early intervention program for young adults experiencing FEP. This model is team-based, multidisciplinary, collaborative, and recovery-oriented, emphasizing shared decision-making between the team and the individual.
Intended Audience
The intended audience for this program includes youth, adolescents, and young adults experiencing FEP. Participants are usually between 15 and 25, but some programs may extend to ages 35 to 40. As an early intervention program, CSC for FEP is designed to bridge existing services for these groups and eliminate the gaps between child, adolescent, and adult mental health programs. Clinical trials for CSC have been restricted to individuals with nonorganic, nonaffective psychotic disorders who have been ill for five years or less. Empirical evidence regarding the program’s effectiveness is most significant to those who meet these criteria. This program is not recommended for individuals who do not meet FEP diagnostic criteria or who have been ill for more than five years and should be referred to other mental health services.
Implementation
The Coordinated Specialty Care (CSC) model is implemented in community behavioral health settings, with interventions delivered in clinics and community or home environments. Key services like employment and education support often occur directly in those settings. CSC programs are tailored to individual client needs, with treatment plans usually spanning two years and involving weekly sessions across various interventions. Services are delivered primarily in person, though telehealth and phone-based services are used when appropriate. Successful implementation requires a multidisciplinary team covering essential roles, such as case management, psychotherapy, and supported employment, with the size of the team varies based on the population served. Critical infrastructure includes ensuring proper team leadership, defining eligibility criteria, and having a strong referral network.
Outcomes
- The CSC-FEP approach produces better clinical outcomes compared to crisis-driven models
- It leads to lower treatment costs
- Individuals experience a higher overall quality of life
- Reduces the duration of untreated psychosis (DUP), leading to better long-term clinical outcomes
- RAISE project found that participants in CSC programs
- More significant improvement in symptoms
- Longer treatment engagement
- Higher likelihood of staying in school
- Maintaining employment
- Remaining socially connected
- Continued studies show improvements in psychosis, depression, mood symptoms, education, employment, and global functioning
- Individual characteristics like race, ethnicity, and DUP can influence clinical and functional outcomes
Evidence
Fidelity and outcome measures are essential for evaluating the implementation of Coordinated Specialty Care (CSC) programs, ensuring interventions are delivered as intended and achieving desired clinical and functional outcomes for individuals with First Episode Psychosis (FEP). While there is no single fidelity tool for CSC, the First Episode Psychosis Services Fidelity Scale-Revised (FEPS-FS-R) and other service-specific tools like the NAVIGATE Supported Employment and Education Fidelity Scale are commonly used. Clinics may also use electronic health records (EHR) or service logs to track service contacts and clinical data when formal fidelity tools are unavailable. National efforts are underway to create a standardized fidelity tool for CSC programs.
Additional Resources