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RESEARCH WEEKLY: Early detection for psychosis on a college campus
By Hope Parker
(September 6, 2023) Reducing the duration of untreated psychosis is vital to improving quality of life and long-term outcomes. Early detection programs that identify and refer individuals with early psychosis to coordinated specialty care programs are one way to reduce DUP.
A study published last month in “Psychiatric Services” evaluated a community-based early detection program in New Mexico University’s counseling center. College campuses are an essential location for early detection, as the first symptoms of psychosis typically occur between the ages of 15-29, when many individuals are pursuing undergraduate and graduate degrees. The goal of this research study was to not only evaluate how successful this intervention was at connecting students to necessary services, but also to investigate where people may be getting lost in the process.
Methods
Over the course of nearly two years, all students seeking counseling services at the University of New Mexico filled out the Prodromal Questionnaire-Brief as a part of intake procedure. The PB-Q is a 21-question survey that asks about positive psychosis symptoms and associated distress due to these symptoms. All treatment providers at the counseling center received psychosis literacy training.
If students received above a certain score, they were referred to the University of New Mexico’s coordinated specialty care (CSC) program for a more in-depth phone screening, which students had to initiate. The phone screening took about 15 minutes and asked about the student’s duration and severity of psychosis symptoms, medications, and mental health, family, and overall history. The program specialist then sent referrals for clinical assessments to the CSC team for eligible students.
If the CSC team believed that a student who was referred would be a good candidate for CSC services, the student was then sent to the clinical high-risk team for a formal Structured Interview for Psychosis-Risk Syndromes (SIPS). Students who were found to be eligible after the SIPS were enrolled in CSC services for either patients with clinical high risk for psychosis or for patients with First-Episode Psychosis, depending on the results of the assessment.
Key findings
A total of 1,945 students completed the PB-Q at University of New Mexico’s counseling center from August 2020 to May 2022. Of those students, 547 (28%) met the cutoff score for the PQ-B to be referred to the phone screening. However, college counselors only actually referred 428 (78%) of those students.
Only 212 (50%) of referred students initiated and completed a phone screening. Of students that completed the phone screening, 140 (66%) students were considered ineligible and 72 (34%) completed the clinical eligibility assessment.
Of the 72 students who completed the clinical eligibility assessment, 14 students were then referred to the FEP CSC program. Three students were accepted to that program, while 11 were considered ineligible. Of the other 58 students who completed the clinical assessment, 41 (71%) completed a SIPS. Of the students who completed the SIPS, 22 (54%) were deemed ineligible, 18 were accepted and enrolled in CSC treatment, and one student met eligibility criteria but declined services.
In total, about 1% of all of the students screened were enrolled in CSC services, including both the three students who were enrolled directly into the FEP program, and the 18 students enrolled after completing the SIPS.
Implications
This study demonstrated how an early detection of psychosis program may work in a college setting. It also identified stages in the process where students may fall through the cracks of the system so that these areas may be improved.
Despite explicitly being asked to refer all students who scored above a cutoff score on the PQ-B, 22% of students who met this requirement were not referred to a phone screening. Providing counselors with additional materials and case studies increased the referral rate, but some counselors still continued to use their clinical judgement over PQ-B scores.
Additionally, half of the total students referred did not initiate the secondary screening. This may be because of feelings of stress or anxiety about the referral or symptoms of psychosis, such as paranoia or disorganization. The authors suggest that allowing time for the counselor and student to form a relationship before referral could help increase follow-through.
The authors also note that the COVID-19 pandemic caused an interruption in services approximately four months before the study began and should be considered, as the counseling center had to rely almost exclusively on telehealth services.
Reference
Saavedra, J.L., et al. (August 2023). The Cascade of Care for Early Psychosis in a College Counseling Center. Psychiatric Services.
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