OPAL 2 Exploratory Project 1

Improving Assessment of Psychosis and Engagement in Treatment

Individuals with psychotic disorders are more likely to disengage from mental health services than patients with other types of mental disorders. In addition to systemic factors (e.g., lack of insurance), other contributors to these differences include deficits in patient-provider communication (e.g., less patient participation), provider inattention to patient’s understandings (e.g., personal illness explanations), and differences in risk exposures (e.g., ability to pay impeding access to care). Hence, patients with psychosis can become dissatisfied, ask fewer questions, withhold information, and discontinue treatment. However, positive communication is linked to negotiating consensus around patients’ views of illness and treatment with greater engagement in services. This project aims to improve provider communication with individuals who have psychosis during outpatient assessment, treatment discussions, care initiation, and maintenance for schizophrenia (SZ) and other psychotic disorders by adapting a 3-session intervention, Cultural Formulation Interview-Engagement Aid (CFI-EA), for individuals with psychosis (CFI-EA/P). This intervention is based on the DSM-5 Cultural Formulation Interview (CFI), a 16-item, semi-structured interview to personalize assessment by improving provider communication behaviors (e.g., open-ended questions; activation statements). The CFI-EA/P includes standardized assessments of mood symptoms and risk exposures to reduce misdiagnosing SZ and to focus provider attention on community factors in engagement. With iterative stakeholder input (patients, clinicians, care coordinators, administrators) and mixed (qualitative-quantitative) methods guided by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), we propose to adapt, manualize, and pilot the CFI-EA/P in a large outpatient mental health system. The study design completes Stage I of the NIH Stage Model of Intervention Development, including: iterative adaptation of the CFI-EA/P manual, training workshop, and fidelity instrument (Stage 1a); evaluation of the CFI-EA/P’s feasibility and acceptability for patients and clinicians (Stage 1b); and pilot testing service outcomes (treatment engagement, communication, shared decision making, diagnostic concordance with research assessment) and patient outcomes (symptom improvements, quality of life, and psychosocial functioning) in a small randomized controlled trial to inform a future larger trial (Stage 1c). Consistent with the ALACRITY model, the CFI-EA/P would be available for immediate use in community-based outpatient clinics to address the treatment engagement of individuals accessing care for psychotic disorders. Study findings will guide further research on the CFI-EA/P.

Investigators:

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