Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Horizon House

Name of Innovative Program: 
Psychosis Education, Assessment, Care, and Empowerment (PEACE)
Sponsoring Organization
Horizon House
Name of Innovative Program Lead: 
Irene Hurford, MD
E-mail Address of Innovative Program Lead: 
hurford@mail.med.upenn.edu
Physical Address of Innovative Program: 
3819 Chestnut St. Philadelphia PA 19104
Project Description: 

The only one of its kind in the Philadelphia region, PEACE helps young people who are experiencing early psychosis to pursue a full and meaningful life. This innovative model brings together best practices in the treatment of first episode psychosis (FEP) and delivers them in a highly individualized, community-based model of care. PEACE is a multidisciplinary program that works with an underserved population.  We emphasize resiliency and believe that psychosis is an obstacle to overcome, not a permanently disabling condition. Our comprehensive array of services includes individual cognitive behavioral therapy (CBT), individual and group family therapy, supported education and employment services, occupational therapy, group therapy, peer support, and evidence-based psychopharmacology focused on minimal effective doses and maximum functioning. We emphasize individual choice and empowerment to provide our young participants with every opportunity to lead a full life of their choosing.

How does the innovative program work to improve behavioral health access?: 

The earliest days of a psychotic illness are a critical period for effective intervention. We consider access to care one of our highest priorities.  Over 30 years of research into duration of untreated psychosis (DUP) demonstrates that prolonged DUP is associated with more severe symptoms, increased hospitalizations, and poorer functioning and community integration once the psychosis is treated. Therefore we emphasize immediate contact at PEACE. Referring calls are returned within 24 working hours and assessment begins within a week of first contact. We have no waiting list because those with early psychosis cannot wait for care. Additionally, social stressors like trauma, poverty, substance abuse, and family stress are overrepresented in the Medicaid population that we serve, and these obstacles make it difficult for some to engage in traditional outpatient care. This is why we see people in the community where our participants live, including their homes and schools.

How does the innovative program work to improve behavioral health quality? : 

EACE follows best practices for evidence-based FEP care. Recent publications from American trials of FEP programs have replicated what 20 years of international research have demonstrated: high-intensity, team-based care in the earliest stages of psychosis changes outcomes even decades later. PEACE is based on the original international models which were also replicated by the U.S. studies such as RAISE. Our early outcomes data (attached document) show impressive improvements in clinical and functional outcomes within our first year of service. We individualize our care and our treatment approaches to the unique needs of our participants.  PEACE both maintains high fidelity to best practices for FEP models and delivers individualized care to a highly underserved population in a city with dense poverty. Our participants describe our program as life-changing and even life-saving. (see WHYY article). 

How does the innovative program work to address behavioral health costs? : 

Like other FEP programs across the globe, our program already appears to be reducing health care costs by markedly reducing hospital stays among our participants. While our program has a high frequency of outpatient services per participant, those costs are offset by reducing hospital days and ER visits, both of which are big drivers of mental health care costs. Furthermore, our focus on getting young people back to school and work means that fewer of our participants will be on disability or out of the workforce. Within our first year of service we see a significant improvement in those engaged in school or work.  See attached outcomes data. 

Creativity and Innovation: 

The PEACE program demonstrates innovation in the following domains: implementation of evidence based practices, individualized community-based care delivery model, and a unique approach to sustainable funding. Our focus is to provide very high quality, evidence-based care. To that end we have implemented best practices FEP care. However, our emphasis on a CBT model that focuses on improving motivation and self-determination, and our strong belief in the individual's right to choose both the nature of their mental health care and their personal life paths, distinguishes us from other FEP models in the U.S. Furthermore, while other programs have used research funding or dedicated state funds, we have developed our program to be primarily sustainable through Medicaid billing, which sets us apart in terms of our sustainability.  

Leadership: 

Our program is the only community mental health-based first episode psychosis program in Philadelphia, and the first in Pennsylvania. Since we opened in March 2015, PEACE has provided education to over 20 provider agencies on early psychosis symptoms and care, and stigma reduction. We have met with patient advocacy groups both locally and regionally. We have been invited to provide regional and national technical assistance around developing First Episode Psychosis models of care. Our message to advocacy groups and provider agencies is that by emphasizing the resiliency and growth potential of young people no matter what their symptoms, we can transform the way our system delivers care to young and vulnerable individuals with psychosis, and ultimately change the way psychosis is viewed by the broader community and public at large.  

Sustainability: 

PEACE was designed in collaboration with the Philadelphia Department of Behavioral Health and DisAbility Services and Community Behavioral Health to be a Medicaid-billable service. Currently we are also working at the state level to develop a service model for FEP programs that better encompasses the various levels of care that we provide. In 2015 the federal government provided SAMHSA with a 5% block grant to each state to create or supplement FEP programs, based on the compelling data from the NIMH RAISE FEP study.  In 2016 that amount was increased to 10%. PEACE has received some of that funding through OMHSAS and has also been designated the site responsible for overseeing program evaluation for FEP programs state-wide. The early phase of implementation has been funded by a combination support from CBH, Medicaid billable services and funding from the FEP block grant through OMHSAS. Our future sustainability is through Medicaid reimbursement.  

Replicability: 

PEACE provides a model of care consistent with evidence-based FEP programs that have been successfully replicated elsewhere and as such is a highly replicable service. The PEACE leadership team has begun to provide other counties in PA, and counties in other states, with technical assistance around replicating our FEP model of care. 

Results/Outcomes: 

Initial outcomes data demonstrate that within its first year of service, PEACE has reduced number of hospitalizations dramatically, reduced substance abuse among our participants by two thirds, and improved engagement in care by 67%. We have tripled the number of participants over 18 attending school, increased both work and work-related activities like job searching, and increased by 4X the number of participants engaged in some sort of work or school activity.  Our outcomes data are attached. PEACE has also been designated as the lead site for program evaluation for the state-wide FEP effort. We continue to track not simply clinical data but outcomes related to functional improvement and community participation such as employment and education, quality of life, and reduction in utilization of acute and crisis services.

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