PEACE Program: Psychosis Education, Assessment, Care, and Empowerment

Program Description

PEACE (Psychosis Education, Assessment, Care, and Empowerment) is a community based early intervention program for individuals experiencing a first-episode of psychosis in inner-city Philadelphia. Launched in March 2015, through Horizon House Inc., PEACE follows the evidence-based Coordinated Specialty Care (CSC) model to deliver multidisciplinary services under Medicaid. Our mission is to keep people with early signs of psychosis on their chosen life paths by building community awareness about psychosis to reduce stigma and encourage early treatment, and by offering easily accessible, effective treatment and support with a focus on resiliency and recovery. Unfortunately, young people experiencing a first episode of psychosis are often confronted with numerous insults to their ability to navigate their symptoms or their recovery. Among them include a vicious cycle in which family units are disrupted by symptoms of psychosis and in turn the disruption leads to worsening symptoms and finally to crisis. This cycle is even more pronounced in inner-city families that are already struggling with multi-generational cycles of poverty, substance use, mental illness, and trauma. PEACE currently serves approximately 60 individuals, aged 14-28, and, with few exceptions, our participants come from families living in poverty or deep poverty and are often subject to this cycle.

Creativity

At PEACE, we recognize that our participants come from families with profound economic and social needs well beyond the episode of psychosis that led them into our care. Because of this, we strive to provide services which address the ongoing risk factors of psychosis. While PEACE offers family therapy and psychoeducation as part of the core elements of the CSC model, neither of these approaches provide tools for managing crisis in the home or preventing the negative outcomes of crisis. PEACE is collaborating with researchers at the University of Pennsylvania and the Aaron Beck Center to adapt the Recovery Oriented Cognitive Therapy (CT-R) model to be used for crisis intervention in the first episode psychosis (FEP) population. PEACE has been approved to provide care using a case-based rate, which frees us from many of the restrictions other agencies may face in delivering high-intensity care such as CT-R for crisis intervention.

Leadership

PEACE has been a leader for the establishment of CSC programs for early psychosis in Pennsylvania and acts as the principal site for a state-wide FEP program evaluation initiative. Program evaluation involves coordinating meetings for all FEP program leaders and their staff to enforce program fidelity to the core CSC model. The director of PEACE, Dr. Hurford, is also the FEP program trainer for new FEP sites in PA, which provides an opportunity to communicate efforts being made to establish supplementary services to the CSC model within the PEACE program, such as the creation of CT-R for crisis intervention. Through the collaboration with the University of Pennsylvania and the Aaron Beck Center, PEACE has also demonstrated to other FEP program sites the impact of fostering such relationships on community outreach and funding.

Sustainability

PEACE is a program of Horizon House Inc., a cornerstone provider of innovative, community-based, recovery-oriented services to over 4,500 individuals in Southeastern and Northeastern Pennsylvania and the state of Delaware. The Horizon House Inc. agency is a private non-profit 501(c)(3) organization that operates an annual budget in excess of $80 million and employs over 1,250+ full- and part-time staff members. In addition, PEACE is supported by the state office of mental health and substance abuse services (OMHSAS) FEP block grant with opportunities for renewal. PEACE is currently working with other foundations and granting agencies to support the implementation and evaluation of a CRT model for crisis intervention.

Replicability

As the principal site for FEP program evaluation, PEACE already has in place protocols for implementing the core elements of the CSC model. Should another institute or organization be interested in providing services for individuals with FEP, these protocols can easily be made available. By organizing open communication across sites, PEACE encourages adaptation of any supplementary services that are introduced, such as the previously described adaption of CT-R for crisis intervention. In addition, collaboration with affiliates who have experience in adapting protocols to meet specific program needs and in providing training to a range of professionals will be an asset to PEACE.

Results/Outcomes

PEACE has been operating for almost two years and has served over 80 individuals with a first episode of psychosis. Preliminary outcome data has demonstrated an increase in engagement rates and in work or school attendance. In addition, September outcomes data shows a reduction in days of hospitalization from 1485 days in the year prior to joining PEACE to 268 days since PEACE opened. This is in line with results of the NIMH RA1SE trial of CSC programs when compared to standard care (see attached). In addition to site specific outcomes, state wide program evaluation led by PEACE will be used to further demonstrate both short and long term outcomes of the core CSC model. The same techniques will be applied to evaluate the impact of CT-R for crisis intervention on the same outcomes measures.