EDIPPP Intake Procedures

1. EDIPPP Intake Procedures From referral to clinical visits

2. Referral Intake Process First call: Phone screen form and PRIME screen are completed by clinician. A score of 1 is required on the Prime Screen on at least one �P� scale in order to proceed. Clinician records call on phone log.

3. EDIPPP Initial Phone Screening Evidence of psychosis: hallucinations: ����� delusions: ����� unusual thought content: ����� disorganized speech: �����

4. EDIPPP Initial Phone Screening PRODROMAL SYMPTOMS: Difficulties in thinking (attention, concentration, memory, organization): Difficulties in speaking or writing: Anxiety:����� Drop in functioning (work, school, self-care, activities): ����� Perceptual disturbances/sensitivities: ����� 

5. EDIPPP Initial Phone Screening PRODROMAL SYMPTOMS (cont�d): Suspiciousness, ideas of persecution: ����� Grandiosity: ����� Social isolation or withdrawal: ����� Decreased emotional expressiveness or sense of loss of emotions and self: ����� Odd/bizarre behavior or appearance: ����� Disturbances of sleep: ����� mood: ����� motor functioning: ����� appetite/nutrition:

8. Deciding whether to assess� Clinician reviews case with team leader (TL), who determines whether case meets other intake criteria for assessment ( per exclusion criteria list). In some situations, the team may need to hear the case to assist with making a determination. If the decision is made to assess the referral, the TL gives phone screen form to secretary.

9. Screened out calls Phone screen forms of referrals not being assessed are kept in either the �potential� or �not to be assessed� files in the clinical area. Keep these forms in the event there is a future call about the same individual.

10. Starting the assessment process Secretary assigns ID # from the database and starts a manila folder with name and ID#. Folder includes phone screen form and pertinent notes. Manila folder stays in locked file cabinet in an area marked �Assessments.� Clinician assigned to work with family should call to make orientation appointment�ideally, this would be the person who took the referral call.

11. Research becomes involved Secretary gives research coordinator (RC) a copy of phone screen form (ID# at top). RC gives secretary Family Questionnaire packets to give to clinician. Secretary assembles orientation packet for clinician.

12. Components of the Orientation Session

13. Informed Consent Checklist Introduction: Symptoms / Early Intervention Purpose of Informed Consent Process Mild level of symptoms very common in this age group; early intervention is the only known way to prevent or delay the onset of mental illnesses Assessment to determine eligibility

14. Informed Consent Checklist General information: Research Study Purpose 2 years Voluntary Alternative treatments Risks and benefits Participant Stipend (6 months = $__; 1 year = $__; 2 years = $__)

15. Informed Consent Checklist Assessment: 2 � 3 sessions Family involvement Questionnaires and MFG survey

16. Informed Consent Checklist Study Design: Assignment to group on basis of need Counseling w / medication (med based on need and consultation, not experimental) Major research assessments at 6, 12, and 24 months Research blind Differences / similarities between the groups:

17. Informed Consent Checklist Treatment Group: MFG family education Crisis intervention Medication management Supported education and employment Functional assessments/support

18. Informed Consent Checklist Comparison Group: Light case management & monitoring Assistance as needed

19. Informed Consent Checklist HIPAA / Confidentiality: Confidentiality and exceptions Release of information Type of Information collected

20. Confirming Consent: ask questions if necessary to verify appropriate level of understanding!

21. Orientation session Clinician meets with family and potential client prior to the assessment process. �Joining� starts during interview. Use informed consent checklist and orientation protocol. IRB consent forms, Family Questionnaires and Family FPE Survey are completed, along with other necessary forms.

22. Orientation session (cont�d) Review �appointment timeline� with family. Offer research assessment times to family if they choose to proceed. Appointments for research assessments and feedback sessions are given at this time by secretary.

25. Research Visits MONTH 6 Client 3 HOURS 1 YEAR Client 7 � 8 HOURS Parent(s) 4 HOURS Client & Family 1 � HOUR 2 YEARS Client 7 � 8 HOURS Parent(s) 4 HOURS Client & Family 1 � HOUR

26. Research assessments Researchers administer all intake assessments, including neuropsych testing. If an individual is considered psychotic, the team MD and TL will be consulted re: rapid treatment access. In this situation, some research assessments may need to be postponed in order to begin treatment. The �P� scales should at least be administered.

27. Following the assessment process Following research assessments, RC scores SIPS and gives scores to research director (RD), along with research checklist and copy of SIPS. RD then determines whether the client meets criteria for treatment or control. RD gives outcome information to secretary and TL. Those who meet treatment criteria have a chart made according to each EDIPPP site�s regulations. Information on individuals who decline participation at any stage should be kept in appropriate areas (research or clinic).

28. Components of the Feedback Session

29. Feedback session Assigned clinician first reviews SIPS information and research checklist to better understand the client�s symptoms and level of illness. Clinician then meets with family (client included) for feedback session. Clinician should follow EDIPPP feedback session protocol.

30. Feedback session (cont�d) Discuss assessments: SIPS�how client rated on �P� scales Use client�s own language to review his/her level of distress Emphasize that while worrisome, symptoms may only be an indicator of potential future problems

31. If the client meets EDIPPP criteria: Discuss what EDIPPP can offer family Knowledge about mental illness, family support through education, preventative psychosocial interventions, etc. Frequent medication and symptom monitoring, so if any changes arise, it will be noticed far sooner than if treated in another outpatient setting

32. If the client meets EDIPPP criteria (cont�d): Give the family: welcome letter from the P.I. welcome gift package. Discuss the importance of the family�s involvement with on-going research and review future research appointments (give them a copy of the engagement flow-chart if that would help), especially the longer assessments at 6, 12, & 24 months

33. If the client meets EDIPPP criteria (cont�d): Begin initial psychoeducation informational session and joining with family if there�s time Introduce other team members casually or formally if appropriate at this session Schedule future psychoeducation sessions

34. If client does NOT meet criteria: Discuss why they were not offered the experimental treatment Use this as a time to �join� or engage with the family Reassure family that you will help find resources/other providers that would be more suitable to their needs

35. If client does NOT meet criteria (cont�d): Discuss the importance of family�s involvement with on-going research and review future research appointments Ask family�s permission to be contacted periodically (every few months) by a case manager who will inquire about their well-being and offer any needed assistance. Obtain 5 different contacts.

36. Psychoeducational sessions Plan for 2 or more, 1 � hour sessions with family Include MD/RN as indicated Review presenting symptoms and present level of distress and impairment Reassure everyone about level of symptoms and treatment options, including medications Review research components and emphasize their importance Offer basic information about prodrome or first episode and repeat as often as necessary Work with client and family to start treatment planning