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The NYSPA Report: Spotlight on OnTrackNY – New York’s First-Episode Psychosis Early Intervention Program

OnTrackNY is a coordinated specialty care program for adolescents and young adults who have started experiencing psychotic symptoms. Started in 2013, the program is a joint collaboration of the New York State Office of Mental Health (OMH), the New York State Psychiatric Institute (NYSPI), the Center for Practice Innovations at NYSPI and the Columbia University Department of Psychiatry. OnTrackNY was inspired by the early successes of Recovery After an Initial Schizophrenia Episode (RAISE), a project funded by the National Institute of Mental Health. Studies have found that multidisciplinary early psychosis programs have resulted in reduced hospitalization, increased engagement with treatment, improved quality of life and enhanced symptom reduction, among other positive outcomes.1

Individuals eligible for the program include adolescents and young adults between the ages of 16 and 30 who have been experiencing psychotic symptoms for at least one week but not more than two years. Participants must have one of the following primary psychotic disorders: Schizophrenia, Schizoaffective disorder, Schizophreniform disorder, other specified schizophrenia spectrum and other psychotic disorders, Unspecified schizophrenia spectrum and other psychotic disorders, or Delusional disorder. Warning signs may include exhibiting unusual thoughts and behaviors, hearing or seeing things that others don’t and disorganized thinking.

OnTrackNY service sites are located within existing hospitals and outpatient mental health clinics at more than 20 locations across the State, including locations in Manhattan, Queens, Brooklyn, the Bronx, Staten Island, Long Island, Westchester, Orange County, Albany, Syracuse, Binghamton, Buffalo and Rochester. Each location includes a multidisciplinary team comprised of a team leader, licensed primary clinicians, an outreach and recruitment coordinator, a supported education and employment specialist, a prescriber and a nurse. In addition to their individual clinical and professional backgrounds, team members receive specialized training in differentiating first-episode psychosis from other types of mental illness, suicide prevention and cultural competency, among other topics. Each local team serves between 35 and 45 individuals at a time. Funding for OnTrackNY is provided by OMH and the federal community mental health block grant.

Inpatient psychiatric units generate approximately 40% of referrals to the program and approximately 20% of referrals come from outpatient mental health providers, families and self-referrals. The remainder of referrals come from schools, community organizations and hospital emergency departments.

OnTrackNY provides a comprehensive array of treatment and supportive services including pharmacology, case management, psychotherapy, education and employment services, and health and wellness services. The following is an excerpt from a 2017 article about OnTrackNY published in Psychiatric Services, a publication of the American Psychiatric Association that focuses on research, policy and practice issues in the treatment of mental illness:

“Evidence-based psychopharmacology involves prescribing the lowest effective doses of antipsychotics with the fewest possible side effects. An emphasis on health and wellness/primary care coordination addresses cardiometabolic factors associated with antipsychotics by providing education on nutrition and exercise, assessing health with routine lab work and coordinating with other medical professionals. Case management helps individuals and families meet concrete needs (such as health insurance and housing) and connects individuals to outside resources. Cognitive-behavioral-based therapy includes two components. The first is a general supportive approach focusing on engagement and collaborative identification of personal goals. The second focuses on cognitive-behavioral principles to treat symptoms of psychosis and related conditions (such as substance use and trauma). The overarching focus is training in resiliency, illness and wellness management, and coping skills. The delivery of psychotherapy is flexible (for example, provided in groups or individually, in the clinic, or in the community), and the content discussed in sessions is tailored to individual needs and preferences. . . . Peer services were recently added to the model. The peer specialist focuses on building a relationship with participants, enhancing outreach efforts to help them stay connected to the program, connecting them to resources in the community, and empowering them to advocate for themselves and effectively use OnTrackNY services.”2

A central goal of the program is to help participants avoid re-hospitalization and to maintain connections with family, friends and the local community. Participants are encouraged to establish and work towards individual goals related to school, work and interpersonal relationships. Participation in the program is generally limited to an average of two years, although that period of time may vary according to individual needs and preferences. Family involvement and education is an essential component of the program. Family members are provided with information and tools to better understand and cope with their loved one’s illness. Families work closely with participants and the OnTrackNY team to identify and achieve individual clinical and personal goals.

In addition to direct state and federal funding, covered services may be reimbursed by Medicare, Medicaid and/or commercial insurance where available. The OnTrackNY website notes that services are made available to “all referred individuals meeting clinical admission criteria, without wait lists and regardless of insurance status or ability to pay.”

“We are only beginning to understand the considerable value of reducing the duration of untreated psychosis and providing hopeful, developmentally appropriate and high-quality care to young people experiencing the onset of psychosis,” said Lisa Dixon, M.D., M.P.H., Director of OnTrackNY. “It is a privilege to work with the clinical teams offering the program. The young people and their families are so inspiring. We try to be humble and recognize that we still have much work to do in order to improve the program and ensure it serves everyone.”

The OMH 2019 Local Services Plan Guidelines for Mental Hygiene Services further notes: “OMH is seeking to improve early identification and treatment for individuals with psychotic disorders such as schizophrenia through the dissemination of first episode psychosis (FEP) models. The ultimate goal of the FEP initiative is to minimize disability so often associated with schizophrenia and to maximize recovery. New York State’s OnTrackNY initiative for first episode psychosis interventions has expanded statewide with 22 sites as of year-end 2017, and 700 individuals served in the past year alone.”

For more information about OnTrackNY and a list of its locations across New York State, please visit www.ontrackny.org. The OnTrackNY website also provides community resources including videos of personal stories and successes in the program, access to the OnTrackNY blog and monthly newsletter and community social media connections.

References

  1. “Results of a Coordinated Specialty Care Program for Early Psychosis and Predictors of Outcomes,” Psychiatric Services 69:8, August 2018.

2.            “OnTrackNY: The Development of a Coordinated Specialty Care Program for Individuals Experiencing Early Psychosis,” Psychiatric Services 68:4, April 2017.

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