Accelerating Science-to-Practice for Early PsychosisAmy B. Goldstein, Ph.D., Robert K. Heinssen, Ph.D., Susan T. Azrin, Ph.D.

It takes approximately 17 years for research findings to in-fluence clinical practice, and even longer for a scientificdiscovery to have an impact on public health. Seventeenyears also falls within the lower bound of the age of onset forschizophrenia, a devastating mental disorder characterizedby recurrent psychotic episodes and accumulating disability.To improve outcomes for young adults with early psychosis,NIMH launched the Recovery After an Initial SchizophreniaEpisode (RAISE) initiative in 2008. The goals were to de-velop a comprehensive, person-centered intervention forfirst-episode psychosis (FEP), test it in U.S. community treat-ment settings, and expedite dissemination, adoption, and im-plementation of promising findings.

Rapid uptake of evidence-based interventions can occurwhen clinical research purposefully bridges gaps betweenservice users’ needs, scientific curiosity, and policy makers’concerns. The RAISE funding announcement took this intoaccount and required investigators to establish partnershipswith principal stakeholders—that is, service users, familymembers, clinicians, and health care administrators—atevery stage of the research process. RAISE investigatorsstudied implementation processes alongside outcomes anddeveloped training and program materials to support theestablishment of coordinated specialty care (CSC) programsin community clinics. The articles and columns in the spe-cial section suggest notable progress after only seven years—a decade earlier than the often cited 17 years—because theyaddress implementation challenges and answer questionsabout feasibility, accountability, acceptability, effectiveness,and sustainability.

Is it feasible to implement CSC programs in routine settings?Yes. The articles by Dixon and colleagues and byMueser andcolleagues each describe team-based multicomponent pro-grams for FEP. Across the two RAISE studies, 19 new CSCprograms were established by training community mentalhealth providers in stage-specific care for FEP.

Can treatment fidelity be monitored in a practical way?Yes. The Best Practices column by Essock and colleaguesdescribes an approach to CSC fidelity monitoring that usesinformation drawn from readily available data, such asroutine service logs. Practical approaches to fidelity moni-toring may be cost-effective and can provide an ongoing datasource for quality improvement activities.

Will young adults with FEP engage in treatment? Yes. Lessthan 10% of RAISE Connection participants dropped outover two years. Lucksted and colleagues highlight severalfeatures that promoted engagement: the individualized,flexible, and recovery-focused nature of treatment; the em-phasis on shared decision making; and the availability ofservices such as supported employment and education.

Are CSC programs effective? Yes. After one year oftreatment, Srihari and colleagues found fewer hospital-izations and higher vocational engagement among CSCpatients compared with those in usual care. Likewise, overtwo years, Dixon and colleagues noted significant improve-ments in symptoms, social functioning, and school and workactivity among Connection Program participants.

Are CSC programs sustainable? Perhaps. In the Research &Services Partnerships column, Essock and colleagues de-scribe how state mental health authorities in New York andMaryland supported implementation, evaluation, and ex-pansion of the Connection Program. Involvement in RAISEinfluenced each state’s decision to commit funds to extendearly intervention services. The novel three-part financingmodel proposed by Frank and colleagues in the EconomicGrand Rounds column offers another strategy for achievingsustainability: a payment system that rewards delivery ofhigh-quality FEP care.

These articles and columns convey hope that integratedand effective care for FEP is possible in the United States. AsCSC programs multiply, we must anticipate new challengesthat might reduce the public health impact of early in-tervention programs. Addington and colleagues’ brief reportreminds us that many persons with FEP endure long periodsof untreated psychosis, which augurs poorly for long-termrecovery. Ouellet-Plamondon and colleagues in Canada alertus to potential disparities in access among minority groupsand the need for different engagement strategies. Closepartnerships between investigators and stakeholders will becritical for further progress. Through dynamic partnershipsand ongoing collaboration, we should strive to make 17 yearsthe age at which psychosis is prevented.

Division of Services and Intervention Research, National Institute of MentalHealth, Bethesda, Maryland

Psychiatric Services 2015; 66:665; doi: 10.1176/appi.ps.660708

Psychiatric Services 66:7, July 2015 ps.psychiatryonline.org 665

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