HIGHLIGHTS

This Months Highlights

Special Section on RAISE and Other Early
Intervention Services
Four articles, two brief reports, and three columns in this issue
focus on coordinated specialty care programs for individuals
experiencing early psychosis. Such programs, which seek to
change the trajectory and prognosis of schizophrenia through
comprehensive and aggressive treatment in the earliest stages
of illness, have been widely implemented in other countries,
but not in the United States. In 2008, the National Institute of
Mental Health (NIMH) announced the RAISE project (Recovery After an Initial Schizophrenia Episode), later awarding
contracts to two research groups to develop and test potential
interventions. The special section features reports from both
groups. In Taking Issue, Amy B. Goldstein, Ph.D., and her
NIMH colleagues describe the ways in which each report in
the special section addresses implementation challenges
identied when RAISE was launched (page 665). In the
lead article, Kim T. Mueser, Ph.D., and colleagues from one of
the NIMH-funded groups describe the intervention they developed, known as the NAVIGATE program. Core services
include family education, individual resiliency training, supported employment and education, and individualized medication treatment (page 681). In the second article, Lisa B.
Dixon, M.D., M.P.H., principal investigator for the other
NIMH-funded group, and her colleagues provide an overview
of services included in the intervention they developedthe
RAISE Connection Program. These authors also present outcome data on functioning, symptoms, and remission among
clients who received services for up to two years at Connection sites in Baltimore and New York City (page 692). Because engagement is critical to the effectiveness of these
programs, researchers at the Baltimore and New York sites
examined data from semistructured interviews with clients
both those who were well engaged and those who were not.
As Alicia Lucksted, Ph.D., and colleagues report, Connections
focus on life goals was a central factor in engaging clients.
Most interviewees were under age 25, and their engagement
hinged substantially on Connections nonclinical services,
such as supported education and employment (page 700).
In a third article, Vinod H. Srihari, M.D., and colleagues
present ndings from a controlled trial of STEP (Specialized
Treatment Early in Psychosis). STEP, which is not part of the
RAISE initiative, was established in 2006 by the Connecticut
Mental Health Center. After one year, STEP participants had
signicantly fewer and shorter hospital stays than those in

Psychiatric Services 66:7, July 2015

usual treatment and demonstrated better vocational engagement (page 706). Of the three columns in the special
section, two are from RAISE researchers associated with the
Connection Program. In Research & Services Partnerships,
Susan M. Essock, Ph.D., and coauthors describe the Connection Program as a partnership involving researchers and state
mental health authorities. The authors explain why states
are interested in rst-episode services and describe the development of the partnership, nancing mechanisms, and plans
to add teams in Maryland and New York (page 672). As these
programs are implemented more widely, new teams delity to
the intervention is essential. In the Best Practices column,
Dr. Essock and colleagues present a practical approach to delity monitoring that they developed for the Connection
Programone that uses routinely available administrative data
as well as information from client interviews (page 675). Widespread dissemination will also require a funding mechanism
that not only is compatible with approaches already used by
payers but also generates incentives for providers. In Economic Grand Rounds, Richard G. Frank, Ph.D., and colleagues
propose a funding model with three components and describe
how such a model might be implemented (page 678). Two
brief reports complete the special section. The rst, by Jean
Addington, Ph.D., and others associated with the NAVIGATE
program, presents ndings from a study that examined duration
of untreated psychosis (DUP) among community mental health
center clients. Median DUP was 74 weeks, and two-thirds of
participants had DUP of greater than six months (page 754).
Finally, in a two-year study of patients receiving rst-episode
services in Montreal, Clairlaine Ouellet-Plamondon, M.D.,
F.R.C.P.C., and colleagues found high rates of disengagement
among immigrants, even though their medication adherence
was similar to that of nonimmigrants (page 758).
Briey Noted
As Medicaid programs transition from branded secondgeneration antipsychotics to generics, expenditures for
these drugs could decrease by more than 75%, according
to a forecasting study based on analyses of 20082011
Medicaid data (page 719).
This months Open Forum describes SAMHSAs Recovery
to Practice project, a workforce collaborative to increase
clinicians skills in delivering evidence-based, recoveryoriented services (page 751).

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