NIH awards research grants to develop learning health care system for early psychosis treatment

The National Institutes of Health (NIH) awarded six research grants for studies to develop a learning health care system for the treatment of early psychosis. The awards are part of a broad research initiative called Early Psychosis Intervention Network (EPINET), which aims to develop models for the effective delivery of coordinated specialty care (CSC) services for early psychosis. The grants are administered by the National Institute of Mental Health (NIMH), part of NIH.

The word psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. About 100,000 youth and young adults in the United States experience a first episode of psychosis each year. Left untreated, psychotic symptoms can lead to disruptions in school and work, strained family relations, and separation from friends. The longer the symptoms go untreated, the greater the risk of additional problems.

CSC is a recovery-oriented treatment program for people with early psychosis (i.e., those in the early stages of a psychotic illness). It promotes shared decision making and uses a team of specialists who work with the client to create a personal treatment plan. Through these EPINET awards, NIMH aims to establish regional scientific hubs each connected to six or more community-based CSC programs that endorse measurement-based early psychosis treatment. A national data coordinating center will support and extend the work of the regional hubs by integrating data obtained from 58 CSC programs across nine states.

The groundwork for EPINET was laid by NIMH's Recovery After an Initial Schizophrenia Episode (RAISE) initiative. RAISE demonstrated the superiority of team-based, multi-component CSC treatment compared to usual care for early psychosis and the feasibility of implementing CSC programs in U.S. community settings. Individuals in the RAISE studies who received CSC stayed in treatment longer and experienced greater improvement in their symptoms, interpersonal relationships, quality of life, and involvement in work and school compared with those who received typical care.

The RAISE findings have been replicated by other studies, adding momentum to early intervention programs in America. EPINET represents the next chapter in a science-to-service story that started with RAISE but is moving toward learning health care that fosters recovery in early serious mental illness."

Robert K. Heinssen, Ph.D., director, NIMH's Division of Services and Intervention Research (DSIR)

Today, over 260 early psychosis specialty care programs have been established in 49 states. NIMH is seeking to build on states' investments by supporting practice-based research that promotes high quality, continuously improving care across all CSC programs.

As the number of early intervention programs expands, it is essential that we learn how to ensure those receiving these services get the best possible care. Through EPINET, we hope to learn how best to deliver cutting edge care in real-world, community-based settings. This will help us rapidly translate scientific advances into the clinic."

Joshua A. Gordon, M.D., Ph.D., director, NIMH

NIMH has awarded over $40 million in funding for EPINET over five years. The grants that have been awarded include:

EPINET Regional Scientific Hubs

* California Collaborative Network to Promote Data Driven Care and Improve Outcomes in Early Psychosis (EPI-CAL), University of California, Davis, Dr. Tara Ann Niendam

https://projectreporter.nih.gov/project_info_description.cfm?aid=9815936&icde=46520705

* Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO), Feinstein Institute for Medical Research, New York City, Drs. John Kane and Delbert Robinson

https://projectreporter.nih.gov/project_info_description.cfm?aid=9817331&icde=46163017&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&pball=

* Laboratory for Early Psychosis Research (LEAP)-Supplement, McLean Hospital, Belmont, Massachusetts, Drs. Dost Ongur, Miguel Hernan, and John Hsu

https://projectreporter.nih.gov/project_info_description.cfm?aid=10001157&icde=46528315

* OnTrackNY's Learning Healthcare System, New York State Psychiatric Institute, New York City, Drs. Lisa Dixon and Jennifer Humensky

https://projectreporter.nih.gov/project_info_description.cfm?aid=9817350&icde=46067457&ddparam=&ddvalue=&ddsub=&cr=2&csb=default&cs=ASC&pball=

* Targeting Cognition and Motivation in Coordinated Specialty Care for Early Psychosis, University of Minnesota, Minneapolis, Drs. Sophia Vinogradov and Piper Meyer-Kalos

https://projectreporter.nih.gov/project_info_description.cfm?aid=9816739&icde=46401701&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&pball=

EPINET National Data Coordinating Center

* Westat, Rockville, Maryland, Dr. Abram Rosenblatt https://projectreporter.nih.gov/project_info_description.cfm?aid=9816841&icde=46520971&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&pball=

Each regional hub will have one or more studies focused on reducing delays in accessing care, improving cognitive functioning, preventing suicide, increasing treatment adherence, and sustaining clinical gains over time. Each CSC program participating in EPINET will use standard clinical measures and uniform data collection and analysis methods to facilitate learning about the most effective ways to deliver early psychosis treatment. The EPINET National Data Coordinating Center will enable large-scale, practice-based research using data shared by the regional hubs to improve early identification, diagnosis, clinical assessment, intervention effectiveness, and health outcomes in clinics offering evidence-based care to persons in the early stages of psychotic illness.

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