Using Telehealth to Decrease Treatment Interference for First-Episode Psychosis Patients

How successful is remote treatment for first-episode psychosis via telehealth?

Psych Congress Network recently spoke with Elisa Nelson, PhD, psychologist with the Department of Child and Adolescent Psychiatry & Behavioral Sciences at Children's Hospital of Philadelphia, Pennsylvania, and co-authors, Monica Calkins, PhD, and Christian Kohler, PhD, about their study “Telehealth of Coordinated Specialty Care in Early Psychosis During COVID-19” recently published in the Journal of Clinical Psychiatry.

In Part 2 of this Q&A, Drs Nelson, Calkins, and Kohler explain the implications of their study findings for mental health care clinicians, address common misconceptions about treating psychosis remotely, and provide a look at future avenues for continuing research.

Missed Part 1: Maintaining Continuity of Care for First-Episode Psychosis Through Telehealth? Find it here. For more expert insights on how to improve patient outcomes remotely, visit our Telehealth Excellence Forum.

Brionna Mendoza, Associate Digital Editor, Psych Congress Network (PCN): What are the practical applications of your findings for clinicians in the mental healthcare profession?

Elisa Nelson, PhD, Monica Calkins, PhD, and Christian Kohler, PhD: In general, COVID-19 has resulted in an unprecedented demand in mental health services across the United States that were, and still remain, difficult to meet. Attending telehealth services without commuting to an office setting facilitates access to care for consumers and decreases no-show rates, which are higher with in-person visits. Since engagement was stable across the services evaluated, this may suggest that providers have more options for offering effective mental health care across different services and can further tailor treatment to fit an individual’s needs. Identifying the best option (e.g. remote vs. in-person vs. hybrid) has been an ongoing discussion with our treatment team and the participant enrolled in the clinic. For several of the individuals enrolled in our clinic, they need to balance treatment needs with other life obligations such as school, work, and relationships. Offering more options may decrease treatment inference in other areas of their life and maintain more consistent engagement in treatment as the individual recovers.

Mendoza, PCN: Which misconceptions about this topic would you like to clarify for our audience?

Nelson, Calkins, and Kohler: Suspiciousness about being observed or tracked are common clinical symptoms in psychosis and one would expect that young persons with psychosis would be less likely to engage in telehealth services. However, our experience showed that young persons with FEP can effectively engage with providers of CSC in telehealth and make use of the different services.

Mendoza, PCN: What future areas of inquiry do your findings point towards?

Nelson, Calkins, and Kohler: Our clinical population of young persons with FEP who tend to be literate in electronic engagement does not readily translate to more general mental health settings that provide care to people with more diverse clinical conditions, a wider age range and abilities to engage using electronic access. Another inquiry may entail looking at engagement in care across services in rural versus urban CSC settings. An additional future direction for inquiry can include investigating the impact of offering remote services on specific functional outcomes such as obtaining employment, returning to school, and social contact with friends and family.

References

Perkins, D.O., Hongbin, G., Kalima, B., Lieberman, J.A. (2006). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. The American Journal of Psychiatry, 162(10), 1785-1804. https://doi.org/10.1176/appi.ajp.162.10.1785

Kane, J.M., Robinson, D.G., Schooler, N.R., Mueser, K.T., Penn,D.L., Rosenheck, R.A.,…Heinssen, R.K. (2015). Comprehensive versus usual care for first episode psychosis: Two-year outcomes from the NIMH RAISE Early Treatment Program. The American Journal of Psychiatry, 142(4), 362-372. https://doi.org/10.1176/appi.ajp.2015.15050632

Elisa Nelson, PhD, is a psychologist in the Psychosis Evaluation and Recovery Center (PERC) at the University of Pennsylvania (UPENN) and the Children’s Hospital of Philadelphia (CHOP). She completed her post-doctoral training in Recovery-Oriented Cognitive Therapy (CT-R) for individuals with serious mental health conditions at UPENN. She has supported individuals in coordinated specialty care programs in the early stages of psychosis for several years. She is currently researching CT-R concepts and the effectiveness of this approach in coordinated specialty care programs, specifically ways CT-R can be adapted to support families.   

Monica Calkins, PhD, is Associate Professor of Psychology in the University of Pennsylvania Department of Psychiatry's Neurodevelopment & Psychosis Section (NDPS). After receiving her Bachelor’s degree from Temple University, she earned a Ph.D. in Clinical Science and Psychopathology Research at the University of Minnesota before joining Penn as a post-doctoral fellow, subsequently appointed to faculty. Her research focuses on phenotypic and biobehavioral risk factors for psychosis spectrum symptoms in young people. She is the Director of Clinical Research Recruitment and Assessment for NDPS and the Lifespan Brain Institute, Co-Director of the Pennsylvania Early Intervention Center (HeadsUp), and Associate Director of Penn’s Psychosis Evaluation and Recovery Center (PERC). 

Christian Kohler, MD, is Professor of Psychiatry and Neurology in the Neurodevelopment & Psychosis Section (NDPS), Department of Psychiatry of the University of Pennsylvania. After receiving his Doctorate in Medicine at Innsbruck University in Austria, he completed residency training in Psychiatry at Wright State University and in Neurology at the University of Cincinnati. After a NIMH-funded post-doctoral fellowship, he was appointed to faculty at the University of Pennsylvania. Dr. Kohler is the Clinical Director of the Neurodevelopment & Psychosis Section (NDPS), Director of Penn’s Psychosis Evaluation and Recovery Center (PERC) and Co-Director of the Pennsylvania Early Intervention Center (HeadsUp). His research has focused on emotion al processing in young persons with psychosis spectrum symptoms and, more recently, delivery of care during early psychosis.