The OnTrackNY coordinated specialty care program has proved to be a sustainable and scalable model for early interventions to address psychosis: A number of limitations challenge the implementation and maintenance of the program, such as concerns about financial sustainability, fragmentation of child and adult services, and the lack of incentives for coordinated services, according to a study published in Early Intervention in Psychiatry.
There is consistent evidence that early intervention in cases of psychosis leads to improvements in symptoms, treatment satisfaction, and social functioning. For the current study, the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to describe the implementation processes, challenges, and achievements of OnTrackNY in New York State. Investigators used the care process and outcome data that OnTrackNY collects quarterly on all sites to describe the status of each dimension of RE-AIM regarding implementation, as well as to evaluate the program’s shortcomings and achievements.
OnTrackNY enrolled 1215 individuals from October 2013 to 2018, serving patients irrespective of income or health insurance and enrolling individuals an average of 7.7 months after onset of psychosis. A majority of physicians had positive feedback on the care program, and the program created a face valid fidelity scale built upon a practical set of procedures and developed anchors. Promising results were seen regarding rates of enrollment in school, employment, quality of life, and hospitalization, with rates of education/employment increasing from 40% to 80% by 6 months, Global Assessment of Functioning score improvements that continued to 12 months, and rates of hospitalization decreasing from 70% to 10% by 6 months. Overall, the program was able to address early psychosis by reaching a large population in need and providing them with recovery-oriented services.
Study investigators conclude that despite the program’s advancements, there are still significant limitations that jeopardize implementation of coordinated specialty care services, including “the lack of durable financing strategies and support for processes to examine and maintain fidelity. The need for greater availability for services to the population is also apparent. We expect that other [coordinated specialty care] programs throughout the country and worldwide may experience similar challenges.”
Mascayano F, Nossel I, Bello I, et al. Understanding the implementation of coordinated specialty care for early psychosis in New York state: a guide using the RE-AIM framework [published online January 22, 2019]. Early Interv Psychiatry. doi: 10.1111/eip.12782