OnTrackNY: The Development of a Coordinated Specialty Care Program for Individuals Experiencing Early Psychosis

Coordinated specialty care (CSC) is a multidisciplinary team approach for delivering evidence-based, early intervention services to young people experiencing first-episode psychosis (FEP) to improve outcomes (1). OnTrackNY is a CSC program in New York State that provides treatment to individuals ages 16 to 30 who have experienced nonaffective psychosis for less than two years. The program helps young people achieve their goals for school, work, and social relationships. Resources developed for OnTrackNY are available on the program’s Web site (http://ontrackny.org/Training).

The CSC model grew from the Recovery After an Initial Schizophrenia Episode (RAISE) projects, funded by the National Institute of Mental Health (NIMH). Launched in 2008, RAISE aimed to develop and test a treatment model to reduce relapse and long-term disability. NIMH required that the model be ready for rapid deployment if found effective (2). Two RAISE studies, the RAISE Early Treatment Program (ETP) and the RAISE Implementation and Evaluation Study (RAISE-IES), laid the groundwork for larger-scale implementation (2,3). The RAISE-IES Connection Program involved two sites (Baltimore and New York City), with 65 enrollees in a treatment program that provided medication, supported employment and education, family support and education, psychoeducation, skills training, substance abuse treatment, and suicide prevention as part of an implementation feasibility study (no comparison condition). Clients had high rates of engagement, and, overall, clients showed significant improvement in symptoms and functional outcomes (2). In the RAISE-ETP trial, 34 clinics in 21 states were randomly assigned to provide CSC services called NAVIGATE or usual community-based care. Overall, individuals who received NAVIGATE services had significantly better rates of engagement, improved quality of life, and reduced symptoms (3). Both RAISE programs promoted recovery-oriented principles of care, including shared decision making (SDM) and an emphasis on minimizing disability.

Encouraged by the early success of the RAISE Connection Program (2) and committed to an early intervention approach, the New York State Office of Mental Health (OMH) earmarked state funds to expand FEP services. The office of the OMH chief medical officer had overall responsibility. The Center for Practice Innovations (CPI), an OMH-funded training and technical assistance center at the New York State Psychiatric Institute, was charged with program development, implementation, training, and monitoring.

The RAISE Connection Program completed its research in June 2013. At that time, the RAISE-ETP study was still under way and other FEP programs, such as the Early Assessment and Support Alliance in Oregon and Specialized Treatment Early in Psychosis in Connecticut were becoming better known. CPI solicited feedback and review of Connection Program materials from leaders in the field before modifying the model. The Center for Social Innovation was engaged to help brand the program, which was named OnTrackNY to epitomize its positive and hopeful mission. OnTrackNY leadership presumed that although the RAISE studies were positive, the evidence base had significant limitations and the model would evolve and encompass best practices in response to emerging science and local experience and adaptation. The transition from RAISE Connection to OnTrackNY occurred in June 2013 with the initial funding of four teams.

In 2014, U.S. House of Representatives bill 3547 provided an increase of 5% to the Community Mental Health Block Grant program, an allocation targeted at evidence-based programs for early psychosis. The funds were maintained in 2015 and doubled in 2016. This funding and the state’s commitment to make FEP services widely available contributed to the addition of OnTrackNY teams throughout the state.