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Published Online: 9 August 2023

The Cascade of Care for Early Psychosis Detection in a College Counseling Center

Justine L. Saavedra, M.S. [email protected], Annette Crisanti, Ph.D., David T. Lardier, Ph.D., Mauricio Tohen, M.D., Ph.D., Rhoshel Lenroot, M.D., Juan Bustillo, M.D., Dawn Halperin, M.A., L.P.C.C., Bess Friedman, M.Sc., L.M.S.W., Rachel Loewy, Ph.D., Cristina Murray-Krezan, Ph.D., and Stephanie McIver, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 2
https://doi.org/10.1176/appi.ps.20230005
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Abstract

Objective:

Programs for early detection of psychosis help identify individuals experiencing emerging psychosis and link them with appropriate services, thereby reducing the duration of untreated psychosis (DUP). The authors used the cascade-of-care framework to identify various care stages between screening and enrollment in coordinated specialty care (CSC) and to determine attrition at each stage, with the goal of identifying points in the referral process that may affect DUP.

Methods:

Project partners included a college counseling center and CSC program. All college students seeking mental health services at a counseling center between 2020 and 2022 (N=1,945) completed the Prodromal Questionnaire–Brief (PQ-B) at intake. Students who met the distress cutoff score were referred for a phone screening. Those who met criteria on the basis of this screening were referred for assessment and possible enrollment into CSC.

Results:

Six stages in the cascade of care for early detection were identified. Of the students who completed the PQ-B as part of intake (stage 1), 547 (28%) met the PQ-B cutoff score (stage 2). Counselors referred 428 (78%) students who met the PQ-B cutoff score (stage 3), and 212 (50%) of these students completed the phone screening (stage 4). Seventy-two (34%) students completed a CSC eligibility assessment (stage 5), 21 (29%) of whom were enrolled in CSC (stage 6).

Conclusions:

The cascade-of-care framework helped conceptualize the flow within a program for early psychosis detection in order to identify stages that may contribute to lengthier DUP. Future research is warranted to better understand the factors that contribute to DUP at these stages.

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Supplementary Material

File (appi.ps.20230005.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 2 • February 01, 2024
Pages: 161 - 166
PubMed: 37554003

History

Received: 5 January 2023
Revision received: 26 June 2023
Accepted: 28 June 2023
Published online: 9 August 2023
Published in print: February 01, 2024

Keywords

  1. College mental health
  2. Psychoses
  3. Quality improvement
  4. Research design and methodology
  5. Cascade of care

Authors

Affiliations

Justine L. Saavedra, M.S. [email protected]
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Annette Crisanti, Ph.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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David T. Lardier, Ph.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Mauricio Tohen, M.D., Ph.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Rhoshel Lenroot, M.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Juan Bustillo, M.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Dawn Halperin, M.A., L.P.C.C.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Bess Friedman, M.Sc., L.M.S.W.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Rachel Loewy, Ph.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Cristina Murray-Krezan, Ph.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Stephanie McIver, Ph.D.
Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan).
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Notes

Send correspondence to Ms. Saavedra ([email protected]).
Data from this study were presented at the 2022 Congress of the Schizophrenia International Research Society, Florence, Italy (and virtually), April 6–10, 2022.

Competing Interests

Dr. Tohen reports receiving honoraria for consultation for AbbVie, Alkermes, Intercellular Therapies, Johnson & Johnson, Lundbeck, Merck, Otsuka, and Roche. Dr. Bustillo reports receiving book royalties from UpToDate. The other authors report no financial relationships with commercial interests.

Funding Information

Research reported in this article was supported by NIMH (awards R34 MH-120777 and 1R34 MH-12088801).The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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