2007 APA Achievement Awards: Silver and Bronze Achievement Awards

The Early Assessment and Support Team (EAST) is an early intervention project to reduce the biopsychosocial impact of schizophrenia and thereby improve the lives of people with this disease. It is a program of the Mid-Valley Behavioral Care Network (MVBCN), a managed care mental health organization that serves five Oregon counties. It was founded in 2001 as a creative, collaborative partnership between the MVBCN and Salem Hospital, the regional acute care facility. EAST follows best practice guidelines from the foremost international experts, the Early Psychosis Prevention and Intervention Center in Australia, and has integrated best practice toolkits from the U.S. Substance Abuse and Mental Health Services Administration.

In recognition of successfully implementing an exemplary early intervention model into a wide community network, providing treatment and family support to young people in early stages of psychosis, and providing education and support to their communities, EAST was selected to receive APA's 2007 Silver Achievement Award.

EAST is a collaborative partnership including Salem Hospital and the county mental health programs of Linn, Marion, Polk, Yamhill, and Tillamook counties, which have a population of 590,000. EAST has operated continuously since March 2001. In 1999 MVBCN hired a mental health prevention researcher to identify evidence-based prevention models. MVBCN set out to look for programs that would address the discouraging levels of disability, poverty, and marginalization faced by people with schizophrenia in the region. Australia's Early Psychosis Prevention and Intervention Center served as the model. With operations in Melbourne, the center was systematically researching and integrating best practices associated with early psychosis intervention. For the next year, MVBCN went through an implementation planning process, and in January 2001 EAST was created. It consisted of a full-time coordinator, a part-time psychiatrist, and part-time social workers from each of the five counties.

From March 2001 to April 2006, with the exception of a one-month interlude in the first year, EAST has never turned anyone away from its program. EAST serves all individuals who have had a first episode of schizophreniform or bipolar spectrum psychosis within the past 12 months. EAST serves approximately 50 new clients each year. It has had almost 600 clients referred to date, half of whom have been accepted into services. EAST also has provided short-term case management and facilitated access for those who were not appropriate for EAST.

In 2003 EAST began offering multifamily psychoeducation under the supervision of experts from Maine Medical Center. This approach gradually became the routine standard of practice, and today multifamily groups are available to participants in four counties, with Tillamook (population 24,000) doing primarily individual family work. EAST also has integrated the Illness Management and Recovery program and has worked with Chemeketa Community College to offer the curriculum as a for-credit college course.

EAST is now an outstanding national program that serves as a beacon of hope for young people and families. For example, EAST actively works to identify people at the earliest possible stage of psychosis in order to minimize the consequences. EAST routinely does outreach to engage people into a positive, voluntary treatment relationship based on their interests, strengths, and motivation. EAST team members routinely exceed expectations in forming positive relationships.

Another principle of EAST is to treat family members as core members of the team. EAST practitioners work closely with clients' families. Also, services are provided regardless of a client's ability to pay, and services continue to evolve on the basis of the most recent research.

With significant support from local partners, EAST members reached out to all high schools and colleges, as well as to primary care physicians and others. Community education was a major priority, although as referrals came in, the clinical team became less able to conduct these activities.

From its inception, EAST was charged with constructing a new way of doing business within the managed care network. The team faced many challenges. For example, originally all members except the coordinator were assigned to the program only ten hours per week, and all worked for different agencies. The idea behind this structure was to give everyone an entry point into a much larger system change. The team had to create and develop all of its own procedures and practices, with international consultation via the Melbourne program, and then those procedures required careful integration into six different sets of agency-specific requirements. Each individual operated on his or her own "home turf," implementing a program model that was fundamentally inconsistent with the usual way of doing business.

The team rapidly discovered that the program model was intensive and involved a steep learning curve. Team members came from as far away as 120 miles, and they met weekly for two years. Eventually the level of staffing was nearly doubled, some positions were consolidated, vocational services were added, and additional local team members were included. A research position and clinical coordinator position were created to adequately address the tremendous needs of data and clinical oversight unhindered by fund development and similar activities. After the first two years, local teams and case review processes were developed, and annual training for new staff was initiated.

There are many indicators of national- and state-level commitment to the continuation and sustainability of EAST. Over $3 million has been raised in private funds to supplement restricted Medicaid (Oregon Health Plan) dollars. In April 2007 EAST was awarded a $2 million grant by the Robert Wood Johnson Foundation under the Early Detection and Intervention for the Prevention of Psychosis Program, a four-year national effectiveness study that will document the individual and community impact of making prodromal and first-episode evidence-based support available. The directors of the Department of Human Services and Addictions and Mental Health for the state are advocating actively at the federal level to establish funding and have successfully prioritized sustainable funding for EAST. The Oregon State 2007–2009 budget, recently approved by the legislature, includes $4.3 million to fund and begin to disseminate EAST to the rest of Oregon.

With additional support of the Robert Wood Johnson Foundation, EAST has initiated an ongoing sustainability effort aimed at further developing strategic, collaborative long-term public and private partnerships.

Numerous positive outcomes point to EAST's success. Participants in the program have dramatically reduced hospitalization rates, dropping from nearly 50% within the first three months of program participation to approximately 10% in the next quarter, with a gradually reducing trend. About 70% of EAST clients have remained in school or work, and additional vocational supports are being modeled on individual placement and support practices. About 95% of EAST participants have strong family support and involvement in treatment. Medication adherence rates are around 85%, and EAST prescribers strive for low doses with careful monitoring of side effects.

Quarterly data show steady progress on several functional indicators, such as level of independence and time spent with friends. Dozens of EAST graduates volunteer to mentor, speak to groups, and even speak to the media. The fundamental difference with EAST, volunteers often repeat, is that clients feel befriended and can make their own positive choices throughout the program. Numerous individuals state openly that they feel enriched for having experienced psychosis. Although about half of EAST clients choose to apply for Social Security Disability primarily for insurance reasons, many continue to work while they are on disability, and most are active participants in family and community life.

EAST received the Oregon Department of Mental Health and Addiction Services Award for Excellence in 2002, and MVBCN received an award from the National Mental Health Association (now Mental Health America) for its prevention activities in the same year.

As further testament to its success, EAST's staff have been asked to provide technical assistance or training to numerous audiences, including presentations in California, at National County Developmental Disability and Mental Health Directors meetings, and for other Oregon programs. The state of Oregon is now contracting with EAST to become a technical assistance center for other sites interested in adopting early psychosis practices.

Founded in 1998 as part of the Department of Psychiatry at the University of Rochester Medical Center, the Deaf Wellness Center (DWC) has grown to become an internationally renowned program serving the needs of the Deaf and hard-of-hearing community. The program focuses on clinical services, teaching, and research activities related to mental health, health care, sign language interpreting, and other topics that affect the lives of persons in this community.

Although the program was not officially named until 1998, it got its start in 1990 when Robert Pollard, Ph.D., was recruited to the Department of Psychiatry. Dr. Pollard, a psychologist who is fluent in American Sign Language (ASL) and whose career has been exclusively in the deafness and mental health field, immediately began initiating service, teaching, and research initiatives in deafness and mental health. Rochester, New York, is believed to have the largest per capita deaf population in the United States.

Now a leader in this specialized field, the DWC offers services for deaf individuals, promotes training opportunities for deaf mental health professionals and provides training for sign language interpreters so they can work more effectively in mental health service settings. In recognition of exemplary success in providing specialized mental health services to the Deaf community and in promoting research and education related to mental health and deafness, the DWC has been awarded APA's Bronze Achievement Award for 2007.

Program staff are all well-known national and international leaders in this unique field. A full-time staff of seven includes Dr. Pollard, who serves as program director, two other psychologists (one is hard of hearing), a social worker (deaf), a master's-level counselor (deaf), a faculty-rank sign language interpreter-researcher, and an administrative assistant, all of whom are fluent in ASL. The extended clinical service team includes an attending psychiatrist, a nurse practitioner, and a psychiatry resident who work with DWC patients with the assistance of sign language interpreters. For the past eight years, the DWC has been a favored elective rotation opportunity for third-year psychiatry residents who find the experience of working with deaf patients and sign language interpreters rewarding and educational, as well as relevant to psychiatric practice with other linguistic minority and disability populations.

With staff fluent in ASL, the DWC is able to provide outpatient mental health services to the Deaf community. Most of the DWC clients served are deaf and use sign language; however, some are hard of hearing, oral deaf, or hearing people with deaf family members.

In 2006 more than 2,500 patient contacts were made. Services provided include evaluations, individual psychotherapy, case management, and medication evaluations and management. In addition, the DWC conducts several all-deaf psychotherapy groups that are conducted in sign language by sign-fluent therapists. Current groups involve dialectical behavior therapy, mindfulness-based cognitive therapy for depression, anger management, and social skills for deaf individuals with developmental disabilities.

In addition to offering clinical services, the DWC also promotes training opportunities for mental health professionals who are deaf. With funding from the National Institute of Mental Health, Dr. Pollard launched the DWC's Program for Deaf Trainees in 1992. Now supported by other funds, this program attracts deaf individuals from around the United States who are pursuing careers in the mental health field. Thirty-four deaf individuals have been trained. Current trainees include a psychology post-doctoral fellow and a baccalaureate intern, both of whom are deaf and fluent in ASL. Deaf clinicians are trained to effectively serve both deaf and hearing patients.

The program also acts as an excellent educational resource for other groups, such as medical students, psychiatry residents, sign language interpreters, and many other types of professionals and staff.

As part of the University of Rochester Medical Center, the DWC also places a strong emphasis on research. Along with the Departments of Community and Preventive Medicine and Family Medicine, the DWC received a grant from the Centers for Disease Control (over $4 million) to establish the National Center for Deaf Health Research (NCDHR) at the University of Rochester Medical Center, which was opened in 2004. Dr. Pollard is an associate director of NCDHR, and several DWC employees are members of the NCDHR research committee. NCDHR is conducting groundbreaking health surveillance studies using adaptations of national health surveys modified for deaf respondents, including producing a computerized health-risk behavior survey in ASL. Other DWC research projects include developing psychological tests that are appropriate for deaf individuals, developing effective linguistically and culturally appropriate dialectical behavior therapy methods and materials for deaf patients, and developing innovative methods of training sign language interpreters.

In addition the DWC has provided expertise on topics related to deafness, mental health, health, and interpreting. The center has sponsored hundreds of lectures and workshops throughout the United States and Europe, providing consultation services, publishing books and videos (including one that won a national Aegis award of excellence in 2003), and partnering with the University of Rochester Medical Center's interpreter service division to create Strong Connections, a videoconference-based sign language interpreter service for remote hospitals (winner of the 2001 Health Care Advocacy Award from the Healthcare Trustees of New York State).

The program's success is evident in its ability to attract funding. Dr. Pollard has been the principal investigator on 30 grants totaling over $3.4 million. These include research grants, training grants, and a variety of special project grants. DWC also receives some funding through clinical services, product sales, and consultation fees.

The DWC takes its sociocultural obligations to the Deaf community extremely seriously. This commitment is manifested through employment of deaf clinicians; partnerships and direct involvement with many local, regional, and national Deaf organizations; creation of training opportunities for deaf mental health professionals from around the United States; films and publications that are geared toward deaf audiences; and many national and local presentations to deaf audiences in ASL.