Sustained social and vocational recovery is the ultimate goal of specialist first episode psychosis (FEP) services and the most valued outcome by young people and their families. Yet, follow-up studies have indicated that treatment benefits of early psychosis services are not sustained and therefore functional and social recovery is often not fully realised. 

 The recognition of these limitations has brought about a renewed focus on treatment approaches focused on improving long-term recovery from early psychosis. Along with studies evaluating psychosocial interventions focused on preventing relapse and fostering social and vocational recovery, three recent clinical trials have evaluated the effects of extending the duration of specialist support (by one to three years) compared with the typical timeframe of early intervention services (i.e., 2 years), with mixed findings. 

 Recent psychological models have proposed self-efficacy, intrinsic motivation and positive emotions as important targets to promote social functioning in psychosis. Strengths- and mindfulness-based interventions have been put forward as key interventions to increase self-efficacy and positive emotions, respectively, with preliminary studies supporting their potential to improve social functioning in psychosis. Similarly, self-determination theory posits that interventions addressing the basic psychological needs of competence, autonomy and relatedness will increase engagement with the intervention and improve overall functioning through increased intrinsic motivation. 

 A promising and potentially cost-effective alternative to extending the duration of specialist FEP services is to provide lower intensity, maintenance treatment following the initial 2 years of specialist support. Online, mobile and social media-based interventions provide a novel avenue to offer young people lower intensity, effective, sustainable and scalable support beyond discharge from specialist FEP services. 

 Drawing on our previous interventions in preventing relapse and improving vocational attainment in FEP, combined with novel approaches to social recovery (strengths and mindfulness-based approaches) and the principles of self-determination theory, our team developed a world-first digital intervention (Horyzons) designed to foster long-term recovery in FEP. Horyzons blends evidence-based models of social functioning, relapse prevention and vocational recovery in a wrap-around social media therapeutic environment supported by peer workers as well as clinical and vocational professionals. The effectiveness of Horyzons has now been examined via a single-blind randomised controlled trial (RCT) designed to test whether treatment with both Horyzons and treatment as usual (TAU) for 18 months was more effective than TAU alone. 

 While we did not find evidence that Horyzons improved social functioning as measured by the Personal and Social Performance Scale (PSP) compared with TAU (social functioning remained high and stable in both groups from baseline to 18-months follow-up), Horyzons was effective in fostering vocational and educational attainment -key aspects of functional recovery- and reducing utilization of emergency services in young people with FEP over 18-month follow-up. Horyzons was also appealing for young people, with almost 50% of participants logging on for at least 9 months. 

 The implications for the field will be presented and discussed in this session. Horyzons and the MOST platform are now being evaluated and disseminated across Australia and internationally.

Format

Recorded webinar, non-interactive, self-paced distance learning activity with post-test.

This presentation was recorded on November 13, 2020 at the virtual conference, Third National Conference on Advancing Early Psychosis Care in the United States: Addressing Inequities - Race, Culture, and COVID. 

Learning Objectives

• Summarize the state of the early psychosis field in terms of effective interventions/services promoting long-term recovery.
• Describe new models of digital interventions designed to be linked to clinical services.
• Identify the pitfalls of existing online mental health interventions.

Outline

• Transforming face-to-face interventions
• Integrative digital approach to youth mental health services
• Moderated Online Social Therapy (MOST): Digitally enhanced youth mental health care

Target Audience

Psychologists, Social Workers, and Other Mental Health Professionals

Instructional Level

 Intermediate

Estimate Time to Complete

Estimated Duration: 1.0 hour
Program Start Date: May 3, 2021 
Program End Date: May 3, 2024

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™, CE credit for psychologists, CE credit for social workers, or a certificate of participation may do so by completing all sections of the course, including viewing the full video (≥60 minutes) and submitting an evaluation. A multiple-choice quiz is provided based on the content. A passing score of 75% must be achieved. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), CE certificate (social workers), or certificate of participation (other disciplines) showing the completion date and hours/credits earned.

Continuing Education Credit

Physicians

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The APA designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Psychologists

The American Psychiatric Association is approved by the American Psychological Association to sponsor continuing education for psychologists. American Psychiatric Association maintains responsibility for this program and its content.

Social Workers 

American Psychiatric Association, provider #1743, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. American Psychiatric Association maintains responsibility for this course. ACE provider approval period: 05/18/2020 – 05/18/2021 and 05/18/2021-05/18/2024. Social workers completing this course receive 1.0 (clinical) continuing education credits.

Continuing education requirements vary from state to state. Many state boards grant reciprocity with national accrediting organizations and other state boards. It is the responsibility of each professional to understand the requirements for license renewal or check with the state or national licensing board and/or professional organization to become more familiar with their policies for acceptable continuing education credit. Social workers and Psychologists should contact their regulatory board to determine course approval.

Faculty and Planner Disclosures

Instructor

• Mario Alvarez-Jimenez, Ph.D., D.Clin.Psy., is Director of Orygen Digital, at Orygen, The University of Melbourne. Over the past 10 years, Professor Alvarez-Jimenez has founded and consolidated Orygen Digital as a large world's leading innovation and research centre (65 researchers and professionals, from 15 different disciplines, more than 25 research projects) developing, evaluating and implementing digital interventions that dovetail with the national and international network of youth mental health services and enhance their accessibility, long-term impact and cost-effectiveness. Orygen Digital's Moderated Online Social Therapy (MOST) platform is now being roll-out across all 41 Victorian Youth Mental Health services. This will constitute the first large network of digitally enhanced youth mental health services anywhere in the world.  Reports no financial relationships with commercial interests.

Program Planners

• Steven Adelsheim, M.D. Reports no financial relationships with commercial interests.
• Catherine Adams, L.M.S.W., A.C.S.W., C.A.A.D.C. Reports no financial relationships with commercial interests.
• Susan T. Azrin, Ph.D.  Reports no financial relationships with commercial interests.
• Iruma Bello, Ph.D.  Reports no financial relationships with commercial interests.
• Gary Michael Blau, M.S., Ph.D.  Reports no financial relationships with commercial interests.
• Teri S. Brister, Ph.D., L.P.C.  Reports no financial relationships with commercial interests.
• Nybelle An-Vi Caruso, B.S.  Reports no financial relationships with commercial interests.
• Amy N. Cohen, Ph.D.  Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D.  Dr. Cotes discloses the following relationships: Consultant: Saladax Biomedical, American Psychiatric Association Grant/Research: Ostuka, Lundbeck, Roche, Alkermes
• Judith Dauberman, M.A., Ph.D.  Reports no financial relationships with commercial interests.
• Steven P. Dettwyler, Ph.D.  Reports no financial relationships with commercial interests.
• Lisa B. Dixon, M.D., M.P.H.  Reports no financial relationships with commercial interests.
• Melissa Edmondson Smith, Ph.D.  Reports no financial relationships with commercial interests.
• Chantel Garrett. Ms. Garrett discloses the following relationships: Stock: Invitae, stockholder Livongo, stockholder Color, private equity holder Consultant: Maine Health Northwell Health One Mind Grant/Research: One Mind National Institute of Health
• Tristan Gorrindo, M.D.  Reports no financial relationships with commercial interests.
• Kate Hardy, ClinPsych.D.  Ms. Hardy discloses the following relationships: Consultant: SME for Click Therapeutics
• Robert K. Heinssen, Ph.D., A.B.P.P. Reports no financial relationships with commercial interests.
• Brian Hepburn, M.D.  Reports no financial relationships with commercial interests.
• Patrick Kaufmann, B.S.  Reports no financial relationships with commercial interests.
• Sherin Khan, L.C.S.W. Reports no financial relationships with commercial interests.
• Steven R. Lopez, Ph.D. Reports no financial relationships with commercial interests.
• Ted Lutterman.  Reports no financial relationships with commercial interests.
• Tushita Mayanil, M.D.  Reports no financial relationships with commercial interests.
• Ryan Melton, Ph.D.  Reports no financial relationships with commercial interests.
• Oladunni Oluwoye , Ph.D.  Reports no financial relationships with commercial interests.
• Abram Rosenblatt, Ph.D.  Reports no financial relationships with commercial interests.
• David L. Shern, Ph.D.  Dr. Shern discloses the following relationships: Grant/Research: Through my employment at NASMHPD, I co-chair the dissemination function of the Early Psychosis Intervention network as part of the national data coordinating center at Westat. Westat was awarded the coordinating center grant by NIMH Other: serve on the Board of Livanta

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