First Episode Psychosis
OnTrack Central Nebraska (OnTrack/CN) is a comprehensive intervention program for individuals ages 15-25 who have experienced a first episode of psychosis. Treatment is provided by a team of behavioral health professionals who focus on helping people work toward personal goals and recovery. More broadly, the OnTrack/CN program helps consumers navigate the road to recovery from an episode of psychosis, including supporting efforts to function well at home, on the job, at school, and in the social world. This comprehensive program includes four different treatment components that work collaboratively as a team with the consumer. These components include: Medication Management, Supported Employment and Education, Individual Psychotherapy, and Family Psychotherapy/Education.
Individualized Medication Management is aimed at reducing symptoms and preventing relapses in order to help people achieve their desired goals.
Family Psychotherapy/Education is aimed at:
- Teaching families about psychosis and its treatment.
- Reducing relapses by encouraging medication adherence and monitoring early warning signs of relapse.
- Supporting the client’s work towards personal recovery goals.
- Reducing family stress through improved communication and problem solving skills.
Individual Psychotherapy is aimed at:
- Helping clients achieve personal goals by helping them understand their disorder and its treatment.
- Processing the experience of psychosis.
- Managing symptoms through increased social and resiliency skills.
Supported Employment and Education is aimed at:
- Helping clients to develop education and employment goals related to their career interests.
- Specialists work with clients to help them obtain jobs or enroll in educational programs.
- Follow along supports are provided for all clients who are employed or in school to help them be successful.
On Track/CN has been developed to provide the best treatment possible for individuals in their first episode of psychosis. The program is modeled after the Coordinated Specialty Care Team model that was developed through the National Institute of Mental Health’s research program Recovery After an Initial Schizophrenia Episode or RAISE which was designed to develop and test interventions to improve the trajectory and prognosis of schizophrenia. Team members participated in an intensive three-day training with OnTrack/USA and receive monthly care consultation and additional role training throughout the first year of the program.
Many studies show that the greater the duration of time that a person with first episode of psychosis goes untreated, the more problems occur. For example, the longer the duration of untreated psychosis, the longer it takes to stabilize the psychotic symptoms, and the worse the person’s overall functioning following symptom stabilization.
Even when treatment for a first episode of psychosis is successfully started, people often have problems in treatment modalities that are not attuned to their unique needs and goals. Youth and young adults who are experiencing FEP are often frightened and confused, and struggle to understand what is happening to them. They also present unique challenges to family members and clinical providers, including irrational behavior, aggression against self or others, difficulties communicating and relating, and conflicts with authority figures. Impaired awareness of illness may be an additional complicating factor. Despite these complexities, early intervention with evidence-based therapies offers real hope for clinical and functional recovery.
All of the members of the OnTrack/CN Team meet weekly to develop ideas for preliminary individualized treatment plans for new clients, discuss and review progress towards treatment goals for established clients, and identify and address other issues related to the clinical management of each client’s disorder. Individualized treatment plans include treatment goals, crisis plan and interventions, medication management, wellness management, employment and/or education goals, and linkages with community and peer resources. Team meetings are led by the Team Leader and last 30-90 minutes, depending on the number of clients in the program and the complexity of their treatment needs. As new clients are enrolled in the program, preliminary treatment planning meetings are held on a weekly basis as needed, as part of regular team meetings.
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