Powell Anna-Leigh, Hinger Cassandra, Marshall-Lee Erica D, Miller-Roberts Tonya, Phillips Kayla
Department of Clinical Psychology, College of Health Professions, Mercer University, Atlanta, GA, 30341, USA.
Georgia State University, Atlanta, USA.
Community Ment Health J. 2021 Feb;57(2):268-276. doi: 10.1007/s10597-020-00644-1. Epub 2020 May 29.
Specialized early interventions (SEI) for individuals diagnosed with a first episode of psychosis (FEP) are effective treatment modalities (Azrin et al. in Psychiatr Ann 45(11):548, https://doi.org/10.3928/00485713-20151103-05 , 2015). SEI offered immediately or shortly following a first episode improves functional and clinical outcomes for those individuals with, and at risk for, serious mental illness (SMI; Correll et al. in JAMA Psychiatry 75(6):555-565, https://doi.org/10.1001/jamapsychiatry.2018.0623 , 2018). In the United States, SEI programs referred to as Coordinated Specialty Care (CSC), have been utilized to provide a beneficial, team-based, multi-component method of treating FEP. However, despite the success, CSC programming is still met with considerable challenges. This article reviews existing CSC literature to identify and explore relevant barriers to successful implementation of CSC. Identified barriers include stigma, cultural competence, disengagement, measurement and evaluation, workforce development, implementation in rural areas, and financial stability. The ongoing efforts to address these barriers are described and areas for continued improvements are discussed.
针对首次发作精神病（FEP）患者的专门早期干预（SEI）是有效的治疗方式（阿兹林等人，《精神病学年鉴》45(11):548，https://doi.org/10.3928/00485713-20151103-05，2015年）。在首次发作后立即或不久提供的SEI可改善患有严重精神疾病（SMI）以及有患严重精神疾病风险的个体的功能和临床结局（科雷尔等人，《美国医学会精神病学杂志》75(6):555-565，https://doi.org/10.1001/jamapsychiatry.2018.0623，2018年）。在美国，被称为协调专科护理（CSC）的SEI项目已被用于提供一种有益的、基于团队的、多组成部分的FEP治疗方法。然而，尽管取得了成功，CSC项目仍面临相当大的挑战。本文回顾了现有的CSC文献，以识别和探讨CSC成功实施的相关障碍。已识别的障碍包括耻辱感、文化能力、脱离接触、测量与评估、劳动力发展、农村地区的实施以及财务稳定性。文中描述了为应对这些障碍正在做出的努力，并讨论了持续改进的领域。
