Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement.

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

Prevalence and correlates of school drop-out prior to initial treatment of nonaffective psychosis: further evidence suggesting a need for supported education.

BACKGROUND: Because dropping out of high school (i.e., secondary education) contributes prominently to numerous social, economic, and health conditions, formal public health initiatives promoting population health and social justice, especially in at-risk populations, are increasingly encouraged to address high school drop-out. The relative dearth of research attention on school drop-out prior to first treatment contact in young adults with psychotic disorders indicates a need for investigation of the associations between school drop-out and illness-related variables so that interventions may be tailored appropriately to this unique population. METHODS: This study provides a descriptive characterization of the prevalence and correlates of high school drop-out in a sample of 109 patients hospitalized for the evaluation and treatment of a first episode of nonaffective psychosis. RESULTS: Findings from this urban, socially disadvantaged, predominantly African American sample indicate that school drop-out is a marker of diverse detrimental social problems in first-episode psychosis, and that further research is required to fully characterize the most appropriate interventions for such individuals. CONCLUSIONS: Future research might seek to intervene through an integrated treatment approach that incorporates supported education, symptom reduction and management, and comorbid substance use treatment in first-episode patients.

Associations between past alcohol, cannabis, and cocaine use and current schizotypy among first-degree relatives of patients with schizophrenia and non-psychiatric controls.

Associations between past use of alcohol, cannabis, and cocaine and various domains of schizotypy were examined in first-degree relatives of patients with schizophrenia and non-psychiatric controls. Substance use was operationalized in three ways: (1) having ever used the substance, (2) age at first use, and (3) past frequency/amount of use during three time periods in late adolescence/early adulthood. Schizotypy was assessed using the Schizotypal Personality Questionnaire (SPQ). Participants who had ever used cannabis had significantly higher cognitive-perceptual, interpersonal, and total schizotypy scores compared to those who had not. Younger age of alcohol use onset was associated with more schizotypy in adulthood, and younger age of first cannabis use was related to more interpersonal schizotypy. More frequent/heavier use of alcohol in the 25-29 age-range, and cannabis in early adulthood, were associated with more schizotypy. The use of addictive substances, particularly cannabis, is related to schizotypy in complex ways.

Factors related to knowledge retention after crisis intervention team training for police officers.

OBJECTIVES: This study examined whether knowledge scores of Crisis Intervention Team (CIT) officers would decline in the months following CIT training and whether shorter time since training would be a significant predictor of mental health knowledge retention. This study also examined whether sociodemographic and work-related characteristics would predict knowledge retention. METHODS: Eighty-eight CIT officers trained within the past three years completed an online survey containing sociodemographic and work-related questions and 17 of the 40 items used on the knowledge test that is administered at the end of training. Officers' posttraining and follow-up exam scores were matched. RESULTS: As expected, knowledge scores decreased significantly in the months after CIT training. Less experienced officers had lower follow-up scores. However, time elapsed since training did not predict knowledge retention. CONCLUSIONS: The findings indicate that CIT officers would benefit from continuing education about mental illnesses and that more seasoned officers may be better candidates for CIT training, at least in terms of knowledge retention.

Mode of onset of psychosis and family involvement in help-seeking as determinants of duration of untreated psychosis.

BACKGROUND: The duration of untreated psychosis (DUP) is a potentially modifiable determinant of the early course of nonaffective psychotic disorders, though a paucity of research has addressed determinants of DUP. Recent data from London and Nottingham, UK indicated that a shorter DUP was predicted by: (1) an acute mode of onset, (2) employment, and (3) active involvement of at least one family member in seeking evaluation (Morgan et al. Br J Psychiatry 189:446-452, 2006). The present analysis was conducted in an effort to replicate those findings in a predominantly low-income, urban, African American sample. METHOD: DUP and the three key predictors of interest were assessed using standardized procedures. All analytic plans replicated those of Morgan and colleagues (Morgan et al. Br J Psychiatry 189:446-452, 2006) to the largest extent possible. Sufficient information was available to rate DUP for 73 patients. RESULTS: The median DUP was 23.4 weeks. Bivariate tests, survival analysis, and Cox regression revealed that an insidious mode of onset was associated with a substantially longer DUP compared with an acute onset, and that family involvement in help-seeking was independently associated with a longer duration. CONCLUSIONS: While mode of onset is a reliable illness-related determinant of DUP, further research is needed on the complex ways in which family-related variables influence DUP.

No association between psychometrically-determined schizotypy and olfactory identification ability in first-degree relatives of patients with schizophrenia and non-psychiatric controls.

OBJECTIVE: This study examined potential associations between schizotypy--including positive, negative, and disorganized domains--and olfactory identification ability. Based on a prior report (Park, S., Schoppe, S., 1997. Olfactory identification deficit in relation to schizotypy. Schizophr. Res. 26, 191-197), it was hypothesized that positive and negative schizotypy would be associated with poorer olfactory identification ability, at least among male participants. METHOD: As part of a larger study, the Schizotypal Personality Questionnaire (SPQ) and University of Pennsylvania Smell Identification Test (UPSIT) were administered to 98 participants, including 44 healthy first-degree relatives of individuals with schizophrenia and related disorders and 54 non-psychiatric controls. Potential associations between SPQ subscales and UPSIT score were examined while considering the effects of sociodemographic variables on these measures. RESULTS: SPQ and UPSIT scores were not significantly different in first-degree relatives and controls. There was no evidence of an association between SPQ domains and UPSIT score, even when controlling for possible confounding variables, including age and educational attainment. CONCLUSIONS: The nascent literature on potential associations between schizotypy and olfactory identification ability has yielded mixed findings to date. The current study does not support a correlation between these two markers, and this lack of association--in addition to equal olfactory identification performance in relatives and controls--casts doubt on the utility of the UPSIT as a measure of an endophenotypic trait. Future research would benefit from larger, more diverse samples; the addition of objective, interviewer-based measures of schizotypy; and attention to potentially confounding sociodemographic variables.

The impact of mode of onset of psychosis on pathways to care in a hospitalized, predominantly African-American, first-episode sample.

AIM: Given recent findings that mode of onset is a determinant of duration of untreated psychosis (DUP), along with a dearth of research coupling the mode of onset and pathways to care constructs, this study explored the possible effects of mode of onset on pathways to care. METHODS: The study included 76 patients hospitalized for first-episode, nonaffective psychosis in two urban, public-sector psychiatric units. Consensus-based best estimates were derived for mode of onset, pathways to care variables and DUP. Associations between mode of onset and several types of pathways to care variables were examined: (i) two key duration variables during the pathway; (ii) four variables pertaining to services contacted, sources of help and reasons for psychiatric contact; and (iii) the number of help-seeking contacts during the pathway. RESULTS: None of the sociodemographic or clinical variables examined (except DUP) were associated with mode of onset. In further assessing the association between mode of onset and DUP, mode of onset was related to the first component of DUP - delay in initiating any help contact - but not with the duration from initiating the first help contact until hospitalization. Mode of onset was not significantly associated with a number of other key pathways to care variables (e.g. type of first help-seeking contact, number of help-seeking contacts). CONCLUSION: The present findings suggest that both community-wide informational campaigns and early intervention programmes may benefit from focusing on gradually developing psychosis, which confers a longer delay to initiating care.

Preliminary evidence of effects of crisis intervention team training on self-efficacy and social distance.

OBJECTIVE: The Crisis Intervention Team (CIT) program is a collaborative model involving mental health professionals and law enforcement officers that is being implemented in a multitude of localities across the country. This study had two main objectives: (1) To assess perceptions of self-efficacy and desired social distance of control officers and officers entering CIT training with regard to individuals with psychiatric syndromes (depression and schizophrenia) and individuals with substance dependence (alcohol and cocaine), and (2) To examine the effects, if any, of CIT training on self-efficacy and social distance. METHODS: Between March and July 2006, a survey was administered to 34 control police officers, 58 officers just before a 40-h CIT training program, and 40 of these officers upon completion of the training. RESULTS: At baseline, pre-CIT officers did not differ from control non-CIT officers in terms of self-efficacy or social distance relating to the four disorders. Officers trained in CIT demonstrated enhanced self-efficacy for interacting with individuals with depression, cocaine dependence, schizophrenia, and alcohol dependence. Additionally, CIT-trained officers reported reduced social distance regarding individuals with these four psychiatric conditions. Regarding the schizophrenia vignette, there was a significant interaction between pre-CIT/post-CIT status and family history of psychiatric treatment in the prediction of social distance. CONCLUSIONS: Enhancements in self-efficacy and reductions in social distance may have important implications in terms of improving officers' interactions with people with mental illnesses and substance use disorders. Given the importance of the problem of law enforcement/criminal justice involvement among people with such illnesses, and the dearth of research on this growing collaborative service model, further research is needed on officer-level outcomes of the CIT program.

Lack of support for the inability to taste phenylthiocarbamide as an endophenotypic marker in patients with schizophrenia and their first-degree relatives.

OBJECTIVE: This study sought to replicate recent findings that both patients and relatives are significantly more likely to be phenylthiocarbamide (PTC) nontasters than healthy controls, and that within the patient group, nontasters have more severe positive and/or negative symptoms than tasters. Associations between PTC-tasting status and olfactory identification scores also were examined. METHOD: PTC perception and olfactory identification were assessed in 48 patients with schizophrenia or schizoaffective disorder, 28 first-degree relatives, and 32 healthy volunteers. RESULTS: The three groups did not differ in PTC taste sensitivity. Findings did not change after: a sensitivity analysis that re-categorized participants who "possibly" tasted PTC, excluding Caucasian participants, or restricting the sample of patients to only those with schizophrenia. Among the patients, tasters and nontasters did not differ with regard to positive, negative, or general psychopathology symptoms. In the combined sample and the three groups separately, there were no associations between PTC-tasting status and olfactory identification scores. CONCLUSIONS: This study, conducted specifically as an attempt to replicate previously reported findings, failed to provide support for PTC perception as an endophenotypic marker for schizophrenia. Further research is warranted.

Associations between schizotypal features and indicators of neurological and morphological abnormalities.

OBJECTIVE: Limited research suggests that subtle neurological and morphological abnormalities that have been documented in patients with schizophrenia also may be associated with schizotypal traits in non-psychiatric samples. Based on the notion that neurological soft signs (NSS) may mark a genetic diathesis, this study hypothesized that NSS scores would be related to the level of schizotypy in relatives of schizophrenia patients and in controls. Additionally, associations between MPA scores and schizotypy were explored in these two groups. METHOD: Twenty-six first-degree relatives of schizophrenia patients and 38 controls with no personal or family history of psychosis were assessed for schizotypy using the Structured Clinical Interview for DSM-IV Axis II Disorders schizotypal personality disorder module, as well as the self-administered Schizotypal Personality Questionnaire. The Neurological Evaluation Scale and a structured examination for MPAs also were administered. RESULTS: Mean schizotypy scores did not differ between relatives and controls. Both NSS and MPAs were associated with the level of interviewer-assessed schizotypal features in controls but not in relatives of patients with schizophrenia. NSS and MPAs were not associated with self-reported schizotypy in either group. CONCLUSIONS: These findings demonstrate that both NSS and MPAs are associated with interview-based schizotypal traits, at least in non-psychiatric participants. Future research should seek to replicate these results in other samples of relatives and controls.

Psychometric properties of the Brief Version of the Schizotypal Personality Questionnaire in relatives of patients with schizophrenia-spectrum disorders and non-psychiatric controls.

The Schizotypal Personality Questionnaire-Brief Version (SPQ-B), which includes cognitive-perceptual, interpersonal, and disorganized domains, was developed as a concise, self-report measure of schizotypy. This analysis was conducted to: (1) determine the internal consistency reliability of SPQ-B total and subscale scores, (2) use confirmatory factor analysis to assess the three-factor model as well as a single-factor solution, and (3) examine a measure of concurrent criterion validity of SPQ-B scores. The study was conducted at a large, urban, university-affiliated, public-sector health system in the southeastern United States. Data were obtained from 118 participants, including 61 biological relatives of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder, and 57 non-psychiatric controls. Relatives and controls did not differ significantly on SPQ-B total or subscale scores (or on the full 74-item SPQ total or subscale scores). Internal consistency reliability was adequate for the total SPQ-B score and the interpersonal subscale but was less than ideal for the cognitive-perceptual and disorganized subscales. Regarding the confirmatory factor analysis, though the three-factor solution yielded reasonably good fit to the data, the single-factor solution provided equal fit. Correlations between the three subscales ranged from .63 to .74. With regard to criterion validity, correlations between the SPQ-B total and subscale scores and schizotypy scores derived from a semi-structured, interview-based assessment revealed correlations generally ranging from .40 to .60. The SPQ-B may be a useful brief screening measure of schizotypy, though some limitations in its psychometric properties were evident in this sample. It may be advisable to use total SPQ-B scores rather than subscale scores in some situations, or to use factor analytic techniques to study the instrument's latent structure in specific samples.