Harnessing a Two-State FEP LHS to Optimize Engagement and Prevent Disengagement in CSC - Overall Component - Abstract This Program Project Grant entitled Harnessing a Two-State FEP LHS to Optimize Engagement and Prevent Disengagement in CSC will leverage Connection Learning Healthcare System (CLHS) - a two-state learning healthcare system and Early Psychosis Intervention Network (EPINET) hub (MH120550, Bennett PI) - to pursue integrated research and knowledge generation focused on optimizing Coordinated Specialty Care (CSC) engagement and preventing disengagement in youth with first episode psychosis (FEP). CLHS has a demonstrated track record of collecting, managing, and analyzing data from the EPINET Core Assessment Battery (CAB) from 23 CSC programs across Pennsylvania and Maryland. The close collaboration and combined expertise of investigators from the University of Maryland, the University of Pennsylvania, Johns Hopkins University, the University of Pittsburgh, and Sheppard Pratt Healthcare has supported practice-based data collection, hub-centered data analysis, and translation of data to practice through learning healthcare and culture building initiatives. The group of investigators has internationally renowned experience in research on schizophrenia, FEP, and CSC implementation, as well as in psychiatric services research, interventions development and implementation in psychosis, cognition and cognitive assessment; neuroimaging and brain functioning in schizophrenia, clinical trials, implementation science, psychopharmacology, culturally competent clinical care, participatory, and peer services research. This consortium has interacted and in a superbly collaborative manner sharing technical and scientific information through formal monthly face-to-face or Zoom-based meetings, frequent telephone or electronic communication and across-campus visits. This offers tremendous opportunities for in- depth study of disengagement risk and of strategies that can prevent it. The Administrative Core will build on the infrastructure of CLHS to support two well-specified research projects and to foster additional research, knowledge generation, and quality improvement initiatives focused on preventing CSC disengagement by providing services in data collection, management, and analysis; supporting learning healthcare system activities that integrate CSC program ideas into research development; and fostering involvement of participants with lived experience of psychosis and family members to make research on disengagement responsive to the experiences of people who are directly impacted by CSC. The Clinical Practice Data Research Project will use CLHS CAB data to develop and validate longitudinal models for predicting risk of CSC disengagement and to integrate stakeholder input on the clinical utility of using risk information in clinical practice. The Prospective Practice-Oriented Research Project to develop a hub-based engagement navigator service for supporting participants and families at high risk for disengagement. We will use robust participatory research methods to ensure the integration of CSC program staff, participants, and family members in the development of all aspects of and materials for the navigator service and conduct a mixed methods hub wide ENS evaluation using a hybrid type I open cohort stepped wedge design to examine feasibility, acceptability, and effectiveness in changing target mechanisms and improving disengagement outcomes.
