| The Early Psychosis Community Carepath
Through the Early Psychosis Intervention Program in the Fraser
South Area of British Columbia, Canada a carepath for early
psychosis was developed and implemented across all community
mental health centres in the region -- for both Adult
and Child & Youth Mental Health.
A carepath is a plan that outlines the sequence and timing
of clinical interventions for professional staff caring for
a specific client group. Terms such as "pathways to care,
care maps, clinical pathways and critical pathways" are
used interchangeably to describe carepaths. While there are
differences across the format, level of detail and instructions
for use, the vast majority of all carepaths have the following
goals:
- Provide a practical "best practices" guide
to care that fits within the system in which care is being
offered
- Standardize care and reduce variation in practice and in
documentation
- Provide a method for evaluating and improving quality of
care
The carepath developed for early psychosis includes prompts
for interventions and standardized assessments and has ultimately
replaced the charting system used in the mental health centres
for early psychosis clients in Fraser South. One-year evaluation
revealed that the carepath was associated with improvements
in care.
Consistent with recommendations for early psychosis care being
dependent on the phase of recovery, the carepath was divided
according to stages:
- engagement and assessment
- recovery
- relapse
Each stage is associated with different guidelines for care.
Engagement and Assessment
The purpose of the engagement stage is to quickly establish
contact, ensure continuity of care and actively engage client
and family. The assessment stage focuses on providing a comprehensive
assessment and engaging in treatment planning as well as evaluating
progress in treatment. Standardized assessment templates were
included in this section and were also developed as electronic
forms. There are different forms for the initial assessment
and assessment updates. Each assessment form includes a place
for documenting an individualized care plan which is problem-based
with the purpose of ensuring that other client needs (comorbidity,
social problems, etc.) are captured in care. Tools for assessment
are also included for this stage.
Recovery
The purpose of the recovery stage is to facilitate stabilization
and reintegration and to provide education and other core psychosocial
treatments. Educational handouts and educational session overviews
were developed and included for the following topics: what
is psychosis, what causes psychosis, early intervention, medications,
psychosocial treatments, stress management, relapse prevention,
social functioning, lifestyle, goal setting, problem solving,
family coping, drugs and alcohol, and coping with persistent
symptoms. Additionally, templates were included for the relapse
prevention plan, goal setting, and problem solving.
Relapse
The relapse stage is for clients who have a relapse (exacerbation
of psychosis or psychiatric hospitalization). Not all clients
will go onto this part of the carepath. The purpose is to ensure
safety, minimize disruption, and facilitate stabilization and
reintegration. This stage of recovery approach enables part
of the carepath to be used as long as necessary if the client's
recovery is prolonged. |
