NEED FOR HOSPITALIZATION
In some cases it will be obvious that the person needs immediate hospitalization, and in this instance, the screening clinician will make arrangements for hospital admission with a PEPP psychiatrist and the First Episode Unit. The clinician will accompany the client to the hospital ward and provide the family with information and support as necessary.
In typical screening circumstances, the receiving clinician reviews screening data gathered from the client and family interviews and screening instruments with a consultant psychiatrist in the program within twenty-four hours to make a decision regarding disposition of the case. A client, who does not meet the criteria for proceeding with a full assessment, is provided with information and/or a referral to other appropriate resources. If the client meets the criteria for possible admission to PEPP (please see PEPP criteria), or is believed to be showing early signs of psychosis, a two-hour consultation time is scheduled to begin the assessment procedure. The referral source is informed as to the outcome of the screening by telephone or fax, and a letter summarizing the findings is prepared by the case manager and sent to the referral source (if a professional or agency).
In certain circumstances, the client may be identified as possibly experiencing a first episode of psychosis through hospital admission, the full assessment and treatment will proceed according to protocol (see below). The program social worker will make contact with the family during the client’s hospitalization, preferably through a home visit if acceptable to the family and the patient.
ACTIVE COMMUNITY CASE DETECTION
Once the early intervention program had been established with procedures for assessment and treatment, a community wide case detection program was undertaken as an extension of the procedures already in place. Such an endeavour has involved additional resources. The procedure ranges from providing information regarding identification of psychotic symptoms and behaviour to potential sources of referral to providing basic information regarding psychosis to all members of the community.
The latter generally involved community-wide campaigns using written materials, TV and radio, setting up specific education programs in all secondary schools and post-secondary institutions and providing public forums for education. The impact of such programs on early case detection and reducing delay in initiation of treatment has yet to be fully assessed and/or realized. While such an endeavour may appear foreboding and be potentially expensive, it is possible to achieve some of the objectives of community case detection inexpensively if certain strategies are used. PEPP has utilized the following strategies in this regard:
- Providing information in an attractive format in different media (posters, pamphlets, film, etc.) to be disseminated to potential referral sources and clients and to the general public. The posters consist of a brief description of key symptoms of psychosis and the brochures provide a detailed description of the nature of psychosis, its early signs and the advantages of early intervention.
- Involving consumers (patients and their families): consumers have been involved from planning stage of the case detection campaign, in fundraising activities and finally in the wider dissemination of the material to the community at large.
- Posters have been placed in key situations such as shopping malls, pharmacies and public transit system.
- Information is disseminated to key potential sources of referral such as family physicians, other health practitioners and high schools and other educational institutions. This involves direct contact with each institution, followed by presentations, seminars and workshops with teachers and guidance counselors.
- By working closely with consumers (parents and families of patients) the program has become involved in major community events as a means to expose people in the community to the idea of psychosis in general and early intervention in particular, Examples: service club community breakfasts.
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