The Wellness and Recovery after Psychosis (WRAP) Without Walls Program (WWW): Assertive Community Outreach for Young Adults with Substance Induced Psychosis (SIP) or Early Course Psychosis with Co-Occurring Substance Use Disorders
Ellie Reagan, BS (1), Anne Berrigan, LICSW (1), Thisara Jayasinghe (1), Abi Martin, PsyD (2), Emily Kline, PhD (2), Amy Yule MD (2), Hannah Brown, MD (2)
1. Boston Medical Center (BMC)
2. Boston Medical Center (BMC) and Boston University School of Medicine (BUSM)
Abstract
Background: A barrier to providing comprehensive, multi-disciplinary first episode psychosis (FEP) interventions to high-risk youth with substance induced psychosis or co-occurring FEP and a substance use disorder (SUD) is that programs are usually office-based. Many youth with substance induced psychosis or psychosis with co-occurring SUD have low motivation to change their substance use or engage in substance use and mental health treatment. Furthermore, urban youth of color and their families face systemic barriers to office-based treatment including limited resources for transportation, decreased access to technology for telemedicine visits, and less time during clinic hours to attend appointments due to work and other caregiving responsibilities. To address limitations associated with office-based care WRAP has expanded services to provide mobile, community-based multidisciplinary treatment through WRAP Without Walls (WWW). The WWW program is funded by a grant from the Jack Satter Foundation.
Methods: WWW was designed to treat youth under the age of 26 years with symptoms of psychosis and a substance use disorder. The WWW model is an adaptation of the Assertive Community Treatment model that provides community-based services including individual therapy, family psychoeducation, medication management, peer support, advocacy, and case management.
Results: In WWW’s first year, the program identified and interviewed 12 community stakeholders that work with youth with psychosis and/or frequent substance use to guide program design. The program also hired staff, identified referral sources, conducted a literature review to support staff training and treatment/service guides, and has piloted the program, now with 7 patients engaged in care.
Conclusions: The WWW pilot program will provide information and practice guidelines on how a hospital-based program can extend services into home and community settings. As a result, more young adults with co-occurring psychosis and SUD can be treated at a critical time in the course of their illness, and improve longitudinal outcomes.