Beyond Medications: Exploring Referrals to Non-Pharmacologic Coordinated Specialty Care Services at Intake
Jennifer Lancet,(1,2), Brittany Gouse,(1,2) Samantha LaMartine,(1,2) Sarosh Khan,(1,2) Anne Thompson,(1,2) Amelia Blanton,(1,2) Temitope Ogundare,(1,2) Hannah E. Brown(1,2)
1. WRAP Research Program, Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian & Avedisian School of Medicine
Background: Coordinated Specialty Care (CSC) offers a comprehensive, recovery-focused, multidisciplinary team-based model designed to treat individuals with first-episode psychosis (FEP). Non-pharmacologic interventions, such as individual therapy and peer support, promote recovery and improve long-term outcomes and quality of life. Here, we describe patterns of patient interest in non-pharmacologic services at intake to an FEP program that uses a shared decision-making approach to offering CSC services to patients rather than requiring uniform participation in the NAVIGATE FEP model.
Methods: We retrospectively examined the electronic health records of all individuals enrolled in Boston Medical Center’s FEP program from 01/01/2020 to 08/21/2022. The primary outcome was a referral to non-pharmacologic CSC outcomes (i.e., peer support, individual therapy, family support, FEP group therapy). All FEP patients are offered the same CSC services at intake. We used independent t-test and chi-squared analysis to explore sociodemographic differences between patients who were and were not interested in non-pharmacologic CSC services. We assessed these associations further with multivariable logistic regression controlling for disease severity (i.e., defined as prior hospitalizations) and telehealth visit modality.
Results: Of the 71 enrolled patients, 62% chose to be referred to at least one non-pharmacologic CSC service. Most opted for individual therapy (52.1%), followed by the FEP group (27.1%), family support (24.3%), and peer support (8.6%). In multivariable logistic regression models, no significant association was found between age, race and ethnicity, gender, insurance status, or prior hospitalization and non-engagement in non-pharmacologic CSC services.
Conclusions: There is significant variability in patients’ preferences for services within a CSC model when they are allowed to choose. These preferences are not influenced by sociodemographic or clinical factors. Future research will explore longitudinal changes in service utilization, examining how patients’ preferences and engagement evolve over time, including the selecti