title: Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study.
abstract: BACKGROUND
  Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams ('First-episode Services' or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES?
  
  
  METHODS
  The primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREP(R)) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREP(R) over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral.
  
  
  CONCLUSIONS
  STEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02069925 . Registered 20 February 2014.
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. vinod.srihari@yale.edu.|Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. vinod.srihari@yale.edu.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Srihari
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. cenk.tek@yale.edu.|Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. cenk.tek@yale.edu.
authors.forename: Cenk
authors.initials: C
authors.lastname: Tek
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. Jessica.pollard@yale.edu.|Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. Jessica.pollard@yale.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pollard
authors.affiliation: Commonwealth Research Center, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 75 Fenwood Road, 5th Floor, Boston, MA, 02115, USA. szimmet@bidmc.harvard.edu.
authors.forename: Suzannah
authors.initials: S
authors.lastname: Zimmet
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. jekeat@gmail.com.
authors.forename: Jane
authors.initials: J
authors.lastname: Keat
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. john.cahill@yale.edu.|Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. john.cahill@yale.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Cahill
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. suat.kucukgoncu@yale.edu.
authors.forename: Suat
authors.initials: S
authors.lastname: Kucukgoncu
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. barbara.walsh@yale.edu.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Walsh
authors.affiliation: Yale Center for Analytical Sciences (YCAS), 300 George Street, New Haven, CT, 06511, USA. fang-yong.li@yale.edu.
authors.forename: Fangyong
authors.initials: F
authors.lastname: Li
authors.affiliation: Yale Center for Analytical Sciences (YCAS), 300 George Street, New Haven, CT, 06511, USA. ralitza.gueorguieva@yale.edu.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. nina.levine@yale.edu.
authors.forename: Nina
authors.initials: N
authors.lastname: Levine
authors.affiliation: Commonwealth Research Center, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 75 Fenwood Road, 5th Floor, Boston, MA, 02115, USA. rmeshola@bidmc.harvard.edu.
authors.forename: Raquelle I
authors.initials: RI
authors.lastname: Mesholam-Gately
authors.affiliation: Commonwealth Research Center, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 75 Fenwood Road, 5th Floor, Boston, MA, 02115, USA. mfriedm3@bidmc.harvard.edu.
authors.forename: Michelle
authors.initials: M
authors.lastname: Friedman-Yakoobian
authors.affiliation: Commonwealth Research Center, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 75 Fenwood Road, 5th Floor, Boston, MA, 02115, USA. lseidman@bidmc.harvard.edu.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Seidman
authors.affiliation: Commonwealth Research Center, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 75 Fenwood Road, 5th Floor, Boston, MA, 02115, USA. mkeshava@bidmc.harvard.edu.
authors.forename: Matcheri S
authors.initials: MS
authors.lastname: Keshavan
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. thomas.mcglashan@yale.edu.|Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. thomas.mcglashan@yale.edu.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: McGlashan
authors.affiliation: Department of Psychiatry, Yale University, 34 Park Street, New Haven, CT, 06519, USA. scott.woods@yale.edu.|Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. scott.woods@yale.edu.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Woods
mesh_terms: D003695:Delivery of Health Care / Q000379:methods / Q000639:trends; D042241:Early Diagnosis; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology