Research

About the Study

RAISE - Recovery After an Initial Schizophrenia Episode

This study, funded by National Institute of Mental Health (NIMH), is a multi-site randomized controlled trial designed to evaluate the benefits of a comprehensive pharmacological and psychosocial treatment package (NAVIGATE) for individuals with first episode psychosis compared to usual community mental health treatment (community care). In this study, all sites will be expected to engage individuals early in their first episode of psychosis and to recruit them into the study. Half of the sites will be randomized to provide the RAISE Enhanced Treatment program and the other half of the sites will be randomized to provide community care. All study participants will be assessed at baseline and every 6 months for at least 2 years via high technology video-based assessments by clinical evaluators who are blind to treatment assignment.

The program is led by Dr John Kane at The Zucker Hillside Hospital in New York and colleagues from institutions including Dartmouth Medical School, University of North Carolina at Chapel Hill, Yale Medical School, University of Calgary, UCLA, and SUNY Downstate Medical Center.

Goals of RAISE Project

• To improve the long-term trajectory of schizophrenia and reduce its disability over the lifetime by providing rapid, comprehensive, effective treatment at the first episode of psychosis
• To develop and evaluate an intervention for first episode psychosis that can be delivered in a wide range of clinical settings and can be paid for primarily by existing funding mechanisms
• To compare NAVIGATE which is the RAISE Enhanced Treatment intervention with community care in a rigorous, randomized controlled trial

Overview of the NAVIGATE Program

• The RAISE Enhanced Treatment Program is team-based and devoted to providing a comprehensive, individualized, and developmentally appropriate intervention for the first episode of psychosis. It has been designed to be largely reimbursable through existing funding mechanisms.

TREATMENT COMPONENTS OF NAVIGATE, THE ENHANCED CARE PACKAGE

• Regular collaborative treatment planning and follow-up
  • Includes individual, family (or other significant persons), RAISE treatment team
  • Conducted at baseline and every 6 months


• Individualized psychopharmacological and medical management
  • Individually tailored to participant's symptoms and preferences
  • Guided by medication algorithm
  • Assisted by computerized decision support system
  • Measurement-based assessment of therapeutic response and side effects
  • Medical management of side effects such as weight gain


• Individualized resiliency training (IRT)
  • Individual counseling designed to improve personal resiliency and facilitate progress towards personal goals
  • Weekly or less frequent meetings, based on participant preferences
  • Core module includes: assessment and goal setting, information about psychosis and its management, processing the experience of psychosis, developing a relapse prevention plan, and resiliency training
  • Additional modules selected using shared decision-making and based on participants' needs and goals, including:
    • Managing distress
    • Coping with symptoms
    • Dealing with substance abuse
    • Improving social relationships and leisure activities
    • Improving health (e.g., smoking, weight control, exercise)
  • Case management provided
  
  
  • Family psychoeducation
    • Involves "family" as defined by participant
    • Participant included in family sessions
    • Family and participant both considered "members of the treatment team"
    • Provides information about nature and management of psychosis, and the role of the family in helping the participant
    • Provides options for further work on communication and problem solving skills
    • Frequency and intensity of sessions is determined by family need and preference
    • Most sessions begin weekly and taper after 1-2 months
  
  
  • Supported employment/education (SEE)
    • 1 RAISE team specialist focuses solely on work/school
    • Goal is to help individual return to school/work and to optimize performance there
    • Personal preference guides the goals of working with the SEE specialist
    • Emphasis on competitive work or enrollment in educational programs in the community
    • Rapid job search or re-enrollment in school rather than prolonged assessment
    • Most services provided in community, not clinic
    • Supports provided as needed after successful attainment of work or enrollment in school