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UNITED STATES DEPARTMENT OF LABOR

Implementing coordinated specialty care for early psychosis: The RAISE Connection Program (Dixon et al., 2015)

Review Guidelines

Causal Evidence Guidelines

Absence of conflict of interest.

Citation

Dixon, L. B., Goldman, H. H., Bennett, M. E., Wang, Y., McNamara, K. A., Mendon, S. J., Goldstein, A. B., Choi, C. W., Lee, R. J., Lieberman, J. A., & Essock, S. M. (2015). Implementing coordinated specialty care for early psychosis: The RAISE Connection Program. Psychiatric Services, 66(7), 691–698. https://doi.org/10.1176/appi.ps.201400281

Highlights

  • The study’s objective was to examine the impact of the Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program on employment, education, and health outcomes.  
  • The study used an interrupted time series design to compare occupational and health outcomes before and after participation in the RAISE Connection Program. 
  • The study found that the RAISE Connection Program was significantly associated with increased odds of employment or school enrollment, higher social functioning, and decreased occurrence of symptoms of schizophrenia and psychosis. 
  • This study receives a low evidence rating. This means we are not confident that any estimated effects are attributable to the RAISE Connection Program; other factors are likely to have contributed.

Intervention Examined

Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program

Features of the Intervention

In response to research suggesting that schizophrenia is a modifiable illness if observed during the initial period of symptom onset, programming was developed to promote early intervention for schizophrenia. The RAISE Connection Program implemented team-based interventions for individuals experiencing early psychosis. The program serves individuals aged 15 to 35 who met the criteria for a diagnosis of schizophrenia or psychosis. Individuals who enrolled were able to receive multiple treatment services such as medication, supportive employment and education, family support, skills training, substance abuse treatment, psychoeducation, and suicide prevention. Participants were able to engage in services on a flexible basis to reflect their preferences and availability over the span of two years.  

Features of the Study

The study used an interrupted time series design to compare differences in education, employment, and health outcomes before and after participation in the RAISE Connection Program. The program was implemented in Baltimore, Maryland and New York, New York. Across the two sites, 65 eligible individuals enrolled in the RAISE Connection Program. Participants met the criteria for a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, or general psychosis. The sample was primarily male (63%), the largest proportions were Black (43%) and White (39%), with an average age of 22.2 years, and the majority were living with their parents (65%). Study authors used data collected from standardized assessments measuring social and occupational outcomes, symptoms, and other related treatment outcomes. Assessments were collected by trained interviewers at baseline and at 6-month intervals over a two-year period (at 6, 12, 18, and 24 months). The authors used a statistical model to compare the outcomes of participants before and after they participated in the RAISE Connection Program. 

Findings

Employment

  • The study found a significant relationship between the RAISE Connection Program and higher occupational functioning with increased odds of work participation. 

Education and skills gains

  • The study also found a significant relationship between the RAISE Connection Program and higher occupational functioning with increased odds of being enrolled in school. 

Health

  • The study found a significant relationship between the RAISE Connection Program and higher social functioning. The study also found a significant relationship between the RAISE Connection Program and a reduced occurrence of symptoms of schizophrenia and psychosis.   

Considerations for Interpreting the Findings

The authors compared the outcomes of participants measured before and after they participated in the RAISE Connection Program. For these types of designs, the authors must observe outcomes for multiple periods before the intervention to rule out the possibility that participants had increasing or decreasing trends in the outcomes examined before enrollment in the program. That is, if participants who had increasing employment or education participation tended to enroll in the program, we would anticipate further increases over time, even if they didn’t participate in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study receives a low causal evidence rating. 

Causal Evidence Rating

The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to the RAISE Connection Program; other factors are likely to have contributed.  

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