EDIPPP Protocol

The Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP) is a multi-site, national replication project sponsored by the Robert Wood Johnson Foundation. Its main purpose is to evaluate the effectiveness of early detection and intervention of psychosis programs in diverse populations. Each site’s program is based on the Portland Identification and Early Referral (PIER) model, which was developed in 2001 in Portland, Maine by Dr. William McFarlane and his multidisciplinary team.

Outreach

Outreach education to community stakeholders is an important component of EDIPPP. Each replication site is trained in outreach methods prior to implementing the model, and then spends its first months scheduling and holding presentations to community groups on the early warning signs of psychosis, the program components, and how to make a referral. Subsequently, each site participates in an evaluation process of their outreach activities through the Edwin S. Muskie School of Public Service located at the University of Southern Maine. Monthly all-site conference calls are held to discuss outreach issues.

Research Design and Protocol

Each EDIPPP site follows standard procedures and protocols established by the EDIPPP National Program Office (NPO) for clinical and research operations. These procedures and protocols have been carefully reviewed and approved by each site’s Institutional Review Board, a group of experts and community members who work to assure that the research participants’ rights are not compromised. The study design is based on the regression-discontinuity model, in which people are assigned to the treatment group based on their level of prodromal (early) symptoms.  Those at low-risk of illness are assigned to the control group.  Study procedures are carefully monitored by NPO staff on a regular basis.

Client and Family Involvement

EDIPPP serves adolescents and young adults between the ages of 12 and 25 who live in a designated area surrounding the replication sites.  It is a family-focused study, so families and clients are the first priority for all EDIPPP sites. From the first contact, clinicians and researchers talk with families about EDIPPP being a research treatment program and encourage them to participate only if it makes sense for them. Following an orientation to EDIPPP, individual family members consent to participate in the research and treatment if indicated. The program is voluntary throughout an individual’s two-year participation.

Treatment

The treatment group receives evidence-based interventions that are known to be effective for individuals with schizophrenia for reducing symptoms, preventing relapse of symptoms, and promoting functioning.  These treatments include family psychoeducation, supported employment, supported education, and medication management if medication is indicated. The low-risk control group is carefully monitored on a monthly basis by a care manager who follows a strict protocol and responds quickly should low-level symptoms progress towards the prodromal or psychotic range.

Research

Those who are referred to an EDIPPP site are screened by a mental health professional to determine whether the person is demonstrating prodromal (early) signs of psychosis.  Once this is determined, s/he is assessed by the research team using a standardized tool for identifying psychotic symptoms called the Structured Interview for Prodromal Symptoms (SIPS) (McGlashan, et al., 2003).  Scores produced by this tool direct EDIPPP staff to assign the client to the treatment or low-risk control group.  Once enrolled in EDIPPP, the client and his/her family are assessed throughout the course of their participation to monitor symptoms and functioning.