Felton Early Psychosis Program
- Need: A treatment model for those showing early signs of schizophrenia.
- Intervention: The Felton Prevention and Recovery in Early Psychosis (PREP) program was started in rural and urban California counties. Felton PREP encourages schizophrenia remission in clients through medication and psychosocial initiatives.
- Results: Clients’ hospitalization and psychiatric emergency room visits were reduced by 70% after 1 year of treatment. Schizophrenia symptoms also reduced significantly among Felton PREP clients.
Promising (About evidence-level criteria)
According to the National Institute for Mental Health, 1% of the population has schizophrenia. While it is a treatable mental disorder if caught in the early stages, it generally takes an average of 2.8 years before a correct diagnosis and effective treatment plan is implemented. By that time, functioning impairments have already developed.While many states were cutting mental health programs to save on cost, Felton Institute partnered with researchers at the University of California, San Francisco to develop the Felton Early Psychosis Program (formerly known as the Prevention and Recovery in Early Psychosis program, or "PREP") for California residents in San Francisco, Alameda, San Mateo, San Joaquin, and Monterey counties. An outpatient intervention program, the Felon Early Psychosis Program serves people ages 14 to 35 who have had early signs and symptoms of schizophrenia, schizoaffective disorder, schizophreniform disorder, or other specified psychotic disorder.
Felton Early Psychosis Program's efforts are aimed to encourage schizophrenia's remission in clients through medication and psychosocial initiatives. Their comprehensive care approach is made up of a team of providers, including therapists, psychiatrists, psychiatric nurse practitioners, family partners, care advocates, and employment and education specialists.
The program uses evidence-based practices and fidelity monitoring to train their teams. Their goal is to 1) identify schizophrenic patients at the disorder’s early stages and 2) help participants become stable, goal-oriented, and independent within 2 years of entering the program. This proactive approach to mental illness was first developed abroad, but has been applied slowly in the United States.
The original program received funding from the California Mental Health Services Act (MHSA) in 2004. Felton also received the Centers for Medicare & Medicaid Services (CMS) Health Care Innovations Awards (HCIA) to expand its programs to additional locations.
This video features interviews from Felton Early Psychosis Program staff and graduates at their program's 10-year celebration.
Below is a list of treatment approaches the Felton Early Psychosis Program uses with clients in individual, family, and group therapy sessions.
- Extensive Outreach & Community Education – Diffuses the stigma surrounding schizophrenia and encourages social inclusion through educational efforts.
- Early Intervention – Reduces the severity of the psychotic symptoms and improves long-term outcomes.
- Cognitive Behavioral Therapy (CBTp) – Helps individuals manage their symptoms more effectively through goal-oriented individual therapy.
- Algorithm-Based Medication Management – Develops a medication plan for the client that provides relief from symptoms at low dosage levels, prevents over-medication, and reduces side effects.
- Multi-Family Groups – Helps the client build a peer support system by educating families and friends.
- Strength-Based Care Management – Focuses on the client's educational, vocational, and personal goals. The Felton Early Psychosis Program works with the client and family to create a long-term treatment plan and utilize community resources.
- Dartmouth's Individual Placement and Support – Helps clients reach their goals through the development of an educational and career plan.
Below are the positive effects of the Felton Early Psychosis Program in rural San Joaquin and Monterey Counties (results from the CMS HCIA Year-3 Report and the Felton Early Psychosis Program website):
- Enrollment in the program surpassed their goal of 140 in the 10th
- Out of 188 clients interviewed about the program via the Structured Clinical Interview for the DSM-IV (SCID), everyone reported that program services improved their quality of health and life.
- Felton Early Psychosis Program clients' hospitalization and emergency room visits were reduced by 70% after 1 year of treatment, resulting in county savings of $15,000 per year per client.
- By the end of the program, 3/4 of the clients were enrolled in school or held a steady job.
- Most participants showed improvements in CBTp.
- Most participants reached their goals within 1 year of their involvement with the program.
- Staff observed significant changes in clients' integration into their community.
- The presence of the program increased awareness of the disease and treatment options.
- Clients had significant reductions in symptoms like hallucinations, unrealistic beliefs, unusual behavior, social isolation, and lethargy.
In 2014, the program was recognized by the
National Council for Behavioral Health with a Science to
Service Award for inspiring hope, leadership, and
making an impact in the mental health field.
In 2015, Felton Early Psychosis Program staff member Dina Tyler was recognized by the National Council for Behavioral Health as Peer Specialist of the Year.
- Hardy K.V., Moore M., Rose D., Bennett R., Jackson-Lane C., Gause M., Jackson A., Loewy R. (2011). Filling the implementation gap: a community–academic partnership approach to early intervention in psychosis. Early Intervention in Psychiatry, 5(4), 366-374.
- Mental Health Weekly Program Shatters Long-Held Assumptions, Mental Health Weekly
- Mental Health Weekly Innovation Embraces Lowest-Dose Medication, Mental Health Weekly
Testimonies from the Felton Early Psychosis Program (formerly "PREP") participants that were published in the newsletter “Voices of PREP,” November 2016 issue:
- “PREP has been a light in the darkness for me.”
- “They helped me deal with how to solve problems and how to use coping skills to get through the day.”
- “I just wasn't there. And then PREP brought me back to who I was.”
- “Not only will they help my son, but they also help the whole family. He has a five-year-old daughter; they attend to her as well. They're here not only for the client’s needs, but for the whole family’s needs as well.”
- Recruiting and retaining staff to serve rural counties – finding people already invested in the local community and in close proximity to the office – was difficult.
- The distance from other counties to Felton Early Psychosis Program's headquarters in San Francisco created a communication barrier between the offices. To resolve this issue, the program invested in video-conferencing technology to provide remote coaching to team members.
- Because of the number of clients scattered throughout Northern California counties, a significant amount of time was spent traveling to connect with clients. The lack of public transportation also hindered clients and their families from attending treatment sessions.
- In the early stages, there were many referrals of potential clients who were ineligible for the program's services. In response, the Felton Early Psychosis Program took time to more accurately train county staff on qualifications, and the number ineligible clients referrals decreased.
- The Felton Early Psychosis Program brought a different approach to service provision with rigorous outcome-driven methods for rural communities. Building relationships with existing behavioral health providers and the broader community and offering education about their mission was essential for fostering now-thriving partnerships.
- The commitment of the program's leadership team played a huge role in its development. It helped to have success at other sites for stakeholders to refer to when deciding to partner.
- The Felton Early Psychosis Program offers ongoing training, coaching, and support for staff to spur development and professional growth. This adds to the incentives for qualified individuals and the retaining of committed employees.
- Investing in video-conferencing technology to accommodate rural locations played a large role in the development of the Felton Early Psychosis Program in San Joaquin and Monterey Counties.
- The mix of the therapies and evidence-based practices is what made the program effective, not any one strategy in particular.
- Adoption of the program's approach requires a heavy commitment to the training of staff and client coaching. Teams have to be willing to make changes in clinical supervision practices and monitor clinicians' sessions with clients for evaluation.
Felton Institute has adapted this model to treat Bipolar Disorder. The new program is called Bipolar Early Assessment and Management (BEAM).
Felton Early Psychosis Program is a data-driven program that uses 5 evidence-based practices helps clients and their families manage the disease over the course of a lifetime:
- Synergy, Felton Early Psychosis Program's comprehensive treatment approach of care management
- Cognitive Behavioral Therapy for Psychosis (CBTp)
- Algorithm-guided medication management
- Individual and family group therapy
- Educational and vocational counseling
November 20, 2016
November 30, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.