Determinants of pathways to care among young adults with early psychosis entering a Coordinated Specialty Care program

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Amplify OnTrackNY publication summaries summarize peer-reviewed publications focused on quality improvement or research conducted to help us learn & improve the program.

Study snapshot

Pathways to care are defined as the ways in which people find treatment, which is typically either through referral or through help-seeking. The time someone begins to develop symptoms to the time they begin receiving treatment is called Duration of Untreated Psychosis (DUP). This study explores the different pathways to care for OnTrackNY participants and factors associated with a longer DUP.¹  

This study asks:

1. What is the pathway to care, starting from the start of symptoms and ending with enrollment at OnTrackNY?
2. What are the characteristics associated with the length of time between the start of symptoms and enrollment in OnTrackNY?

Participant and family reports were used to determine when symptoms began. At admission to OnTrackNY, participants were asked about their "pathway to care" which included contacts they had with outside services because of their symptoms, before being referred to OnTrackNY. 

Figure 1: Who participated in this study?

This study is based on 779 diverse OnTrackNY participants enrolled between October 2013 and August 2017. The majority of these individuals (74%) identify as male and 87% were at least 18 years of age

Study findings

Finding 1. The average time from the beginning of symptoms to the first mental health service contact was a little over 2 months (73.7 days).

Finding 2. The average time from the beginning of symptoms to enrollment in OnTrackNY was nearly 8 months (231.2 days).

Finding 3. Being in school, better ability to maintain relationships, and a greater number of emergency room visits or hospitalizations were associated with a shorter time to enrollment in OnTrackNY.

Finding 4. Three factors were associated with a longer time before enrollment in OnTrackNY. This included having violent thoughts or behaviors, having a mental health visit in a community clinic as the first service contact, or hallucinations as the reason for the first service contact.

Finding 5. The length of time between first service contact and being referred to OnTrackNY was longer than the length of time between first experiencing symptoms and first service contact.
 

Final thoughts

Reducing the referral time from when a person seeks mental health treatment to early intervention services is important to consider for reducing the overall duration of untreated symptoms (DUP). Strategies to reduce referral delays are needed.

References

1. Marino L, Scodes J, Ngo H, Nossel I, Bello I, Wall M, Dixon L. Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program. Early Intervention in Psychiatry. 2020 Oct;14(5):544-552. doi: 10.1111/eip.12877. Epub 2019 Sep 10. PMID: 31502409.

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