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      The Provision of Education and Employment Support At the Outreach and Support in South London (OASIS) Service for People at Clinical High Risk for Psychosis

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          Abstract

          Clinical services for the early detection of individuals at clinical high risk of psychosis, such as Outreach and Support in South-London (OASIS), have been successful in providing psychological intervention and psychosocial support to young people experiencing emerging signs of serious mental disorders. Despite this, several studies have repeatedly shown that vocational and functional recovery in the clinical high risk for psychosis population is still low. This study aimed at evaluating the presence and nature of educational and employment focused interventions within the OASIS service, in order to inform research and clinical interventions aimed at supporting young people with early signs of psychosis on their path to vocational recovery. The specific objectives were to compare current practice i) to standards defined by the National Institute of Care Excellence guidelines; and ii) to principles defined by Individual Placement and Support (IPS). Nine standards of practice were derived. The OASIS caseload electronic records entered between January 2015 and January 2017 were manually screened. Data collected include sociodemographic, assessment of employment and educational status and support needs, interventions received, contacts with schools, employers and external vocational providers, employment, and educational status. Standards were considered as “met” if they were met for at least 90% of clients. Results suggest that, two out of nine standards were met while the remaining standards were only partially met. In particular, support provided was always focused on competitive employment and mainstream education and support was always based on people’s interest. Implications for clinical and research practice are discussed.

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          Most cited references27

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          Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk: A Meta-analytical Stratification.

          Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown.
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            Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk.

            Subjects at ultra high-risk (UHR) for psychosis have an enhanced vulnerability to develop the disorder but the risk factors accounting for this accrued risk are undetermined.
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              EPA guidance on the early intervention in clinical high risk states of psychoses.

              This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                08 November 2019
                2019
                : 10
                : 799
                Affiliations
                [1] 1Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, United Kingdom
                [2] 2Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust , London, United Kingdom
                [3] 3Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, United Kingdom
                [4] 4Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, United Kingdom
                [5] 5Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy
                [6] 6Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust , London, United Kingdom
                Author notes

                Edited by: Yen Kuang Yang, National Cheng Kung University Hospital, Taiwan

                Reviewed by: Chen-Chung Liu, National Taiwan University Hospital, Taiwan; Yanling He, Shanghai Mental Health Center (SMHC), China; Su-Ting Hsu, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan

                *Correspondence: Stefania Tognin, Stefania.tognin@ 123456kcl.ac.uk

                This article was submitted to Schizophrenia, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2019.00799
                6856789
                060d5202-ce7f-47a9-ac3b-491ff217148c
                Copyright © 2019 Tognin, Grady, Ventura, Valmaggia, Sear, McGuire, Fusar-Poli and Spencer

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 24 January 2019
                : 07 October 2019
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 43, Pages: 9, Words: 5684
                Funding
                Funded by: Maudsley Charity 10.13039/100012176
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                education,employment,vocational support,clinical high risk for psychosis,early detection in psychosis

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