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Table 1 Elements rated essential with strong consensus

From: Essential elements of an early intervention service for psychosis: the opinions of expert clinicians

Element Grouping
EIS should deal with people in their first episode of psychosis The client group
EIS should be composed of staff whose sole or main responsibility is to the EIS Team structure
EIS should have at least one member trained in CBT Team structure
The EIS approach should incorporate medical, social and psychological models Team structure
The EIS should emphasise clients' views on their problems and level of functioning Team structure
The EIS should include a consultant psychiatrist with dedicated sessions Membership
The EIS should include at least one psychiatric nurse Membership
The EIS should include a clinical psychologist Membership
EIS should have support from CAMHS when prescribing for under 16 year olds Membership
The EIS should have close links with CAMHS Membership
The EIS should assess clients referred on suspicion rather than certainty of psychosis Initial assessment
The EIS should encourage direct referrals from primary care Initial assessment
The EIS should regularly audit effectiveness of referral pathways & training programmes Initial assessment
The EIS should offer a rapid initial assessment Initial assessment
An EIS assessment should include a psychiatric history and mental state examination Initial assessment
An EIS assessment should include an assessment of risk (including suicide) Initial assessment
An EIS assessment should include a social functioning and resource assessment Initial assessment
An EIS assessment should include an assessment of the client's family Initial assessment
An EIS assessment should include the client's aspirations and understanding of their illness Initial assessment
An EIS assessment should be multi-disciplinary Initial assessment
Each EIS client should have a relapse risk assessment Initial assessment
The EIS should have access to translation services Initial assessment
EIS should not be concerned about precise diagnosis so long as in psychotic spectrum Initial assessment
The EIS should accept referrals from child and adolescent mental health services Initial assessment
The goal of early contact should be engagement rather than treatment Initial assessment
The EIS assessment should identify areas of distress Initial assessment
EIS should have a assertive approach to engagning the client & their family/social network engagement
The EIS should not close the case if the client fails to engage engagement
The EIS should allocate a key worker to all clients accepted into the service engagement
The EIS should provide services away from traditional psychiatric settings to avoid stigma engagement
EIS should emphasise the identification and treatment of depression amongst its clients Non-pharmaceutical
EIS should emphasise the identification & treatment of suicidal thinking Non-pharmaceutical
The EIS should provide CBT to clients with treatment-resistant positive symptoms Non-pharmaceutical
Each EIS client should have a relapse prevention plan Non-pharmaceutical
The EIS should provide clients with educational materials about psychosis Non-pharmaceutical
The EIS should use low-dose atypical neuroleptics as the first line drug treatment Pharmaceutical
Clients with disabling negative symptoms should have review of drug treatment Pharmaceutical
The EIS should actively involve clients in decisions about medication Pharmaceutical
EIS clients should get detailed information about medication Pharmaceutical
The EIS should engage the client's family/significant others at an early stage Relatives and sig others
The EIS should involve family and significant others in the client's ongoing review process Relatives and sig others
The EIS should provide families with psychoeducation and support Relatives and sig others
The EIS should provide families with Psychoeducational Family Intervention Relatives and sig others
A relapse prevention plan should be shared with the client's family/significant others Relatives and sig others
EIS should have access to separate age-appropriate in-patient facilities for young people Admission to Hospital
The EIS should be able to provide intensive community support when a client is in crisis Admission to Hospital
Each EIS service user/family/carer should know how to access support in a crisis Admission to Hospital
EIS clients should be able to access out-of-hours support from a 24 hour crisis team Admission to Hospital
When a client is an in-patient, EIS team should be actively involved in in-patient reviews Admission to Hospital
When a client is an in-patient, EIS team should be actively involved in discharge planning Admission to Hospital
The EIS should be prepared to use its powers under mental health legislation Admission to Hospital
There should be a single point of contact so primary care and other agencies can check out potential concerns/resources and to ease the confusion of roles/responsibilities Community connections