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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