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Table 2 Elements rated essential with good consensus

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

Element Grouping
The EIS should deal with people who are in their first three years of a psychotic illness The client group
The EIS should integrate child/adolescent and adult mental health services The client group
The EIS should have access to separate age-appropriate facilities for young people The client group
The EIS should focus on people under the age of 35 years The client group
The EIS should adhere to the principles of Assertive Community Treatment Team structure
The EIS should promote peer support and self help initiatives Team structure
The EIS should include a social worker Membership
The EIS should include an occupational therapist Membership
The EIS should include a support worker Membership
The EIS should include at least one representative from CAMHS Membership
The EIS should include a specialist in vocational rehabilitation Membership
In the early phases of a psychotic illness the EIS should adopt a "watch and wait" brief Initial assessment
Each EIS client should receive an early assessment of educational/vocational functioning Initial assessment
EIS care plans should be reviewed every 6 months Initial assessment
The EIS should routinely assess clients for substance misuse Initial assessment
EIS should assign key workers on suspicion of psychosis but discharge if not psychotic Initial assessment
The EIS should work with clients in the prodromal phase of psychosis Initial assessment
The EIS should encourage direct referrals from services for young people Initial assessment
Where possible the EIS should assess clients at home or in primary care engagement
Where possible the EIS should treat clients at home or in primary care engagement
The EIS should maintain contact with the client and family for 3 years after acceptance engagement
The EIS should have a range of venues for assessment and treatment engagement
The EIS should have an emphasis on finding employment or resuming work Non-pharmaceutical
EIS should assess and treat symptoms of post-traumatic stress disorder Non-pharmaceutical
The EIS should provide CBT to clients with disabling negative symptoms Non-pharmaceutical
The EIS should include therapists trained and accredited in providing CBT for psychosis Non-pharmaceutical
The EIS should have formal links with local colleges, careers advisory services & VR agencies Non-pharmaceutical
Each client should have access to a vocational/educational training programme Non-pharmaceutical
The EIS should be able to provide psychological interventions for substance misuse Non-pharmaceutical
EIS should provide psychological interventions for anxiety/social phobias/avoidance Non-pharmaceutical
The EIS should help clients develop daily living skills, where appropriate Non-pharmaceutical
The EIS should include health promotion as part of its psycho-education package Non-pharmaceutical
EIS should treat prodromal symptoms symptoms with CBT even when diagnosis uncertain Non-pharmaceutical
EIS should regularly monitor medication side-effects using standardised monitoring tools Pharmaceutical
EIS should involve the service user in monitoring the side-effects of drug treatment Pharmaceutical
EIS should treat psychotic prodromal symptoms with drugs, even when diagnosis uncertain Pharmaceutical
EIS should be persistent in treating residual positive symptoms with drug treatments Pharmaceutical
Clients with positive symptoms not responding to other treatments should have clozapine trial Pharmaceutical
Clients with positive symptoms 6 weeks after acute episode should have review drug treatment Pharmaceutical
The EIS should offer clients the choice of pharmacological treatment Pharmaceutical
EIS should attempt to maintain/establish contact between young clients & other young people Relatives and sig others
The EIS should make initial contact with the client's family within one week of referral Relatives and sig others
Initial contact with family should include "debriefing session", with opportunity to air feelings Relatives and sig others
EIS should include therapists trained & accredited in Psychoeducational Family Interventions Relatives and sig others
EIS should have access to age-appropriate crisis resolution facilities (non-inpatient crisis beds) Admission to Hospital
When client requires acute care joint assessment should take place between EIS & acute team Admission to Hospital
When client is in-patient, the EIS consultant should be responsible for his/her care Admission to Hospital
EIS should be involved in community based programmes to reduce stigma of mental illness Community links
EIS should provide symptom awareness programmes for relevant agencies Community links
The EIS should provide clients with information about local service user groups Community links
The EIS should ensure that the primary care team remain closely involved in client's treatment Community links
The EIS should actively promote the use of community facilities Community links
The EIS should foster close collaboration with youth organisations Community links
EIS should have strategy for engaging the local community, based on needs and demography Community links