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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