General Onboarding
Welcome to EPI-NC First Episode Psychosis (FEP) programs!
We are glad you joined our team and hope his will help you navigate your understanding of FEP, CSC and the role of EPI-NC. Please ask questions and let us know what you need to best adjust.
First please contact epi_nc@unc.edu in order to gain access to EPI-NC teams’ folder. The onboarding documents can be found on the Onboarding Tab on our website.
A little about FEP in NC…
The first FEP program in North Carolina was OASIS, opened in 2005 in the Department of Psychiatry at University of North Carolina – Chapel Hill. It was followed by Encompass in Raleigh, RHA SHORE in Wilmington, and the Eagle Program at Behavioral Health Charlotte. Most recently AEGIS was opened in Asheville and the newest addition, WeCare2 in Burnsville, NC. EPI-NC (Early Psychosis Interventions of North Carolina) provides Technical Assistance and support to each of the CSC clinics, including training and education, fidelity monitoring and quality assurance, data collection and interpretation, and ongoing continuing education opportunities in evidence-based and cutting-edge interventions. You are part of a dynamic team of professionals working together to improve care and outcomes for those in our state who are in the early stages of psychosis.
We use an evidence-based Coordinated Specialty Care (CSC) model based on education, resiliency, and recover. The model includes a psychiatrist, family therapist, individual therapist, IPS/SEES counselor, and Peer Support Specialist. Nursing and administrative associates are also an important part of your clinic. Some sites have digital navigators, case managers or other support staff. The team works together closely to provide psychoeducation, psychiatric medication management, individual therapy, family therapy and education, a multi-family group, employment/education support and peer support services.
What to expect in the first few weeks: FEP CSC is unique (and may feel complicated and overwhelming) due to various sources of funding and associated supports (employer, LME-MCO, State of NC and EPI-NC) but they are invested in your program and its success. Have patience with your process – it will all make sense soon!
Please Review the Following Training: Basics of Coordinated Specialty Care for Early Psychosis
Below are some things to get started:
- You have multiple important roles at your clinic. In this document we will break it into the administrative and clinical roles. It would be recommended to separately block time for your clinical and administrative roles.
- Initially, complete the follow orientations
- Team: Spend time attending your treatment team meetings, any administrative meetings unique to your site, shadowing staff, listening to their experiences. It is part of CSC fidelity that all team members actively contribute to team meetings regarding any participant they are currently working with. Practice making your voice heard in the team meeting setting.
- System: These are the different systems you work withing: Your employer (hospital or managed care company), possibly at least one LME-MCO, DHHS, withing the State of NC, EPI-NC.
- Model: Read the NAVIGATE Model: Team Member
- Community: If you are new to your community, identify community stakeholders with your team and set up times to visit so you can start to build relationships with possible collaborators (crisis services, local ED, referral sources, possibly places to refer if not appropriate for your clinic, basic need resources, local law enforcement, schools).
- Review your program’s FEP PowerPoints, presentation, psychoeducation that is shared with patients/families to increase the depth of FEP knowledge (please refer to appendix)
- Familiarize yourself with organizations structure
Administrative
Regularly Scheduled Meetings:
Team Meetings – A Coordinated Specialty Care clinic has high level of communication regarding each patient and family we serve. An effective time to do this is during the weekly treatment team meeting. Meetings should include all team members and cover new admissions, clinical crises, complex cases and discharges. Each patient/family should be reviewed every 30 days. Please refer to fidelity #3 and the meeting agenda can be found in the appendix.
Employer Specific Meetings – This will be provided by your employer and team.
EPI-NC Monthly Consultation: Please refer to fidelity (appendix) – You will be advised by EPI-NC when the monthly consultation occurs for your discipline.
Project ECHO meetings – The EPI-NC Project EHCO is designed to provide a learning link between Coordinated Specialty Care providers across North Carolina. We meet via Zoom, the second Wednesday of every month from 12-1:30pmwhere we will hear a case presentation from one of our 6 CSC clinics, have a Q&A, and learn from a specialist on the topic and how it relates to CSC. Please contact epi_nc@unc.edu to be added to iECHO platform. To view an ECHO presentation template, click here.
EPI-NC Annual conference – EPI-NC hosts an annual conference where each of the 6 CSC clinics meet, network, collaborate and learn.
Community meeting and education, Research Meetings, etc. – Check with your team
Clinical
Clinical Operations Topics
How can someone begin services with us? FEP clinics provide evidenced based care to a unique population o those who are/might be experiencing a first episode of psychosis. To meet program fidelity standard, more than 95% of admissions must meet the following criteria: between15-30 years old, FEP onset no more than 3 years ago or has been previous client who is appropriate for readmission, has one of the following diagnoses: schizophrenia, schizoaffective, schizophreniform, brief psychotic do, unspecified schizophrenia spectrum and other psychotic do, bipolar with psychotic feature and also no significant development disorder.
Early intervention has a significant impact on the trajectory of someone’s recover process. Outreach and engagement are crucial, and each team member will have a role. Please refer to Fidelity Guidelines #1 and #2
Frequency of Treatment Sessions: Frequent clinical encounters are especially important throughout treatment but especially important in the first 6 months. It is recommended patients see several providers each week. As they move through the stages of their recovery, frequency is dictated what is clinically indicated but typically decreases as symptoms decrease and functional recover improves.
How does someone get discharged from the clinic? There are a variety of ways that someone is ready for discharge form an FEP clinic. Common reasons for discharge are they’ve completed their treatment and no longer need this level of care, they are relocating, they choose a different provider, after admission it is determined they do in fact have another diagnosis (substance use, developmental disorder, etc.) that has become the primary need or they are no longer engaged despite staff efforts. All along this would be discussed in treatment team meetings, engagement (if needed) attempts by team members will have been completed, any obstacles to treatment addressed when possible. It’s important to provide our recommendations, support development of a relapse prevention plan, any needed referrals and clear communication about their status and steps if future needs arise.
Other topics for consideration unique to your location:
- Crisis protocol
- After hours protocol
- Stages of recovery
- Communication on a CSC team is more than what might be typical on an outpatient team but is an important part of the model. Special consideration should be given to creating a positive environment where each team member is valued for their strengths.