Exercise reduces the chance of heart disease, and quitting smoking lowers cancer risk. Few will debate these facts of the body, but others likely question what can be done when the health concerns center around the mind.

“People don’t usually associate prevention with mental illness,” says Gwen Derr, project director of Delaware CORE (Community Outreach, Referral and Early Intervention). “We want them to make that connection.”

The Delaware Division of Prevention and Behavioral Health Services (DPBHS) and the Delaware Division of Substance Abuse and Mental Health (DSAMH) have partnered to form Delaware CORE. The unique program serves Delawareans ages 12 to 25 who have symptoms of early psychosis and their families and friends. If left unchecked, early psychosis can likely lead to full psychosis, a severe mental disorder in which people experience hallucinations, delusions and disorganization (confusion when attempting to speak or think).

Through an array of services, Delaware CORE’s providers diligently work to diagnose early psychosis and help to show prevention and recovery from this serious condition can be achieved.

“In future generations, I hope it won’t be a surprise that we can intervene with these issues,” says Christine Hanna-Ronald, clinical director with Psychotherapeutic Services Inc., a provider of clinical services for the program.

A new development

Early psychosis generally develops between ages 12 and 25, a time now considered a “golden window” for the best chances of successful treatment, says Dr. Charles Webb, co-principal investigator with DPBHS. Unlike full psychosis, early psychosis generally manifests with subtle, vague and hard-to-define symptoms. For example, people may hear an odd noise rustling in the background rather than the classic haunting voices. Other signs may include changes in behavior—tendency to isolate from others and a drop in performance at school or work—and changes in thoughts or perceptions—marked suspicion of others and having unusual beliefs.

“It’s all about the brain,” Hanna-Ronald says. “Just like any other organ in the body, there can be illness.”

Several decades ago, European researchers discovered that addressing early psychosis by teaching patients coping skills and problem solving can help to delay, reduce symptom intensity or even completely prevent full psychosis, Webb says.

DPBHS worked with Dr. William McFarlane, who developed the revolutionary Portland Identification and Early Referral Program in Maine, and in October 2014, received a five-year, $5 million grant from the U.S. Substance Abuse and Mental Health Administration to found Delaware CORE, one of the growing number of programs that exist in the country to address early psychosis.

Call to mind

The program began operating in earnest in 2015 and has served approximately 55 patients to date, with many of the referrals coming from middle and high schools. Each person begins the intake process with a prescreen interview over the phone, where one of Delaware CORE’s clinicians will ask general questions about the onset of early psychosis symptoms, medications and any history of hospitalizations.

If that patient shows signs of the condition, the program will set up an in-person session based on the more definitive Structured Interview for Psychosis-Risk Syndrome co-authored by Dr. Barbara Walsh of Yale School of Medicine. Webb calls this step a crucial part of the intervention process. When this assessment comes back positive, it suggests a person has a one in three chance of developing full psychosis.

Delaware CORE’s staff explains the findings with the patient and his or her family, engaging them in a series of joining sessions to see if they want to participate in the voluntary program.

“We perform extensive psycho-education about what’s going on with their loved one,” Hanna-Ronald says. “It helps to demystify everything, builds a rapport and removes blame.”

Delaware CORE tailors its services to meet the specific needs of each person, but main program facets include clinical support, psychiatric support if medication is needed, and educational, vocational and occupational consultation.

“They may be struggling in school or at work because the symptoms interfere with how they process information or stay on task if they’re disrupted by sensory experiences,” Hanna-Ronald says.

In another important part, several families in the program come together for biweekly group sessions to help problem solve their issues and receive continued education from Delaware CORE facilitators, Webb says.

“Support groups for ADHD and substance abuse are widely available,” he notes. “But it’s very possible someone can have early psychosis symptoms and never encounter another person in their school, work or community who has it as well. These multifamily groups can be a relief. They’re all in the same boat and can become a resource to each other.”

Delaware CORE plans to make youth peer support another key component of services available. Once it has formalized the peer role and training curriculum, this support will be offered in DPBHS programs throughout the state.

An uncertain future

Patients generally stay in the program for one to two years. The federal grant covers all services except medication; however, even then, it has a partner at a state pharmacy program that can provide help if they need it.

President Trump’s current proposed budget has eliminated the final year of the Healthy Transition grant, which Delaware CORE falls under, Derr says. Assuming it passes, this means the government funding will cease Sept. 30, 2018, and the team will potentially need to retool its operations.

The program would have to pursue reimbursement through Medicaid, Webb says. This could be problematic, though, because a few effective pieces of the program aren’t currently reimbursable. In particular, he points to their community, physician and school outreach that educates people on early psychosis.

Despite the looming financial obstacle, Webb and the rest of the Delaware CORE leaders remain hopeful they will continue to serve the public and help young people and their families in need across the state.

“We have made headway where people can control their symptoms while maintaining their functioning,” Webb says. “The program lays the groundwork for making this a possibility.”

For more information about Delaware CORE, visit delawarecore.com or call (888) 284-6030.

Youth Advisory Council

The Delaware Division of Prevention and Behavioral Health Services (DPBHS) has allied with the Delaware Division of Vocational Rehabilitation to form the Delaware-wide mental/behavioral health Youth Advisory Council (YAC).

A part of Delaware CORE, YAC provides people between 16 and 25 years old, who have experienced the mental/behavioral health system, the opportunity to learn and develop leadership skills and give back to their communities, says Geeta Kotak, youth coordinator of DPBHS. “Youth and young adults will learn that their voices matter and will be provided guidance on how to express their opinions and be heard.”

CORE project director Gwen Derr says the chance to dim the stigma of early psychosis and mental disease in general makes this component of the program very powerful.

“We’re developing something where youth feel comfortable helping each other and getting the word out,” she says.

To become a member of the council or for more information, email geeta.kotak@state.de.us.

Dr. Charles Webb, co-principal investigator with the Delaware Division of Prevention and Behavioral Health Services, stands with Gwen Derr, project director of Delaware CORE and Christine Hanna-Ronald, clinical director with Psychotherapeutic Services Inc. //Photo by Joe del Tufo of Moonloop Photography