Program to Improve Attendance in First-Episode Psychosis Treatment

Financial Incentives to Increase Treatment Attendance in First-Episode Psychosis Care: A Non-Randomized, Adaptive Pilot Study

This study is testing a new program that uses financial rewards and text reminders to help people with first-episode psychosis stick to their treatment and see if it works well for them and their doctors.

Quick facts

• Phase: Early Phase 1
• Study type: Interventional
• Enrollment: 145 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of Pennsylvania (Academic / other)
• Locations: 3 sites (Raleigh, North Carolina and 2 other locations)
• Trial ID: NCT05967195 on ClinicalTrials.gov

What this trial studies

This pilot program aims to enhance treatment engagement for individuals experiencing first-episode psychosis by implementing a behavioral change strategy that includes financial incentives and text message reminders. The study will involve 80 patient-participants from two Coordinated Specialty Care clinics, assessing the feasibility and acceptability of the intervention from both patient and clinician perspectives. Additionally, clinicians from other clinics will be recruited to evaluate the scalability of the program. The goal is to address the high disengagement rates in treatment, which can lead to poor outcomes.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older who are experiencing first-episode psychosis and are enrolled in Coordinated Specialty Care programs.

Not a fit: Patients who are expected to leave the Coordinated Specialty Care program within six months may not benefit from this intervention.

Why it matters

Potential benefit: If successful, this program could significantly improve treatment adherence and outcomes for patients with first-episode psychosis.

How similar studies have performed: While the use of financial incentives in healthcare is not novel, this specific approach targeting first-episode psychosis treatment engagement is relatively untested.

Eligibility criteria

Inclusion Criteria:

1. For all participants, age ≥ 18 years old.
2. For intervention trial and patient feasibility and acceptability measurement: Patients with first-episode psychosis, enrolled in Coordinated Specialty Care at the Psychosis Education, Assessment, Care and Empowerment (PEACE) clinic and Psychosis Evaluation and Recovery Center (PERC).
3. For clinician feasibility and acceptability measurement at intervention sites: Clinicians working at PEACE and PERC where the intervention will be piloted.
4. For clinician implementation facilitator and barrier assessment at other Connection LHS sites to assess for scalability: Clinicians in Connection LHS who work at sites other than PEACE and PERC.Participants must sign the informed consent form

Exclusion Criteria:

1. For intervention trial and patient feasibility and acceptability measurement: Expectation of leaving coordinated specialty care programing within 6 months (which will exclude all of the PI's patient panel) and/or intellectual disability of sufficient degree that the patient's primary psychiatrist expects to compromise capacity to consent to this research and/or psychosis secondary to another medical condition (which may not share the same motivational features that are otherwise understood about the primary psychiatric conditions with psychosis).
2. For clinician feasibility and acceptability measurement at intervention sites: Study investigators who work at these clinics will be excluded from participation in the feasibility and acceptability study component given their role in the trial planning and execution.
3. For clinician implementation facilitator and barrier assessment at other Connection LHS sites to assess for scalability: none.

Where this trial is running

Raleigh, North Carolina and 2 other locations

• University of North Carolina at Chapel Hill (ENCOMPASS Program) — Raleigh, North Carolina, United States (Not_yet_recruiting)
• PEACE Program, Horizon House, Inc. — Philadelphia, Pennsylvania, United States (Not_yet_recruiting)
• University of Pennsylvania — Philadephia, Pennsylvania, United States (Recruiting)

Study contacts

• Study coordinator: Willam R Smith, MD, PhD

Conditions First-Episode Psychosis