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Articles   |    
Essential Evidence-Based Components of First-Episode Psychosis Services
Donald Emile Addington, M.B.B.S.; Emily McKenzie, M.Sc.; Ross Norman, Ph.D.; JianLi Wang, Ph.D.; Gary R. Bond, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200156
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Dr. Addington, Ms. McKenzie, and Dr. Wang are affiliated with the Department of Psychiatry, University of Calgary, Special Services Building, Second Floor, Foothills Medical Centre, 1403 29th St. N.W., Calgary, Alberta T2N 2T9, Canada (e-mail: addingto@ucalgary.ca).
Dr. Wang is also with the Department of Community Health Sciences at the university.
Dr. Norman is with the Department of Health Outcomes and Health Services Research, London Health Sciences Centre, London, Ontario, Canada.
Dr. Bond is with the Psychiatric Research Center, Dartmouth College, Hanover, New Hampshire.

Copyright © 2013 by the American Psychiatric Association


Objective  The purpose of this study was to identify essential evidence-based components of first-episode psychosis services.

Methods  The study was conducted in two stages. In the first stage a systematic review of both peer-reviewed and gray literature (January 1980 to April 2010) was conducted. Databases searched included MEDLINE, PsycINFO, and EMBASE. In the second stage, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential.

Results  The review identified 1,020 citations; abstracts were reviewed for relevance. A total of 280 peer-reviewed articles met criteria for relevance. Two researchers independently reviewed these articles and identified 75 unique service components. Each component was assigned a level of supporting evidence. Twenty-seven experts completed the first Delphi round, of whom 23 participated in the second. Consensus was achieved in two rounds, with 32 components rated as essential.

Conclusions  The two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form a foundation for developing a fidelity scale for such services. It may also be helpful to funders and providers as a summary of essential services.

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Table 1Components of first-episode psychosis services rated as essential in a Delphi process
Table Footer Note

a A, strong evidence; B, supportive evidence; C, opinion; D, no evidence of benefit or harm

Table Footer Note

b The degree of consensus achieved was assessed by calculating the semi-interquartile range of the score assigned by the stakeholder for each component. The range is defined as half of the difference between the 75th percentile score minus the 25th percentile score.



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