Jennifer Humensky1,2, Roman Kotov3, Lisa Dixon1,2, Evelyn Bromet3; 1Columbia University, 2New York State Psychiatric Institute, 3Stony Brook University School of Medicine
Background: Evidence-based coordinated specialty care (CSC) for early psychosis treatment has grown rapidly in the United States. Since programs are relatively new, findings on long-term functioning after treatment ends derive only from pre-CSC research. The Suffolk County Mental Health Project (SCMHP) has followed a cohort of individuals diagnosed with recent-onset psychosis in the early 1990s, thus permitting examination of the long-term (20-year) vocational patterns in the cohort. The current analysis focuses on the subsample of the SCMHP who appears to have met the criteria for enrollment in OnTrackNY, the state’s CSC intervention, had it been available (n=153). Methods: Assessments were conducted at baseline, and at 6 months and 2, 4, 10 and 20 year follow-ups. Random effects models examine trends in vocational participation over time. Results: Baseline vocational (education and employment) participation for those who would have met OnTrackNY enrollment criteria is similar to published estimates of OnTrackNY, namely, 47% (n=71) for SCMHP and 44% (n=144) for OnTrackNY. Overall, vocational participation in the SCMHP declined, particularly by the 20-year follow-up (OR=0.41[95% CI: 0.17-0.98]), and especially for full-time vocational participation (OR=0.02 [95% CI:0.004-0.09]. Rates of part-time participation increased (OR=6.39[95%CI:2.09-19.52], as did public assistance enrollment. Baseline vocational participation was the strongest predictor of subsequent vocational participation; other key predictors were baseline educational attainment, race/ethnicity, and illness severity. Conclusions: While baseline rates are similar, vocational participation declined over time in SCMHP; in contrast, it doubled to over 80% for OnTrackNY enrollees. Future research should examine how participation changes after CSC treatment ends.
