IEPA 11

Khalima Bolden1, Rosenthal Adi1, Monet Meyer1, Sarah Gobrial1, Krista Lane1, Ruth Shim1, Tyler Lesh1, J. Daniel Ragland1, Loewy Rachel2, Savill Mark2, Carter Cameron1, Niendam Tara1; 1University California - Davis, Sacramento, CA, 2University California - San Francisco, San Francisco, CA
               
The duration between onset of psychosis and accurate diagnosis and treatment is a significant predictor of outcome, making rapid linkage to care imperative. Barriers such as stigma, difficulty navigating the system, and financial burden lengthen this process. The current study investigates the effect of these barriers on clinic engagement (i.e. completion of initial early psychosis eligibility assessment). We operationalized logistical (e.g. trouble contacting client), attitudinal (e.g. stigma), systemic (e.g. barriers associated with the healthcare system), structural (e.g. economic barriers), and illness-related barriers (e.g. extreme paranoia) coded from phone logs of 196 individuals referred to specialty early psychosis (EP) services in Sacramento, CA (age=17.6, female=55.1%, Caucasian=31.1%, Hispanic=36.2%). Barriers were coded as present/absent for each interaction; analyses examined the proportion of total interactions where barriers were present. Individuals who completed the initial assessment (n=141) experienced an average of 6.9 barriers during the linkage period, while noncompleters (n=55) experienced an average of 10.2 barriers.  For completers, logistic barriers were the most common (39.1% of interactions), followed by systemic (1.9%), structural (1.8%), attitudinal (1.3%), and illness-related (0.2%) barriers. For noncompleters, logistic barriers were the most common (69.0% of interactions), followed by attitudinal (6.3%), systemic (5.3%), structural (4.6%), and illness-related (0.9%) barriers. Noncompleters experienced proportionally more barriers overall (80.7%) than completers (43.0%) (p<.001), as well as increased logistic (p<.001), attitudinal (p<.001), structural (p=.04), systemic (p=.002), and illness-related barriers (p=.022). Understanding the barriers individuals face in accessing specialty care is an essential step in improving the linkage process and reducing the duration of untreated psychosis.