Professionals and their Organizational Roles in Pathways to Care for Early Psychosis: Where Are the Social Workers?

Abstract

Problem: Expediting pathways to effective treatment may reduce the duration of untreated psychosis, thereby improving long-term functioning for individuals experiencing early psychosis. Previous research rarely addresses the role of social workers along the pathway to care for these individuals, with few studies conducted in the United States. Understanding professional roles may provide strategies to shorten pathways and expedite effective treatment for individuals experiencing early psychosis. Method: This exploratory study used a cross-sectional design to examine professional designations and organizational roles of service providers referring individuals to a research program providing specialty early intervention services for psychosis. Of individuals referred (n=320), 169 were assessed for eligibility, 74 were eligible for admission, and 60 were admitted. Tests of association were used to evaluate relationships between roles and professional designations of referring professionals, service-seeker demographics, and clinic eligibility and admission for referred service-seekers. Logistic regression analyses were conducted to evaluate whether professions, roles, or demographic factors predict service-seeker eligibility and admission. Results: Most referrals came through social work professionals (36%) and professionals not licensed to prescribe (54%). Professional designations and organizational roles were strongly associated (V = .700, p <.05). Highest referring role/profession combinations included prescribing psychiatrists (20%), and case-manager social workers (19.4%). The odds of being eligible were: 1) greater for individuals with some college than with no college, 2) less likely for individuals referred from outpatient settings than inpatient settings, and 3) greater for individuals referred from non-prescribing professions than individuals referred from prescribing professions or teams of both. The odds of being admitted were greater for individuals referred from inpatient settings. Conclusions: Social workers and other non-prescribers may be positioned to implement interventions to expedite pathway to care in the United States. Understanding the impact of roles and professions on eligibility and admission requires further research with larger samples in community settings. The ability to refer eligible individuals may be unnecessary for community-based treatment. Community settings may welcome high referral volumes when individuals do not meet criteria for FEP. Offering treatment to individuals at risk for psychosis and monitoring for FEP may be a better approach to reducing DUP.