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First-episode psychosis can strip away one's identity, obscure one’s history, and shatter one’s vision for the future. And often, this process happens through contact with the mental health system, rather than the condition itself. At just 17 years old, Leah Giorgini found herself navigating a descent to invisibility after a traumatic childhood marred with violence, neglect, and parental death led to a first episode of psychosis. Once a high achiever, Leah became a patient adrift from the world, paralyzed by antipsychotic medication and low expectations. However, when a progressive therapist lent Leah a book about Feminist Perspectives on Mental Health, Leah suddenly felt seen as a whole person in context and began to reemerge as a visible and capable individual. Now an Occupational Therapist working in nonprofit leadership, Leah is working to change the societal inequities that lead to and perpetuate human suffering. She will present her story and outline how connecting the dots of trauma, intersectionality, and occupation can lead to rights-based care that helps people feel seen and empowered.  By the end of this training, participants will be able to:  Describe the importance of acknowledging intersectionality in mental health care, particularly in understanding how various aspects of identity, such as gender, race, and socioeconomic status, intersect with experiences of psychosis and recovery.  Describe the role of occupation in the recovery process for individuals with first-episode psychosis, and understand how occupational therapy principles can be integrated into rights-based care approaches to support individuals in regaining agency and meaning in their lives.  Identify the key factors contributing to the social invisibility experienced by individuals with first-episode psychosis, including the impact of interactions with the mental health system.  About the Presenter: Leah is a British-Indonesian immigrant who moved from England to the United States in 2016. As a psychiatric survivor, domestic violence survivor, former foster youth, and a person who has previously experienced homelessness, Leah is working towards a world free of oppression and injustice. She believes that promoting psychological and social approaches to psychosis is equity in action towards this vision.  Trained as an Occupational Therapist, Leah primarily worked in clinical mental health settings until she came to the United States, where she found a home working in nonprofit leadership. Leah has worked in an array of settings with people diagnosed with psychosis, including working in early intervention in psychosis, assertive outreach, a mental health recovery café, a high-secure forensic hospital, and homeless emergency shelters. She currently serves as Executive Director of the US Chapter of the International Society for Psychological and Social Approaches to Psychosis (ISPS-US.)   

Although there is increasing awareness of the social determinants of mental health, the intersection of social determinants and first-episode psychosis is still a developing field. This presentation will highlight the growth in the field and the increasing complexity that must be considered as it relates to structural racism and oppression. Evidence of the role of social determinants of mental health in driving inequitable outcomes in first-episode psychosis will be discussed. Finally, solutions for improving outcomes and achieving mental health equity will be considered.  Learning Objectives:  Define key concepts associated with the social determinants of mental health Evaluate recent evidence of the role of social determinants in driving first-episode psychosis outcomes Identify solutions to achieving greater equity in first-episode psychosis outcomes   About the Presenter: Ruth Shim, MD, MPH (she/her) is the Luke & Grace Kim Professor in Cultural Psychiatry and Professor of Clinical Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California, Davis. She also serves as Associate Dean of Diverse and Inclusive Education at the University of California, Davis School of Medicine. Dr. Shim received an MPH in health policy from Rollins School of Public Health at Emory University and an MD from Emory University School of Medicine. She is a member of the Board of Trustees of the Robert Wood Johnson Foundation and the Scientific Advisory Council of Bring Change to Mind, an organization co-founded by actress Glenn Close to reduce stigma and discrimination associated with mental illness. She serves on the Research and Evaluation Committee of the California Mental Health Services Oversight and Accountability Commission. She serves on the Editorial Boards of JAMA Psychiatry, Psychiatric Services, Community Mental Health Journal, and American Psychiatric Publishing, and is co-editor of the books, The Social Determinants of Mental Health, and Social (In)Justice and Mental Health. Dr. Shim is an at-large member of the National Academies of Sciences, Engineering, and Medicine Forum on Mental Health and Substance Use Disorders. In 2021, she was the recipient of a NAMI Exemplary Psychiatrist Award and the UC Davis Health Deans’ Award for Excellence in Mentoring. She was named a Top 20 Black Change Maker of 2023 by The Sacramento Bee. Dr. Shim provides clinical psychiatric care in the UC Davis Early Diagnosis and Preventative Treatment (EDAPT) Clinic.

Living with a psychotic disorder can be an experience of uncertainty, isolation, and diminished hope for young people and their loved ones. For providers, supporting people with complex psychological conditions increases the risk of burnout. This presentation discusses how intentional kindness and community-building strategies are good medicine practices that can benefit young people with psychosis, families, and care teams.  This presentation challenges providers face to maintain spaces that support deep human connection: This presentation will discuss specific barriers and responses to barriers faced during the last three years to sustain and expand human connection among program participants and care team members.  Learning Objectives Have a greater understanding of the subtle and explicit ways how psychotic disorders impact a large network of people, to include young people experiencing symptoms, family members, and care providers.   Review the positive impact that kindness practices and intentional human connection have in people’s physical, mental and spiritual health.   Discuss specific ways how EPICenter (A FEP in Tucson Arizona) integrates kindness practices and community building initiatives as core components of their program.     About the Presenter: Gustavo Perez, PhD, (he/him) is a clinical associate professor at the University of Arizona, College of Medicine, Psychiatry Department where he directs the Early Psychosis Intervention Center (EPICenter). Dr. Perez's priorities include: Supporting young adults with serious mental illness in building a life of connection and purpose, advocating for families, preparing the next generation of providers to offer best diagnostic and intervention practices, and engaging with local communities to reduce stigma and increase opportunities for youth in different stages of psychotic disorder. Dr. Perez is a licensed psychologist and a certified trauma specialist. He completed his doctorate degree in school psychology at the University of Texas at Austin and his clinical psychology internship at the University of New Mexico in Albuquerque. Prior to joining the University of Arizona, Dr. Perez was the chief psychologist at the Pima County Juvenile Detention Center in Tucson AZ.

In this 60-min session we will explore the common challenges providers face when supporting people who see, hear, and otherwise experience things that others around them do not. Tasked with time-sensitive concrete requirements, such as completing an eligibility assessment or person-centered recovery plan (PCRP), professionals may struggle to meet the needs of the behavioral health system while also prioritizing the more immediate and subjective needs of the human being in front of them. Join Amy and Amanda as they share from both their relevant personal and professional experience regarding this challenge and highlight ideas for staying connected with yourself and the people you support. Although the session is brief, attendees can expect story-telling, short examples, and a few take-home resources.  Learning Objectives: Describe two actions that promote trust and partnership during a mental health distress,  Name two behaviors professionals should avoid that can damage the relationship with people who are hearing and seeing things that others do not, and  Identify an approach that simultaneously balances the needs of the person and the system.    About the Presenters: Amanda Bowman, LCSW-S, PSS (she/her) is a clinical social worker, certified peer specialist supervisor, and WRAPⓇ facilitator, using her professional and lived experience with mental health challenges to promote person-centered practices in behavioral health care. Coming from direct social work practice and administrative leadership within the public mental health system, she joined Via Hope in 2013, where she served as Recovery Institute Director until 2023. In this role, she oversaw the development and delivery of organizational change programs, which included statewide initiatives to support the implementation of person-centered planning, peer support services, and trauma-responsive work environments. Now the owner of Sidecar Consulting, Amanda uses her passion for participatory learning methods to facilitate collaborative learning events and serves as a subject matter expert for programs designed to support change within and across agencies. She has called Austin home since 2000 when she moved from Louisiana to obtain a Master’s degree at UT. Outside of work, you may find Amanda with her family hiking the Barton Creek Greenbelt or enjoying live music. Amy Pierce (she/her) has been working in the Peer Movement in the State of Texas for almost two decades. She currently serves as Recovery Institute Associate Manager at Via Hope by serving as a subject matter expert on the implementation of peer services and  other recovery-oriented practices. She has extensive experience in the peer support sector, having started the first peer support program in the state hospitals in Texas, implementing peer support programs in the community as well as the Program Coordinator for a transitional peer residential housing project.   Prior to Via Hope, she was the CEO of Resiliency Unleashed, an international training and consulting company. Amy is a peer, and family member, with both mental health and addictions experience. Amy was previously Chair of the PAIMI Council in Texas and currently serves on the Disability Rights Texas Board of Directors.

This presentation will explore ways to make meaning of experiences labeled as psychosis, as well as identify strategies for building partnerships to help navigate those experiences along the way. As we learn to pause and unpack not only our own purpose, but also the perspectives of those we are supporting, we can deepen our connections and more easily find the path to guide people toward becoming the experts of their own experiences in a way that works for them. Approaches from the Hearing Voices Movement and Intentional Peer Support will be introduced through the values of the Wildflower Alliance. Over a decade of working with people and their families – as well as a lifetime of first-hand experiences of voices, visions and unusual and extreme states – will inform the presentation.  Learning Objectives:  Participants will be able to name at least strategies for managing voices and extreme states beyond medication and distraction.  Participants will be able at least two ways trauma can impact the type of voices and unusual beliefs a person may have.  Participants will be able to name two dialogue approaches that increase connection and partnership    About the Presenter:  Cindy Hadge is an internationally recognized educator providing training and consultations to mental health providers, worldwide who are looking for innovative ways to approach voice-hearing, extreme states, and trauma. She draws from her own experience of childhood trauma, experiences in the traditional mental health system, and navigating her own voices, visions, and unusual beliefs. She is passionate about developing and facilitating healing spaces for those going through these kinds of experiences and their families. Cindy is a pioneer in developing Hearing Voices Network USA Family and Friends Groups in 2019 and has been an HVN USA trainer since 2012. Cindy is the Lead Trainer for the Wildflower Alliance as well as an Intentional Peer Support trainer.

The Massachusetts Psychosis Network for Early Treatment (MAPNET) and the New England Mental Health Technology Transfer Center (MHTTC) host a virtual monthly “Early Psychosis Prescriber Consultation Series” led by Dr. Matcheri Keshavan on prescribing practices for early psychosis, including a review of a selected monthly topic. Our May topic was “Long-Acting Injectable Antipsychotics (LAIs)." ​​Dr. Keshavan is Stanley Cobb Professor of Psychiatry at the Beth Israel Deaconess Medical Center, Harvard Medical School, as well as Academic Head of the department. He is the Editor-in-Chief of Schizophrenia Research (Elsevier) and serves on the editorial board for journals such as Early Intervention in Psychiatry and Asian Journal of Psychiatry. His main areas of research include the neurodevelopmental basis of schizophrenia, neuroimaging, and early intervention. He has an active clinical practice.

This webinar provided tips for increasing engagement and understanding insight when working with individuals who experience psychosis. Some of the learning goals of this webinar include: Understanding some of the common barriers to engagement in treatment for individuals who experience psychosis Learning strategies for building rapport and trust with clients whose symptoms may interfere with having insight about their condition Developing a deeper understanding of the role of empathy for the individual’s experience and validation of their values when fostering engagement and therapeutic progress Discussing important cultural and ethical considerations to keep in mind when working with individuals who struggle with developing insight into their psychotic symptoms About the Presenters: Emily Kline is an Assistant Professor of Psychiatry at the Boston University Chobanian & Avedisian School of Medicine and the Director of Psychological Services in the Wellness and Recovery After Psychosis (WRAP) Program at Boston Medical Center. She is an expert in adolescent and young adult development, emerging psychotic disorders, and serious mental illness. She has published over 40 peer reviewed papers and several book chapters on psychosis prediction, detection, diagnosis, and treatment. Her current research focuses on improving communication between parents and youth and increasing access to high quality mental health treatment for young people in distress. Dr. Kline authored The School of Hard Talks: How to Have Real Conversations with Your (Almost Grown) Kids (2023) as well as a The School of Hard Talks Online which is an online course for parents who are hoping to learn to improve their communication with their teens. Jenny Lancet MS, MBA is a Peer Support Specialist with the WRAP Program at Boston Medical Center. She provides one-on-one support by assisting others in their own journeys of recovery through sharing her own experiences and promoting hope that recovery is possible. In her spare time she enjoys photographing the city.

Presented by: Angela Schindler-Berg, MS, LMHP Angela Schindler-Berg is a Licensed Mental Health Practitioner and has worked with primary care clinics and integrated community-based mental health services for over 25 years.   As the Nebraska Project Lead for HealthTeamWorks, Angie promotes healthcare delivery that utilizes evidence based mental health practices, effective team-based care, care management resources, quality improvement processes, and strategic population health to improve the quality of health/life for individuals.  As a practice facilitator Ms. Schindler-Berg has worked on CMS/CMMI initiatives such as the Comprehensive Primary Care (CPC+) and with SAMHSA on the Primary and Behavioral Health Care Initiative (PBHCI).   Currently, Ms. Schindler-Berg supports the University of Nebraska Medical Center-Munroe Meyer Institute as a contracted Regional Trainer with the Region 7 Mid-America Mental Health Technical Transfer Center (MHTTC) She facilitates a collaborative network of supports, focusing on resource development and dissemination, training and technical assistance, and workforce development for the mental health field.  Angie received her Master of Science with Drake University in Rehabilitation Administration and Clinical Rehabilitation Counseling. She brings expertise in integrated care, mental health, care management, crisis intervention and trauma informed care.    Learn more about this Learning Community: First Episode Psychosis Learning Community  

By the end of this webinar, participants were able to describe: The nature of insight and treatment engagement in psychotic disorders An overview of the causes of impaired insight and treatment engagement in psychotic disorders. Approaches to management of impaired insight and treatment engagement/alliance in psychotic disorders.   Presenter: ​​Dr. Keshavan is Stanley Cobb Professor of Psychiatry at the Beth Israel Deaconess Medical Center, Harvard Medical School, as well as Academic Head of the department. He is the Editor-in-Chief of Schizophrenia Research (Elsevier) and serves on the editorial board for journals such as Early Intervention in Psychiatry and Asian Journal of Psychiatry. His main areas of research include the neurodevelopmental basis of schizophrenia, neuroimaging, and early intervention. He has an active clinical practice.   This webinar was co-hosted by the Massachusetts Psychosis Network for Early Treatment (MAPNET, www.mapnet.online).

Raúl Condemarín shares culturally responsive strategies that he uses as a psychiatrist with host Lola Nedic. This podcast episode is sponsored by the New England Mental Health Technology Transfer Center Network (MHTTC).

Additional resource: National School Mental Health Implementation Guidance Modules and Related Projects Presented by: Jessica Christensen, M.Ed, holds a bachelor’s degree in Secondary English Education and a master’s in Education. With over a decade of middle school teaching experience, she moved from the classroom to the non-profit sector. Following the conclusion of Please Pass the Love in May 2023, she transitioned from Please Pass the Love to a full-time role at MHTTC. Jessica offers valuable insights to enhance mental well-being in education, empowering educators, and guiding districts to strengthen their mental health frameworks. Learn more about this Learning Community: First Episode Psychosis Learning Community

About this Resource: Open Dialogue is a therapeutic approach to psychosis that operates as a system of care to facilitate continuity and recovery for individuals experiencing psychosis. This infographic, which accompanies our Open Dialogue on-demand recording, reviews the history and key principles as well as provides a case study example of this therapeutic approach.

Hosts Joey Rodriguez and Lola Nedic discuss culturally responsive strategies and the future of culturally responsive care. This podcast episode is sponsored by the New England Mental Health Technology Transfer Center Network (MHTTC).

This webinar provided tips for working with families of individuals with psychosis in outpatient community settings. Questions that were addressed include:   How can I develop a good working relationship with families in order to support care even though I don’t have a lot of experience working with families and I have a large caseload? How can I manage confidentiality? How can I help families develop a better understanding of their relative and their symptoms and treatment? What are some important considerations for providing culturally responsive care when working with families? What can I learn to feel more equipped to support families entering care in the context of a recent onset of psychotic symptoms?   Presenter: Julie M. McCarthy, PhD, is a clinician-scientist in the Division of Psychotic Disorders at McLean Hospital in Belmont, Massachusetts. Her research aims to identify neurobiological and psychosocial treatment targets and develop/evaluate treatments for individuals and families experiencing co-occurring psychotic and substance use disorders.

Coordinated Specialty Care (CSC) is an evidence-based, recovery-oriented, multidisciplinary treatment program tailored for individuals experiencing Early Psychosis. CSC involves joint treatment planning (or shared decision-making) between the people in treatment and recovery and their care team, which can include mental health providers such as peer specialists, psychiatrists, psychologists, social workers, and case managers. CSC can provide individual and family counseling, medication management, case coordination and assistance with educational and career objectives, as well as other services. Learn more in this brief and check out our free online course for more information.

  This presentation provided a brief overview of how harm risk (suicidality and self-injury) can present in young people experiencing early psychosis. We reviewed a selection of psychotherapy strategies that can be helpful in targeting these concerns, highlighting functional analysis, distress tolerance skills, and the CAMS (Collaborative Assessment and Management of Suicidality). We discussed these strategies in the context of disguised client examples, and encouraged suggestions and case consultation from the audience.   Presenter: Michelle L. West, PhD, Director, Program for Early Assessment, Care, & Study (PEACS), Assistant Professor, Department of Psychiatry, University of Colorado – School of Medicine (CUSOM). Dr. West is a clinical psychologist who specializes in assessment, treatment, and research for young people showing possible early risk for psychotic spectrum illnesses. This webinar was presented in collaboration with the Massachusetts Mental Health Center GrandRounds series.   View a recording of this 2/23/24 session here. 

Author: Dr. Nicholas Breitborde, Ph. D. Dr. Nicholas Breitborde is Professor and Vice Chair for Academic Affairs in the Department of Psychiatry and Behavioral Health at The Ohio State University and Director of the OSU Early Psychosis Intervention Center (EPICENTER). He serves as a Content Area Expert for the Global Burden of Disease Study and is a member of the American Psychological Association Task Force on Serious Mental Illness/Severe Emotional Disturbances. To date, his research has been cited over 40,000 times and has been funded by agencies such as the National Institute for Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Learn more about this Learning Community: First Episode Psychosis Learning Community

Dr. Gagen reviewed a metacognitive framework for understanding psychosis and discussed a specific psychotherapeutic intervention--Metacognition Reflection and Insight Therapy. We discussed the definition of metacognition and the four main domains that are measured, the relationship between metacognitive capacity and psychological distress, and the research evidence that supports this approach.   Presenter: Emily Gagen, Ph.D., is a licensed clinical psychologist at the Brookline Community Mental Health Center. She is the director of the Massachusetts Psychosis Access and Triage Hub (M-PATH) and a member of the team at the Center for Early Detection, Assessment, and Response to Risk (CEDAR). Dr. Gagen has worked with individuals with psychosis and schizophrenia-spectrum disorders for 15 years and specializes in the treatment of young adults with early psychosis.   View a recording of this 1/26/24 session here.

Presented by: Angie Schindler-Berg, MS, LMHP Angela Schindler-Berg is a Licensed Mental Health Practitioner and has worked with primary care clinics and integrated community-based mental health services for over 25 years.   As the Nebraska Project Lead for HealthTeamWorks, Angie promotes healthcare delivery that utilizes evidence based mental health practices, effective team-based care, care management resources, quality improvement processes, and strategic population health to improve the quality of health/life for individuals.  As a practice facilitator Ms. Schindler-Berg has worked on CMS/CMMI initiatives such as the Comprehensive Primary Care (CPC+) and with SAMHSA on the Primary and Behavioral Health Care Initiative (PBHCI).   Currently, Ms. Schindler-Berg supports the University of Nebraska Medical Center-Munroe Meyer Institute as a contracted Regional Trainer with the Region 7 Mid-America Mental Health Technical Transfer Center (MHTTC) She facilitates a collaborative network of supports, focusing on resource development and dissemination, training and technical assistance, and workforce development for the mental health field.  Angie received her Master of Science with Drake University in Rehabilitation Administration and Clinical Rehabilitation Counseling. She brings expertise in integrated care, mental health, care management, crisis intervention and trauma informed care.     Learn more about this Learning Community: First Episode Psychosis Learning Community

This session informed participants about a variety of innovative strategies providers can share with families to assist them in supporting people who hear voices or experience other unusual beliefs or extreme states that are often labeled as psychosis. Internationally recognized educator, consultant, and presenter Cindy Hadge draws from her own experiences overcoming childhood trauma as well as her experiences supporting family members to fuel her passion and inform her work resulting in invaluable information and tools shared with participants.   Presenter: Cindy Hadge has become an internationally recognized educator providing training and consultations to mental health providers worldwide who are looking for innovative ways to approach voice-hearing and extreme states. She is also passionate about developing and facilitating healing spaces and workshops for families whose loved ones are not responding well to the current mental health system’s offerings. As Lead Trainer of the Wildflower Alliance, Cindy has keynoted a variety of conferences.   View a recording of this 1/9/24 session here. 

Amanda Weber and host Joey Rodriguez discuss culturally responsive care for youth experiencing early psychosis. This podcast episode is sponsored by the New England Mental Health Technology Transfer Center Network (MHTTC).

View the slides: Implementing Peer Support Specialists in a First Episode Psychosis Program Author: Marla Smith, MS, LMHP, LMHC Marla Smith has been an integral part of the Mid-America Mental Health Technology Transfer Center (MHTTC) since November 2020. Her primary role involves coordinating behavioral health training, particularly focusing on individuals diagnosed with serious mental illnesses. As a licensed Mental Health Counselor in both Nebraska and Iowa, Marla brings extensive experience, having worked directly with clients of all ages for nearly 20 years. Her approach emphasizes the importance of connection, meeting individuals where they are, and using respectful, trauma-informed communication to support positive change. Marla holds a Master's degree in Youth and Family Services from Bellevue University. Outside of work, she cherishes family time and indulges in crafting as a favorite pastime.  Learn more about this Learning Community: First Episode Psychosis Learning Community

  This talk discussed when, how, and why to prescribe clozapine. Dr. Laitman gave specific approaches to minimize predictable side effects and maximize benefits. He also presented his own data supporting this approach.   Presenter: Dr. Robert Laitman is an internist who specializes in the use of clozapine in an optimal fashion for individuals with schizophrenia or other psychotic spectrum disorders.   This webinar was co-hosted by the Massachusetts Psychosis Network for Early Treatment (MAPNET, www.mapnet.online)   View a recording of this session here. 

Grounded in national and regional EPINET data on discharge in early psychosis services, this presentation focused on social and cultural vectors underlying the 'hard' problem of disengagement and presented alternative approaches for addressing distrust, and strengthening clinical relationships by centering lived experiences of psychosis, socioeconomic disadvantage, racism, and cultural difference.   Presenter: Nev Jones PhD is a patient-alumna of specialized early psychosis services and currently assistant professor in the School of Social Work and Department of Psychiatry at the University of Pittsburgh. As a program developer, evaluator and researcher, her work has sought to amplify the perspectives of those most impacted by the public mental health system, foreground the role of social and structural determinants, and support transformative change.   View a recording of this session here.