Early Intervention Financing and Resources: Final Report. 2. Methodology


The main research questions of the Early Intervention Financing and Resources project concern the financing of the multi-element intervention for first-episode psychosis. Overarching questions focus on embedding these services within the context of usual treatment settings in the United States, including community mental health centers (CMHCs) and outpatient clinics. Financing is a key element of successful implementation, as reflected in the findings of the earlier ASPE studies on financing RAISE (Patton, Ratner and Salkever, 2010) and RAISE-related services such as supported employment (Karakus, Frey, Goldman, Fields and Drake, 2011). These questions on services implementation and financing were included in our interview guide for use with NIMH and central study personnel, as well as in the discussion guides for the interviews with site personnel, and in the site visit protocols that were developed.

The study employed a range of qualitative research techniques, including document review, key informant interviews, and case study methodology. Only a site visit and case study approach was deemed to be adequate to capture the variability of the approaches to implementation of RAISE services presented by this demonstration program.

It was important to select sites carefully but also recognize and acknowledge the problem of generalizing from what might be a series of idiosyncratic sites. After discussions about what might be learned from visits to the sites, Westat suggested sites that varied in terms of geography, payer mix, and organizational auspices. Then the NIMH recommended five sites for case studies. They were sites that had been able to implement the NAVIGATE services and participate in the study. The sites were diverse in their geographic location and in their approaches to implementing NAVIGATE.

Once site selection was complete, the focus of the site visits and other qualitative analysis (taken from interviews, discussions and document reviews) was on the implementation of the components and their combination into a team approach to early intervention services. The main focus of the site visit interviews was on the ability to finance the intervention, which is a combination of services. Some are typically covered by traditional health insurance (e.g., medications, medication visits to a physician, family therapy, individual therapy), and others are non-traditional services, such as SEE, which often are not covered by health insurance. Even Medicaid, the health insurance program with the benefit structure most likely to cover NAVIGATE services, does not cover all components of these non-traditional services.

The most fine-grained analysis in the case studies examined each component of the multi-element service package to understand the ability of the sites to implement and finance the services. The study explored how the lessons learned from NAVIGATE may be applicable to other sites to further national dissemination and implementation of RAISE early psychosis services in the United States.

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