# Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO)

> **NIH NIH R01** · FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH · 2020 · $1,504,444

## Abstract

PROJECT SUMMARY/ABSTRACT
For the RAISE initiative, we developed the NAVIGATE model of coordinated specialty care (CSC) for first
episode psychosis which supports the EPINET goal of furthering measurement-based care and shared
treatment decisions. To meet the EPINET goal of improving treatment, having all sites providing treatment
using the same model has distinct advantages. Therefore, we have engaged 11 NAVIGATE sites in 4 states,
enabling us to address challenges in different regions and find solutions that are not dependent on the
environment and support of a single state. Based on our experience training NAVIGATE sites and analyses of
RAISE-ETP data, we have identified targets for improvement of services. Our specific targets for improvement
divide into two categories. First, initial approaches added to NAVIGATE care for all participants to provide an
enhanced version of NAVIGATE (E-NAVIGATE). Second, three research projects target critical junctures in
CSC care. Study 1 aims to reduce duration of untreated psychosis (DUP). In RAISE-ETP median DUP was
74 weeks and had a significant impact on quality of life and symptoms. We will study the effect of targeted ads
that appear in response to specific terms when someone searches the internet. We expect that this will
increase the number of young people who will come to our clinics with shorter DUP. Study 2 addresses further
reduction of hospitalization. Even with CSC, approximately one third will be hospitalized within 2 years and
poor adherence to medication can lead to hospitalization. Direct observation of treatment can substantially
improve adherence and reduce hospitalization. We will study a unique suite of methods for direct observation
delivered as an app on a smart phone to support adherence. In a randomized trial we will compare this
intervention to usual E-NAVIGATE to improve adherence and reduce hospitalization. Study 3 is designed to
identify E-NAVIGATE participants who are at high risk for disengagement, and to intervene in order to
prevent/delay disengagement because even with CSC, 30-50% of participants will disengage from treatment
within 2 years. We will compare an internet delivered version of E-NAVIGATE that reduces treatment burden
to usual clinical strategies to prevent disengagement.
We will build upon our RAISE-ETP and post-ETP experience to build a unique network that will deliver an
evolving CSC that changes based upon feedback from experience and a dedicated informatics platform.
Research, designed to be generalizable not only to our network but to CSC practice more broadly, will set the
stage for the next generation of CSC deployment.

## Key facts

- **NIH application ID:** 10001026
- **Project number:** 5R01MH120594-02
- **Recipient organization:** FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
- **Principal Investigator:** JOHN M KANE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $1,504,444
- **Award type:** 5
- **Project period:** 2019-08-22 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10001026

## Citation

> US National Institutes of Health, RePORTER application 10001026, Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO) (5R01MH120594-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10001026. Licensed CC0.

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