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EPPIC Clinical Guidelines

These guidelines are informed by international early psychosis clinical practice guidelines, and are reflective of EPPIC's unique, localised clinical resources and programs. These guidelines inform professional practice in all of EPPIC's inpatient, community, and outpatient settings, across all phases of psychotic illness.
 
There are 16 individual guidelines, which are, in summary:
 
1. Ensuring that identification, monitoring and treatment for individuals with an 'at risk' mental state are optimal

  • All individuals assessed as having an ‘at risk’ mental state are referred to the PACE clinic at EPPIC
  • Community-based awareness campaigns inform relevant groups such as schools and health practitioners

2. EPPIC will offer an accessible and responsive service

  • EPPIC is accessible 24 hours a day, 7 days a week via YAT
  • EPPIC will accept referrals from any source
  • The location of all initial assessments should be at a place of convenience for the client and carer wherever possible
  • All clients and families should, if required, have access to an interpreter and written information in their own language
  • Clients and carers should be represented within the organization and have access to a formal complaints procedure
  • Delays in treatment should be minimized: all clients suspected of experiencing a first-episode psychosis should be considered a priority and be assessed within 24 hours of EPPIC receiving a referral
  • All referrers should be informed of the outcome within 48 hours of the initial assessment
  • All GPs should be informed of the client’s contact with the service within 48 hours after entry to service
  • All clients and families should be given an information pack about treatment and services available at EPPIC within 48 hours after entry to service
  • All within-service transfers of care should be attended by members of the relevant teams to ensure continuity of care within the service

3. Gain a thorough understanding of the person and their situation as quickly as possible

  • All clients should have a comprehensive biopsychosocial assessment undertaken by the acute treating team within 48 hours after entry to the service, including: mental state examination, physical examination including measures for metabolic syndrome, neurological examination, risk assessment, drug and alcohol use, personal history and family history
  • A diagnostic formulation and management plan will be developed from that information
     

4. Provide regular review of the client's progress with treatment. Wherever possible:

  • All clients should be seen by a doctor within 48 hours after entry to service
  • All clients should be seen by a consultant psychiatrist within one week after entry to service
  • All clients should be seen at least twice weekly in the acute phase by the acute treating team, or case manager, and a doctor
  • All families should be seen or contacted at least weekly in the acute phase by the acute treating team or case manager
  • All clients should be seen at least weekly during the early recovery phase
  • All clients should be seen at least fortnightly by a doctor in the early recovery phase
  • All families should be seen or contacted at least fortnightly during the early recovery phase
  • All clients should be seen at least fortnightly during the late recovery phase
  • All clients should be seen at least monthly by a doctor during the late recovery phase
  • All families should be seen or contacted at least two monthly by the treating team during the late recovery phase
  • All clients with persisting positive or negative symptoms, or high suicide risk, should be referred by the treating team to TREAT for review and consultation within 3 months after entry to service, and then at any point during treatment at EPPIC
  • All families of clients with a problematic recovery (meeting referral criteria for TREAT) should be referred by the treating team for family work

5. The rights of clients are upheld

  • All clients and families should be provided with written and verbal information regarding their rights and responsibilities after entry to the service, particularly with respect to involuntary admissions and treatment
  • All clients and families should have access to a complaints procedure
  • All clients should be informed of their privacy rights upon admission
     

6. A case manager and medical doctor should be allocated to each client upon entry into the service

  • All clients should be assigned a case manager and medical doctor within two working days after entry to the service
  • The case manager will formally liaise with the acute treating team within two working days of assignment
  • A written case formulation, including provisional diagnosis and management plan, should be completed by the case manager within three months after entry to the service
  • The case manager should ensure clinical reviews (and associated documentation) are completed at the 3 month, 9 month, and 15 month time points after entry into the service

7. Regular risk assessments are undertaken with each client to inform treatment planning

  • Risk assessments should be undertaken and documented at each client visit
  • The relevant consultant psychiatrist should be informed immediately of any clients identified as a high suicide risk
  • An immediate risk management plan should be developed and documented in conjunction with the client, carers, consultant psychiatrist, and other members of the treating team for all clients identified as a high suicide risk
  • All clients identified as a high suicide risk should be presented and discussed with the clinical supervisor at the earliest opportunity
  • All clients identified as a high suicide risk should be presented at TREAT for consultation and treatment planning at any point during the course of EPPIC treatment
     

8. The case manager coordinates treatment and care of the client throughout the episode of care at EPPIC

  • All clients should have regular mental state and risk assessments
  • The case manager or medical doctor should review and document treatment progress at each client visit
  • The case manager should be present at the client’s doctor appointments to ensure continuity of care
  • Both the case manager and medical doctor should meet with the client and develop an Individual Service Plan within 4 weeks after entry to the service
  • The case manager should review the ISP on a regular basis with the client as well as at the 3 month, 9 month, and 15 month time points after entry to the service
  • The case manager should provide emotional support and psychoeducation, utilizing written and audiovisual material, particularly during the acute and early recovery phases
  • The case manager should develop and document a plan to detect early warning signs and prevent relapse with the client and carers or family
  • The case manager should assist clients to access accommodation, vocational, recreational, welfare and primary health services as documented in the ISP
  • The case manager should consult with the client’s GP on a regular basis and at least every 6 months
     

9. Pharmacological treatments are provided in an optimal way during the acute phase and ongoing management of recovery

  • All new clients should have an antipsychotic medication free period of at least 24 hours
  • Atypical antipsychotic medications are preferred due to their greater tolerability
  • Low doses of antipsychotic medication should be used at the commencement of treatment, for example Risperidone 0.5-1.0 mg, Olanzapine 25-50 mg, Quetiapine 25 mg bd
  • Doses of antipsychotic medication should be adjusted in small increments at appropriately spaced intervals according to efficacy and tolerability
  • Antipsychotic medication should be at the lowest effective dose to avoid side effects
  • All clients experiencing a manic episode should be commenced on a mood stabilizer
  • All clients experiencing a depressive episode of at least moderate severity should be commenced on an antidepressant
  • All clients being considered for clozapine should be referred to TREAT by the treating team
     

10. Individual psychological interventions are provided by the case manager (when training has been provided) and specialist workers as a means of enhancing the individual's ability to cope with early psychosis and prevent relapse

  • All clients with comorbid psychological disorders should be offered COPE as part of standard case management
  • All clients with persisting positive symptoms being considered for STOPP should be referred to TREAT by the treating team
  • All clients with problematic cannabis use should be offered CAP as part of standard case management
  • All clients with problematic drug and alcohol use being considered for drug and alcohol counseling should be referred to SUMITT
  • All clients with significant cognitive deficits should be referred for neuropsychological testing
     

11. Carers and family members are encouraged to be involved as much as possible

  • All families should be contacted as soon as possible or at least within 48 hours following the initial assessment of the client, unless there are significant clinical reasons why this should not be done
  • Families are represented within the service via the Family Working Group, Family Support Steering Committee and at the EPPIC Clinical Operations Group
     

12. Psychoeducation is provided to clients and families

  • All clients and families should be given appropriate written and verbal psychoeducation within one week of the initial assessment. This should account for the young person and their family's cognitive and developmental level. It should also be sensitive to their explanatory model, and be provided in a flexible and collaborative way
  • Appropriate psychoeducation for both clients and families should be provided by the case manager during the acute phase
  • All carers or family should be invited to attend the family and friends education sessions and the family support group by the treating team
     

13. Group programs and vocational rehabilitation are offered and provided to clients

  • All clients should be informed of potential group program activities to facilitate recovery from first episode psychosis
  • All suitable clients should be referred for an introductory session to the group program
  • Within 4 weeks of referral to the group program, or before the client has attended 4 group sessions, he/she will assessed for participation
  • Reviews of client progress will occur at the end of every term or every 3 months
  • A review will be completed prior to discharge from the group program

14. Discharge planning at the end of the episode of care is planned, coordinated and well communicated

  • Discharge planning is discussed with the client and family or carers 3 months prior to discharge
  • The client and family or carers are provided with a post-discharge kit including contact details of EPPIC, their local AMHS, and other important contacts for future reference
  • Contact with the proposed treatment providers is made at least 2 months prior to the expected discharge date to discuss the referral and handover of treatment
  • Orientation to the treatment provider should include a visit and joint handover meeting whereever possible
  • A discharge summary should be completed prior to discharge from EPPIC, and an archive form completed at discharge
  • A discharge summary should be sent to the relevant treatment providers and GP
  • Case managers should ensure that all clients are linked in with a GP when discharged wherever possible

15. Treatment is provided in the least restrictive environment and manner

  • All suitable clients should be home treated during an acute phase
  • Community Treatment Orders should only be in effect for the minimum duration to meet specified treatment goals
  • Involvement of police to enforce treatment should be kept to a minimum
  • The use of seclusion and ICA should be kept to the minimum frequency and duration when managing high risk patients

16. Clinical contacts are documented to assist in coordinated care for each client

  • Documentation in the individual clinical record is dated, signed (with designation) and legible
  • Entries should include mental state and risk assessment, major issues identified, treatment progress, and plan for future treatment

 
A free to download PDF of the EPPIC clinical guidelines can be viewed in full here.
 
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