Adapting Coordinated Specialty Care in the Post COVID-19 Era

Coordinated Specialty Care (CSC) programs provide evidence-based services for young people withrecent onset of a psychotic disorder. New York State's program, OnTrackNY is a nationally recognized modelof CSC treatment. OnTrackNY provides coordinated, team-based services and has demonstratedimprovements in symptoms, functioning, hospitalization, and work/school participation. The rapid rise ofCOVID-19 has created shocks to the health care system, producing numerous rapid changes in behavioralhealth service delivery, including telehealth, in the absence of guidance from evidence or experience. It isunclear how these changes will impact the need for and delivery of psychiatric care and client outcomes. OnTrack Central, an intermediary organization responsible for training and implementation support ofOnTrackNY programs, has created systems for multi-level stakeholder engagement, a centralized datacollection protocol for quality improvement and evaluation of program fidelity, and a mechanism to supportpractice based-research. Our daily engagement of the OnTrackNY network has revealed how recent changesare dramatically impacting CSC services. In 2019, OnTrackNY was awarded a hub within the Early Psychosis Intervention Network (EPINET) toadvance a learning health care system (LHS). The breadth of OnTrackNY sites coupled with OnTrack Centraloversight provides an opportunity to examine the impacts of the COVID-19 crisis in New York State. Thediversity of the 23 OnTrackNY teams located throughout the state enables examination of settings with highand low prevalence of COVID-19 infections and diverse regulatory and workforce environments. TheOnTrackNY network includes programs that operate within variable regulations (outpatient clinics at communityagencies, state-operated facilities, and community and academic hospitals in urban, suburban, and ruralareas) with very diverse participant populations. This project will examine the implications of modifications to service delivery within the OnTrackNY LHSduring and after the COVID-19 crisis. We will use the implementation science framework, Framework forReporting Adaptations and Modifications-Enhanced (FRAME) to systematically evaluate modifications madeand ascertain their impact. We will utilize integrative mixed methods, including qualitative interviews and focusgroups with stakeholders (clients, families, providers and decision makers at the state and local levels) andanalysis of OnTrackNY program data The project aims to assess: 1) the implications of governmental andagency level policy changes and how these decisions impact team staffing and functioning; 2) implications fordelivery of CSC services; and 3) impact on client-level care processes (e.g. utilization of services) andoutcomes. The goal is to develop a CSC Model Adaptation Guide that will be fidelity-consistent, andassociated with consistent engagement, service utilization or favorable outcomes of care.