The PREP partnership originated from two intersecting interests in developing an early psychosis treatment program in San Francisco. First, a co-author (RB) and CEO of Family Service Agency of San Francisco (FSA) experienced a great amount of frustration while trying to access appropriate care for a family member who was exhibiting early signs of psychosis, despite his access to a number of available assessment and treatment services in the SF Bay Area. This led him to first research, and then contact, UCSF researchers working in innovative ways with this population. At the same time, early psychosis researchers in the Department of Psychiatry at UCSF were frustrated with the lack of clinical services to which they could refer research participants seeking treatment. Srihari et al.11
reported similar frustration in seeking services for research participants engaged in the PRIME study at Yale University, which they cite as impetus for the development of STEP, an early psychosis clinic. Initial attempts to develop direct services within the Department at UCSF were unsuccessful, as outpatient services at the time lacked the case management capacity necessary for this population. In addition, early psychosis services for adolescents and young adults did not fit neatly into either of the existing adult or child/adolescent service areas.
Through this connection, a community-academic partnership was formed with FSA providing extensive experience in developing comprehensive service systems for youth and adults and UCSF providing training in evidence-based practices for early psychosis, including formal diagnosis, medication management and Cognitive Behavioural Therapy for Psychosis (CBTp). The PREP partnership was born, its primary goal to rigorously and effectively provide treatment for those with recent onset psychosis or at ultra-high-risk of developing psychosis. PREP embodies the principles of Community Participatory Partnered Research as described by Jones and Wells, 12
emphasising equal partnership in the implementation of ‘research informed programs’ and can be thought of as being on a continuum between research originating in an academic setting and research that originated in the community. Green, Daniel and Novick13
argue that academic-community partnerships are essential in program development as “no one agency has the resources, access and trust relationships to address the wide range of community determinants of public health problems” (p21). They go on to state that productive partnerships commence with the identification of a problem (in the case of PREP, the lack of adequate services for individuals experiencing early psychosis), shared ownership of goals and missions and are built on the strengths of each partner. As described this partnership was forged from the outset, rather than later establishing partnerships and so benefitted from an established relationship and shared vision developed by the partners together. Importantly, it drew upon the strengths of the partners to utilise academic-level stringent implementation with measured fidelity and evaluation of the program, combined with the expertise of the community partners to implement services within the publicly-funded mental healthcare system.
Fortuitously, at the same time that the partners began developing PREP, a funding stream designated specifically for preventative mental health services became available from the State of California. The Mental Health Services Act (MHSA) was passed in 2005, stipulating that personal income over 1 million dollars annually be taxed at an extra one percent rate; these funds were then distributed at the County level to support mental health services with a prevention or early intervention focus. PREP partners educated the San Francisco County Department of Public Health and community members about EI for psychosis. Subsequently, a model was proposed as part of the SF County’s plan and a Request for Proposal was issued for an Early Psychosis Program. During this time, FSA recruited our third partner, Mental Health Association of San Francisco (MHA), an advocacy organisation who could provide community outreach and education. This collaboration helped to forge partnerships with Larkin Street Youth Services, an organisation focused on services for homeless youth, who now house a PREP Peer Outreach provider, and Sojourner Truth Foster Family Service Agency, who employ a PREP clinician to serve the foster care system (see for a description of partner agencies).