Harmony is one of three mental health block grant funded programs in the State of Iowa. It is based upon the NAVIGATE treatment model. NAVIGATE is a comprehensive program designed to provide early and effective treatment to individuals who have experienced a first episode of psychosis. It was developed with support from the National Institute of Mental Health’s ‘Recovery After an Initial Schizophrenia Episode’ (RA1SE) project.
Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
Psychosis is a symptom, not an illness, and it is more common than you may think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as three in 100 people will have an episode at some point in their lives.
First-Episode Psychosis refers to the first time someone experiences psychotic symptoms. People experiencing a first episode of psychosis may not understand what is happening. The symptoms can be disturbing and completely unfamiliar, leaving the person confused and distressed. It is usually unclear during a first episode what will happen with symptoms over the long run and if the early problem will develop into something more long-term. A psychotic episode typically occurs in three phases. The length of each phase varies from person to person.
• Phase 1: Prodrome – The early signs are vague and hardly noticeable. There may be changes in the way some people describe their feelings, thoughts and perceptions.
• Phase 2: Acute – Clear psychotic symptoms are experienced, such as hallucinations, delusions or confused thinking.
• Phase 3: Recovery – Psychosis is treatable and most people recover. The pattern of recovery varies from person to person. Most people first experience psychosis as teenagers or young adults. For some people, psychosis tends to be episodic, with symptoms coming and going at varying levels of intensity after the first episode. Many people can and do recover from psychosis.
Early warning signs before psychosis
Early psychosis or FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn’t understand what’s going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor.
Encouraging people to seek help for early psychosis is important. Families are often the first to see early signs of psychosis and the first to address the issue of seeking treatment. However, a person’s willingness to accept help is often complicated by delusions, fears, stigma and feeling unsettled. In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.
It’s important to get help quickly since early treatment provides the best hope of recovery by slowing, stopping and possibly reversing the effects of psychosis. Early warning signs include the following:
• A worrisome drop in grades or job performance
• Trouble thinking clearly or concentrating
• Suspiciousness or uneasiness with others
• A decline in self-care or personal hygiene
• Spending a lot more time alone than usual
• Strong, inappropriate emotions or having no feelings at all
Signs of early or first-episode psychosis
Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:
• Hearing, seeing, tasting or believing things that others don’t
• Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe
• Strong and inappropriate emotions or no emotions at all
• Withdrawing from family or friends
• A sudden decline in self-care
• Trouble thinking clearly or concentrating
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Psychosis includes a range of symptoms but typically involves one of these two major experiences:
Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:
• Hearing voices (auditory hallucinations)
• Strange sensations or unexplainable feelings
• Seeing glimpses of objects or people that are not there or distortions
Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:
• Believing external forces are controlling thoughts, feelings and behaviors
• Believing that trivial remarks, events or objects have personal meaning or significance
• Thinking you have special powers, are on a special mission or even that you are God.
Our focus is on RECOVERY vs maintenance
• Social/leisure functioning (quality of relationships, involvement in activities, etc.)
• Role functioning (school, work, parenting, etc.)
• Well-being (self-esteem, hope, sense of purpose, etc.)
How is NAVIGATE different from other treatments?
• Stress-Vulnerability Model – biological vulnerability + stress = symptoms
• Biological – Medications
• Stress – IRT, FEP
• Supported employment
• Social Rehabilitation or skills training methods
• Building Hope and Resiliency
• Family and other supports
• Team aspect
• Shared decision making models
• Collaborative Treatment Planning
Phases of Navigate:
• Engagement and Stabilization Phase
• Recovery Phase
• Team Leader/Program Director: Leslie McDonald-Gonzalez, LISW
• Prescriber/Medication Manager (MM): Melissa Konken, NP
• Individual Resiliency Training (IRT) Therapist: Emily Donoghue, LMHC, NCC
• Family Education Program (FEP) Therapist: Tiffany Holbrook, LMHC
• Supported Employment & Education (SEE) Specialist: Callie McCord, PSS
• Community Support (CSS) Specialist: Erika Worrell, LBSW, CCPD
To help individuals with a first or early episode of psychosis, and their families, successfully find their way to psychological and functional well-being. To assist with access to the services they need within the mental health system.
• Early Intervention =Illness Management & Recovery
• Shared Decision Making & Active Learning Model
Team Leader/Program Director
• Provides oversight to the team to ensure adhesion, encourages effective communication, and directs care based on the client’s strengths and preferences
• Responsibilities include: logistics, outreach, referrals, forming the team, leading the team, facilitating team meetings, engaging clients and families, and clinical supervision
Medication Management (MM)
• Prescriber provides pharmacological intervention, which includes assessment and management of medications, side effects, and adherence.
• Use of Compass – measurement based care tool
• Use of shared decision making model
• Integration with team
Individual Resiliency Training (IRT)
• Assists clients in learning about psychosis, processing their experiences, developing a relapse plan, increasing resiliency, learning specific strategies and skills to achieve their own personal goals while promoting recovery.
• Addresses multiple domains of impairment:
• Illness self-management
• Substance use
• Residual and/or emerging symptoms
• Trauma and PTSD
• Functional difficulties
• Aims to promote recovery through strengths and resiliency factors
• Module based
Family Education Program (FEP)
• Provide family (including client) with education about psychosis, coping strategies, and skills for communicating and solving problems.
• To reduce relative burden
• To help the relatives build on their strengths to create and maintain an environment to support he client’s recovery
• Engagement, orientation, and assessment
• Stabilization and facilitating recovery
• Consolidating gains
• Prolonged recovery
Supported Employment and Education (SEE)
• Helps clients get back on track with work or school.
• The goal of SEE is to help people develop and maintain personally meaningful goals related to their careers, their education, and their employment.
• SEE services are individualized for each person based on their preferences, goals, and values.
• SEE services are provided based on the person’s choice to pursue employment or education, or both.
Community Support (CS)
• Identify barriers
• Assist with meeting basic needs
• Links clients and families to identified community resources
• Services are community based
• Extension or supplement all other services
• Age 16-40
• Experiencing symptoms of psychosis
• Meets criteria or has a diagnosis of:
• Schizophrenia with this link https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia
• Schizophreniform Disorder
• Schizoaffective Disorder with this link https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizoaffective-Disorder
• Brief Psychosis
• Psychosis NOS
• Major Depressive Disorder with Psychotic Features
With the above links please make the words be a clickable link. The link should open in a new window and not take the person away from our site.
Funded in part by Iowa Department of Human Services, Mental Health Bock Grant
For more information or to make a referral, please contact:
Leslie McDonald-Gonzalez, Program Director
(712)252-3871, ext. 212