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Clinical High Risk for Psychosis (CHR-P) refers to changes in thinking, perceptions and behavior in adolescence and early adulthood that indicate possible progression to psychosis. The Pennsylvania (PA) Stepped-Care (SC) Approach to CHR-P will provide community outreach to identify young people in Philadelphia and Pittsburgh who meet CHR-P criteria and enroll them in an integrated, SC treatment including family and individual psychoeducation, therapy, substance use education and risk reduction, supported education and employment, peer support, and psychopharmacology, as appropriate for the individual. This effort is crucial for early identification, followed by graduated interventions based on severity of clinical symptoms and dysfunction involving youth with CHR-P and their families. The Psychosis Evaluation and Recovery Center (PERC) at the Neuropsychiatry Program of the University of Pennsylvania (UPENN) and the Hope Team at the University of Pittsburgh Medical Center (UPMC) have extensive experience in assessment and management of youth with CHR-P. PERC/HOPE partner with community-based organizations to provide outreach and coordinated specialty care sensitive to the special needs of this population. PA sites have collaborated on the SAMHSA-funded CHR-P grant since 2018 and have harmonized the approach and data acquisition between the two sites. Other strengths of our collaboration are geographical diversity, recruitment from urban, suburban, and rural settings, diverse age range and ethnicity of youth and young adults. Despite strict social distancing procedures enacted since March 2020, which affected outreach and all aspects of clinical care, PA was able to pursue the goals articulated in the initial application. The current proposal builds on the work achieved to date and proposes new goals to improve community awareness of and accelerate referral pipelines for young people with CHR-P through targeted and enhanced education efforts, provide an integrated SC approach to CHR-P clinical services, and implement quality improvement to enhance service delivery and community education. Each of these goals will involve participants and stakeholders to improve service delivery and outreach. PA will employ several specific strategies to better serve and rapidly recruit young people from underserved and minoritized backgrounds. PA proposes to enroll 25 new young people annually in Years 1, 30 in year 2 and 35 annually in Years 3-4, for a total of 125, split approximately evenly between the two sites. Youth with CHR-P experience variable clinical symptoms, impaired functioning, and quality of life. Their families also experience distress. Prior work indicates that as many as 12% of community youths experience CHR-P symptoms, and the majority initially seek mental health care for associated symptoms such as depression and anxiety. Yet, unless specifically asked about early psychosis symptoms, the presence of CHR-P symptoms may not be detected by care providers who serve as the first points of contact. Delayed treatment access and prolonged duration of untreated psychosis (DUP) are associated with worse outcome during this critical period of development. PA proposes to expand and refine efforts of community outreach with mental health care providers, pediatric and primary care offices, and schools to provide training in CHR-P symptoms and screening. Goals of our SC approach include improvement in clinical symptoms and functioning, preserving the steep developmental trajectory expected in adolescence and early adulthood, and, where possible, limiting DUP. Performance Assessment and Quality Improvement will be performed quarterly in conjunction with outcome measure data collection as program-level data, using selected tools to assess program effectiveness and track pathways to care and outcomes. Our goal is to help those with CHR-P flourish in the community and continue their chosen life paths.

Oregon Health Authority Clinical High-Risk for Psychosis (CHR-P) Program will be implemented in Lane County, Oregon, in partnership with PeaceHealth Medical Group and the EASA Center for Excellence. This project will offer targeted community outreach and education as well as Coordinated Specialty Care to youth and young adults up to age 25 who meet the criteria for Clinical High Risk for Psychosis and are residing Lane County, Oregon. Lane County includes the University of Oregon and is a combination of rural and urban communities with a population of approximately 383,000. The program will serve 84 individuals in year one, 88 in year two and 92 in year three, and 97 in year four, for a total of 361 clients served. Eligibility will be determined through administration of the Structured Interview for Psychosis-Risk Syndromes (SIPS) and will include individuals who are identified as having one of three diagnosable high-risk syndromes. The project will integrate expanded Clinical High-Risk services into its existing Coordinated Specialty Care team and will integrate expanded community education and outreach and a step-wise treatment decision making process and manualized treatment for individuals who are clinically high-risk for psychosis. Interventions will build on current research. The first goal of the project is to strengthen outreach, collaboration and education with community partners to improve identification and recruitment of young adults at risk for CHR-P. This goal will be accomplished by increasing outreach contacts, creating and disseminating educational materials and establishing relationships with primary and secondary outreach locations, including PeaceHealth Medical Group primary care clinics and Lane County Behavioral Health. The second goal is to enrich CHR-P services using evidence-based assessments and treatments and to connect to underserved populations. We will focus on assessments, culturally appropriate curriculum and interventions, and identifying gaps of service. The final goal of the project is to develop educational and training materials that can be accessed by other agencies establishing CHR-services. We aim to create workflow practices and procedures and hold two conferences to disseminate this information and provide education and support to other agencies in Oregon and beyond.

The Research Foundation for Mental Hygiene on behalf of the New York State Office of Mental Health is partnering with the Zucker Hillside Hospital (ZHH) to implement SWAY: Supporting Wellness for Adolescents and Young Adults at Clinical High Risk for Psychosis (CHR-P). Our goals are to (1) increase the identification of youth at CHR-P and connection of individuals with CHR-P to specialized services, (2) train behavioral healthcare staff in evidence-based screening, assessment, and intervention for youth at CHR-P, (3) provide evidence-based interventions for a diverse, underserved communities of youth and young adults ages 12-25 at CHR-P to improve symptoms and functioning, and (4) delay or prevent the onset of psychosis and minimize the duration of untreated psychosis for those who do develop psychotic symptoms. We will train providers in the assessment of CHR-P using the Structured Interview for Psychosis-Risk Syndromes (SIPS) and other tools, and individuals who are identified as meeting CHR-P criteria will be offered enrollment in SWAY, where they will receive stepped-care evidence-based treatment. As recommended by the literature, the evidence-based approach will be flexible and modular to meet the diverse needs of individuals experiencing CHR-related distress and based on the evidence-based interventions provided to individuals experiencing early psychosis, including CBT-informed psychotherapy and psychoeducation for participants and their families. The CHR-P team will include a program coordinator responsible for clinical supervision, overseeing overall team functioning, and outreach; a clinical coordinator who will be the primary therapist; a supported employment and education specialist; and a psychiatrist. We expect to provide stepped-care services to approximately 20 individuals per year, and to serve a total of 80 people during the project period. Services will be provided in a flexible, developmentally sensitive way, in participants' homes, community or in the clinic, with an ability to modify the frequency and intensity of services to meet needs and honor preferences. For individuals who are identified as having early psychosis, either at the time of the eligibility evaluation or due to conversion after enrollment, referrals will be made for Coordinated Specialty Care to the OnTrackNY team at the Early Treatment Program at ZHH, or other OnTrackNY teams based on availability and/or geographic preference of the young person and their family.

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) is committed to establishing and supporting evidence-based practices for youth and young adults (Y/YA) who are at clinical high risk for psychosis (CHR-P). TDMHSAS will serve as the locus of accountability for the Tennessee CHR-P and will be responsible for oversight of state and local grant related activities and outcomes. The CHR-P program will align with system of care guiding values and principles and will fall within an array of community-based services and supports focused on promotion, prevention, early identification, treatment, and recovery. The four CHR-P project goals are to 1) delay or prevent the onset of psychosis by increasing community awareness of the CHR-P program and early identification and screening procedures, 2) improve symptomatic and behavioral functioning in Y/YA at CHR-P, enabling them to resume age-appropriate social, academic, and/or vocational activities, 3) minimize the duration of untreated psychosis for Y/YA who develop psychotic symptoms, and 4) develop and implement capacity building strategies to provide sustained service delivery to Y/YA and their families. This will be accomplished through a partnership with a local service provider, Alliance Healthcare Services, who will implement targeted outreach and engagement strategies and co-locate an evidence-based stepped-care model for CHR-P with their existing coordinated specialty care program, OnTrackTN, in Shelby County, Tennessee. Due to the high prevalence of individuals who experience psychosis in this area as compared to other areas of the state, it is critical to provide early identification and intervention services to Y/YA ages 12 to 25 who are at CHR-P in order to have the greatest impact on prognosis and minimize the duration of untreated psychosis. By co-locating this CHR-P site with an existing OnTrackTN site, service provision for Y/YA on the psychosis spectrum in Shelby County will be enhanced, further minimizing and/or preventing the duration of untreated psychosis. Team-based services and supports will include access to individual and family psychoeducation, substance use risk reduction, Cognitive Behavioral Therapy for psychosis (CBT-p), supported employment and education, young adult and family peer support, evidence-based pharmacotherapy, as warranted, and case management. The stepped-care model will include evidence-based interventions of varying complexity, intensity, and duration that will be utilized to target symptoms, problems, and functional impairments characterizing different clinical high-risk states. It's anticipated that the CHR-P team will serve a total of 88 Y/YA by the end of the grant, including: 15 Y/Y in year 1, 25 Y/YA in year 2, 30 Y/YA in year 3, and 18 Y/YA in year 4. TDMHSAS will also utilize an existing staff within the Office of Research, Division of Administrative and Regulatory Services, who is the evaluator for our Healthy Transitions and First Episode Psychosis Initiatives to conduct evaluation, as well as develop and implement data protocols and procedures that will be used to inform changes in individual treatment and program implementation. This coordinated approach to care, in close collaboration with the OnTrackTN team within the same agency, will increase workforce capacity and create a more robust continuum of care for Y/YA in Shelby County at CHR-P experiencing a first episode of psychosis.

Through the Clinical High Risk for Psychosis (CHR-P) program, Integral Care will implement a stepped-care model to reduce the durations of untreated psychosis for individuals under the age of 24 in Travis County (Austin), Texas. This project will implement evidenced-based screening an assessment utilizing the Prodromal Questionnaire-Brief (PQB) and the Structured Interview for Prodromal Symptoms and expand Integral Care's Coordinated Specialty Care (CSC) services for youth and young adults experiencing psychosis. This evidence based model for treating first episode psychosis supports shared decision making through a team of specialists working together to support the client with their needs and goals and has been shown to result greater improvement in symptoms, relationships, quality of life, work/school involvement, and treatment engagement when compared to traditional services. CSC is part of a continuum of behavioral health services of varying intensity that support transition-age youth and help them remain engaged in care. Outreach and screening efforts will be focused on individuals ages 15-25 and will target three groups: new and current clients who are 15 to 17 years old and have not yet transitioned to adult mental health services, new clients who are 18-25 years old and entering services through standard agency processes (standard intake or crisis), and individuals between the ages 15-25 who are referred from secondary or post-secondary schools. Integral Care plans to serve 500 individual annually through this project. By enhancing its existing CHR-P program and increasing its capacity to deliver CSC services, Integral Care can improve access to care and reduce the wait time for young adults at high risk of psychosis, thus improving clinical prognosis and quality of life outcomes. Goals for this project include: enhancing current CHR-P program by hiring a new Clinical Coordinator and Case Manager, training 30 staff annually in the PQB screening and expanding the age range for eligible clients to include 15 year olds; increasing capacity for CSC in Travis County by hiring additional staff to reduce caseloads and adding 5 slots for clients; ensuring strategies and structures are informed by system of care principles by expanding family and youth partnership[s, expanding youth and family driven quality improvement committee, attending one provider meeting per year to provide information on CHR-P, and incorporating families and youth in shared decision making; and expanding outreach to secondary schools and post secondary education with outreach to a minimum of one secondary or postsecondary school per quarter and screen all referrals from these institutions.

Youth at clinical high risk for psychosis (CHR-P) are under-recognized in community mental health (CMH) settings, and identified youth do not have adequate access to evidence-based care. The UC Davis CHR-P Project closes this critical gap for CHR-P youth (ages 12-25) in Sacramento County, CA through: 1) large-scale electronic screening to identify youth experiencing CHR-P symptoms followed by expert assessment to clarify CHR-P status and 2) linkage to stepped-care intervention to prevent or mitigate negative outcomes supported by expert training and supervision. Project goals are to: 1) Increase capacity of Sacramento County CMH services to identify and link youth experiencing CHR-P symptoms by implementing a universal screening and referral protocol; 2) Increase capacity of Sacramento County CMH services to provide evidence-based care for CHR-P youth via stepped-care of evidence-based assessment and treatment services. Key measurable objectives include: implement universal screening for CHR-P in CMH (yr 1+); implement comprehensive assessment and linkage to stepped-care services for youth who screen positive for CHR-P (yr 1+); train CMH partners in evidence based practices (EBPs) for CHR-P (yr 1-4); and support ongoing training needs via bi-monthly consultation calls (yr 2+). As most CHR-P youth will either see remission of risk-symptoms in the first 12 months (Fusar-Poli, Bonoldi et al. 2012), stepped care approaches place initial assessment and treatment in the community while reserving specialized services, like coordinated specialty care - the evidence based practice for psychosis symptoms that is provided by the UC Davis EDAPT clinic - for youth who do not improve with typical community care. Previous screening research indicates that roughly 30% of those seeking care in similar health systems meet psychosis risk screening criteria (de Jong, Mulder et al. 2018) and UCD has successfully supported implementation of CHR-P screening in multiple Sacramento sites during a prior NIMH study (Niendam, Loewy et al. 2018). As estimates suggest prevalence rates of CHR-P as high as 4-8% (van Os, Linscott et al. 2009), at least 30,000 individuals in Sacramento County may show signs of psychosis-risk that warrant assessment and possibly monitoring or intervention. Currently, UC Davis EDAPT is the only specialty mental health clinic focused on identifying and treating early psychosis, including CHR-P and threshold psychosis within 2 years of onset. Current staffing supports a capacity to treat roughly 80 Medicaid eligible clients/families and 100 private insurance clients/families at any time, meaning the vast majority of those at-risk for psychosis are not currently being identified or receiving specialized services. We propose to leverage our prior experience using electronic psychosis screening to increase identification of CHR-P in the Sacramento community (Niendam, Loewy et al. 2018) and successful implementation of a CHR-P stepped care protocol (Hartmann, Nelson et al., Nelson, Amminger et al. 2018) in the EDAPT clinic (Shapiro, Grattan et al. In Preparation) to increase CHR-P services in CMH settings. Our team is uniquely positioned to carry out this work. UC Davis is nationally recognized as leaders in the development and implementation of EBPs for youth with psychosis in diverse settings. Over the 4-year project, we anticipate screening a total of 2700 individuals in CMH; we estimate conducting 716 comprehensive assessments with youth who screen positive for psychosis; and we estimate 198 youth will receive CHR-P services over the course of the project. By the end of the project, we will have increased CHR-P service capacity from 22 to 66 individuals annually, tripling Sacramento County capacity to provide evidence-based care to youth with CHR-P. this project will also build the necessary screening, assessment, and training infrastructure to support ongoing expansion of CHR-P services in Sacramento County and across the US.

Dear Mind 2 will use the Prime PC as the universal screening tool for the project and the Structured Interview of Psychosis-Risk Syndromes as the assessment tool to identify youth and young adults, not more than 25 years old, at clinical high risk for psychosis. The Coordinated Specialty Care framework will be employed to assure all individual and family needs are identified and the evidence-based resources offered are the least intensive services that can provide the needed treatment and supports. The population to be served is youth under 25 and their families living in the County of Beaver, Pennsylvania. Beaver County is in southwestern Pennsylvania, approximately 30 miles from Pittsburgh and sharing a border with Ohio and West Virginia. Beaver County was ranked in the top 20 (top 1%) nationally for opioid overdose deaths in 2016 (University of Pittsburgh School of Public Health 2018). The County’s median salary is $37,333 with 10% of the population living below federal poverty level with slightly more than 14% of all children in the county experiencing poverty (U.S. Census Bureau 2020). The 2020 Census Bureau population is 164,781 reflecting a 9% decline since 2000 (181,412). Approximately, 27% of the population is under the age of 25 and 3471 used behavioral health Medicaid services in 2017. This number is in addition to those who accessed behavioral health services through third party insurances. The racial composition of the population is predominately Caucasian at 93% followed by African Americans at 8% and 2.9% of households are non-English speaking within the home. Dear Mind 2 will build on four years of the original Dear Mind (Clinical High Risk for Psychosis) grant and more than the decade of system of care work that has come to define the Beaver County service system. A well-established management structure is in place for the Beaver County System of Care. Individuals with lived experience comprise more than 70% of each committee. Schools, the justice system, child welfare, the faith-based community, the manage care provider and the behavioral health system work collaboratively, using evidence-based practices, to support shared clients. An electronic service plan is being shared across systems and work continues to expand information sharing technology. The CSC model built with the original Dear Mind grant will be utilized and enhanced with Dear Mind 2. Goals and measurable outcomes of Dear Mind 2 are to enhance the stepped-care services available through the current CSC model and expand universal screening of early psychosis through enhanced outreach, education, and engagement processes. Research and evaluation will be key to program implementation, redesign, and ultimate success. Dear Mind 2 will outreach to 1500 individuals, screen 650 and enroll 55 by the end of the four-year project.

Fairfax-Falls Church Community Services Board (CSB) is proposing a stepped-care program for individuals who may be considered clinically high-risk for psychosis (CHRP). This program would continue to build off of a current CHRP program that is co-located with a first episode psychosis (FEP) program. The CHRP program will focus on providing Evidence-Based interventions including cognitive behavioral therapy (CBT) for psychosis, and group and family CBT interventions for individuals experiencing attenuated symptoms of psychosis. Individuals served in the program will be between the ages of 14 and 25. Individuals served will come from all areas of the catchment (Fairfax County, Cities of Fairfax and Falls Church, and Towns of Vienna and Herndon). Individuals served would be expected to represent the demographics of the community - 61% are White, 10% are Black, 19% are Asia/Pacific Islanders, 10% are other/multi-racial and 16% are Hispanic. These individuals may be exhibiting pre-psychosis symptoms including noticeable changes in perception, thinking or functioning that may be accompanied by attenuated symptoms of psychosis, brief episodes of psychosis, or have a known first-degree relative with psychosis. Services would start with once weekly outpatient individual therapy, and can be stepped up to more intense services to include medication management, group and family psychotherapy, education and employment supports, and peer support. It is expected that the program will serve at least 35 individuals each year, or 140 over the course of the project. The project's goals are to: educate at least 300 individuals about early psychosis screening and intervention over the course of the project, identify and screen 400 individuals (100 annually) for psychosis-risk syndromes over the course of the project, and provide at least one session of family psychoeducation to at least 140 families over the course of the project. Through intervention and support, the CHRP program expects that 85% of individuals enrolled would be able to be engaged in educational activities or employment. It is expected that through effective and timely intervention through a stepped-care model, that fewer than 10% of individuals enrolled would convert to a first episode of psychosis. The program would intend that 100% of individuals experiencing a first-episode of psychosis would transition into the Fairfax-Falls Church CSB Turning Point coordinated specialty care program.

Project Abstract Summary The Massachusetts Psychosis Prevention Partnership (M3P) is a collaboration between statewide experts in clinical high risk for psychosis (CHR-p). M3P seeks to create a statewide system of care for CHR-p to enhance the accessibility, equity, capacity, and quality of CHR-p services across MA. This is accomplished through community outreach, centralized triage and referral, specialized CHR-p stepped-care treatment, and training in CHR-p evidence-based practices. The primary goals of M3P are as follows: 1) Ensure & expedite early identification of CHR-p via centralized outreach and consultation to community referral partners; 2) Minimize barriers to assessment and referral to CHR-p treatment via a statewide triage and referral call center; 3) Support and improve functioning and decrease likelihood of illness progression for youth at CHR-p via stepped-care treatment; and 4) Expand the statewide workforce of CHR-p service providers via an enhanced training infrastructure. M3P builds upon existing infrastructure provided by members of the Partnership, including the Massachusetts Psychosis Access & Triage Hub (M-PATH), the Massachusetts Psychosis Network for Early Treatment (MAPNET), and the three current clinical programs for CHR-p located in McLean Hospital, Massachusetts General Hospital, and the Brookline Center for Community Mental Health. Outreach (Step 0) is conducted with community referral partners such as schools, primary care, and other social service agencies. At Step 1, youth identified with potential psychosis risk receive brief phone-based screening to determine the level of services needed. At Step 2, youth with identified CHR-p risk receive a comprehensive clinical assessment to aid in treatment planning. Those with moderate symptoms move to Step 3, a brief treatment intervention and connection to community providers, while those with severe symptoms move to Step 4, extended treatment at a coordinated specialty care (CSC) clinic for CHR-p. Lastly, youth identified at any stage to experience full psychosis move to Step 5, extended treatment at a CSC program for first-episode psychosis. Partnerships will be maintained with other community services (ie. Substance Abuse Treatment, In-Home Therapy) to facilitate additional referral for youth with identified needs outside of the psychosis spectrum. Concurrent with these steps, a learning collaborative will be instituted to develop the CHR-p workforce through expert training in evidence-based assessment and treatment practices. By the end of the fourth grant year, M3P will provide outreach to 1,450 individuals, triage and referral services to 900 youth and families, and clinical care to 575 youth and families.

The Center for Health Care Services will implement an outreach and early intervention program designed to assist adolescents showing first signs of psychosis. A Coordinated Specialty Care model will quickly identify and connect 60 youth to age-appropriate treatment. The program will be staffed by clinicians, care managers and peers trained to deliver evidence-based services that foster critical education, employment and community reintegration outcomes. Project Name: A Community Program for Outreach and Intervention with Adolescents at Clinical High Risk for Psychosis Population to Be Served: Youth ages 13 to 19 with early indicators of psychosis, i.e., recent manifestation, no longer than three years. Participant demographics will include: 100% between the ages of 13 and 19; 52% male and 48% female; 52% Hispanic, 24% White, 14% Black; 50% at or below federal poverty guidelines. Goal, Objectives: Goal: Implement a coordinated specialty care model that delivers community based, youth-centric, evidence-based, trauma-informed interventions to identify and prevent or lessen the impact of psychotic disorders in 13-19 year olds at clinical high risk for psychosis. Objective 1: Identify youth at clinical high risk for psychosis and connect potentially eligible individuals to the program. Objective 2: Improve the symptomatic and behavioral functioning of participants to delay, prevent, or manage the onset of psychosis. Objective 3: Enable participants to resume social, academic and/or vocational activities. Objective 4. Use proven practices and strategies to support families in remaining recovery focused and adjusting to special challenges related to the participant’s mental health needs. Primary Services: Individual or group psychotherapy; family support and education, pharmacotherapy, supportive employment and education, and case management. Annual and Four Year Outcomes: At least 15 youth will participate in project services per year; 60 in the four year project period. At least 14 youth will be reconnected with education or employment activities per year; 56 in the four year project period. At least 13 families will be assisted per year in supporting their child’s recovery and minimizing the duration of untreated psychosis; 52 in the four year project period. Number to Be Served: 15 youth per year/60 in four years; 13 families per year/52 in four years.

Project Abstract Summary: Maine CHRP Project Project Description: The State of Maine intends to rebuild and expand capacity to identify, prevent, intervene, and/or lessen the impact of psychotic disorders. This will be accomplished through a collaborative effort between the Maine Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS), the Office of Behavioral Health (OBH), the Office of Child and Family Services (OCFS) and MaineHealth (MH). It will advance over two decades of efforts to intervene early in serious mental health challenges and bring Maine into alignment with current evidence-based and trauma-informed best practice. MH’s Portland Identification and Early Referral (PIER) program leadership, which will implement the project services, has a nationally recognized role in training new clinical high risk for psychosis (CHRP) programs in evidence-informed community outreach, structured clinical assessment, and family-focused coordinated specialty care. This includes ongoing supervision, monitoring treatment fidelity, and measuring outcomes. They are extremely well-qualified to reestablish state-of-the-art CHRP services in Maine. PIER Clinical High-Risk for Psychosis Program (PIER CHRP) will screen for, identify, and engage young people in evidence-based services appropriate for early-stage mental illnesses, reducing the Duration of Untreated Psychosis (DUP) and improving their future mental health outcomes. Accomplishing this in Maine requires addressing challenges of regions with minimal mental health workforce, a geographically dispersed population, and rural poverty. The project team will assess and facilitate appropriate care for a minimum of 220 individuals ages 12-25 and their families or caregivers between September, 2022 and August, 2026. For individuals identified as at CHRP, structured assessments and shared decision-making will guide evidence-informed treatment within a stepped care model. Stepped care will be conducted in close collaboration with statewide peer support services, community mental health services, primary care, schools, law enforcement, youth service organizations, faith-based organizations, indigenous and immigrant communities, and a rich network of other partners. Goals: 1) Identify young people ages 12-25 at CHRP reflective of the five-county catchment area population (Androscoggin, Cumberland, Oxford, Sagadahoc, York). The project will leverage already strong community partnerships to improve early psychosis literacy, psychosis screening, and timely referral of youth from all segments of the community. It will include a bidirectional referral relationship with the existing PIER coordinated specialty care program for first episode psychosis and community workforce development activities. 2) Treat CHRP youth through a trauma-informed stepped care model with steps ranging from psychoeducation and consultation to full team-based care. Initial stratification and step changes will be determined by structured assessments and shared decision-making. Steps will include a range of evidence-based and evidence-informed treatment components and collaboration with and consultation to community providers. 3) Improve clinical and functional outcomes for CHRP youth and young adults and achieve a median duration of untreated psychosis of under 3 months for those who transition to a psychotic disorder. Quarterly review of clinical and program performance data will guide and monitor programmatic changes and quality improvement activities.

This project intends to fundamentally improve the lives and trajectories of adolescents and young adults at clinical high-risk (CHR) for the onset of a psychotic illness such as schizophrenia. We propose to expand upon our already existing CHR collaboration between the University of Maryland School of Medicine, UMBC, and the Maryland Behavioral Health Administration to create a comprehensive, evidence-based, stepped model of care for those at CHR. In addition to risk for psychosis, individuals at CHR present with high rates of depression and anxiety, suicidality, and substance abuse, all of which contribute to the significant functional impairment affecting this population. Additionally, youth in our catchment area are often exposed to environmental risk factors for psychosis at high rates, including poverty, violence exposure, and substance abuse. As a result, it is likely that our target population is at elevated risk for serious mental health problems beyond what is attributable to their CHR symptoms alone; our clinical model attends to both the specific needs associated with CHR, as well as the general mental health and system. The aim of this project is to improve long-term outcomes of individuals at CHR through a staged, modular, and evidence-based intervention. Drawing from the available literature on treatment for those at CHR, we have distilled treatment components from demonstrably effective CHR clinical trials into a series of modules that, following completion of a core psychosocial curriculum, are matched to the client's idiographic needs. Central components of the intervention include culturally-sensitive and state-of-the-art assessment, psychoeducation, cognitive behavioral therapy, supported education and employment, substance use treatment, and pharmacotherapy, as well as seamless transfer to specialty care within our existing clinical network in the case of emergent psychosis. As we have a seven-year history of active community outreach and engagement, consumers will be identified from our comprehensive network of connections with mental health providers throughout the state (including rural Maryland through our tele-psychiatry program). They will then be screened for psychosis-risk, assessed more thoroughly if screening positively, and offered specialized services (either consultation with existing provider, or transfer of care to our team as indicated). By the end of the 4-year funding period, we will have screened 1,000 clients (250/year) for CHR services, conducted SIPS or Mini-SIPS interviews with approximately 200 individuals (50/year), and provided clinical services to approximately 60 (15/year) of those meeting CHR criteria. Our goals are to (1) improve social and role functioning among clients; (2) reduce the severity of psychosis-risk symptoms; (3) prevent or delay progression to formal psychosis; (4) curb the burden of the first psychotic episode, if one is to emerge; and (5) improve overall subjective quality of life for our clients.

Through a collaborative partnership, the New Jersey Department of Children and Families, Division of Children's System of Care and the New Jersey Department of Human Services, Division of Mental Health and Addiction Services have developed the NJ PROMISE program to provide outreach and intervention for youth and young adults up to age 25, who may be experiencing early symptoms of psychosis. Youth and young adults at clinical high risk for psychosis will benefit from early outreach and intervention, to fundamentally change the trajectory and prognosis of psychosis and to mitigate the impact to overall functioning and wellbeing. Through extensive outreach, NJ will be able to connect with youth and young adults who are at clinical high risk for psychosis and provide them with education and interventions to delay, if not prevent, the onset of psychosis. The NJ CSOC DMHAS partnership offers a robust care continuum throughout the state, utilizing established behavioral health agencies who have provided treatment services for persons experiencing first episode psychosis (FEP) sine 2016, and treatment for individuals at clinical high risk for psychosis since 2019. For FFY 2023 through 2026, NJ DCF will administer the program NJ PROMISE 2.0, and anticipates partnering with the existing CHRP clinics that have been operational for the last four years. NJ anticipates providing intervention to approximately 36 youth and young adults across the state annually, and 144 youth and young adults over the four year grant period. Through extensive outreach, coordinated care, the use of evidence based, evidence informed, best, and promising practices as well as the expertise of a team of professionals, participants and their families will have the tools necessary to lead productive lives in their homes and communities. In NJ PROMISE 2.0, we will add a Care Manager to each clinic site, to assist the clinical staff in collaborating with school personnel and other involved providers. The project's measurable goals are to: Reduce the occurrence of psychotic disorder in youth and young adults who are at clinical high risk for psychosis; Increase the functioning of youth and young adults at clinical high risk for psychosis at school and employment settings; Reduce the duration of untreated psychosis in program participants who develop psychosis. By achieving the goals of the program and meeting the outcomes desired, the NJ PROMISE program will lead to significant positive outcomes including the improvement in social, educational, emotional, and vocational activities for youth and young adults which will not only improve the lives of the youth and young adults, but of their families as well.

The proposed project will support the continued operation and expansion of the clinical high-risk for psychosis (CHR-P) program at The Ohio State University Early Psychosis Intervention Center (EPICENTER). The EPICENTER CHR-P program has demonstrated efficacy with regard to minimizing rates of transitions to psychotic disorders, reducing symptomatic distress, and promoting functional improvements among individuals at CHR-P. Care provided at the EPICENTER CHR-P program includes options for psychotherapy, medication, enhancement of social functioning, family services, and vocational/educational support. As part of the step-based care design, individuals presenting to the clinic are initially provided with low intensity interventions and continue to more intensive treatments until they meet predetermined criteria for symptomatic improvement and functional stability. This specialized care is provided to individuals living in Franklin County between the ages 12-25 who meet CHR-P criteria as determined using the Structured Interview for Psychosis Risk States (SIPS). During the course of this project, we anticipate enrolling 20 unique individuals per year in the CHR-P program. Thus, we anticipate enrolling 80 individuals over the course of the funding period. Based on the demographic profile of the population of Franklin County, we anticipate that the racial breakdown of individuals served at this clinic will be 52% White; 27% Black, 8% multiracial, 5% are Asian, with the remaining 7% identifying as Native American, Pacific Islander, or a racial group not specified in the US Census. With regard to ethnicity, we anticipate that approximately 8% will identify as Hispanic.

The Nevada Clinical High Risk for Psychosis Program for Youth (CHR-P) aims to prevent or lessen the impact of psychotic disorders in help-seeking adolescents and transition age youth in southern Nevada who are at clinical high risk for psychosis. NV CHR-P will implement a stepped-care model to provide evidence based interventions in a trauma-informed manner that are designed to prevent or delay the onset of illness in these individuals. Services will be delivered in the Clark County Behavioral Health Region (BHR) in southern Nevada which encompasses Las Vegas in Clark County and part of Nye County. In this BHR, it is estimated that there are 7,882 individuals who meet psychosis-risk criteria and 45,332 individuals with psychosis-risk symptoms who are between 15-25 years of age. NV CHR-P will address unmet service needs and critical gaps in the state's mental health system for these individuals. The program uses evidence based intervention and assessment procedures that are implemented in a stepped care model of treatment for early psychosis. This stepped care model emphasizes the staging of clinical intervention throughout a young person's participation in the program. Lower intensity and lower risk treatments are provided as first-line interventions and decisions about treatment completion, maintenance therapy or a step-up to more intensive care is based on objective measures of treatment response. Interventions are designed to (1) Improve clinical symptoms and behavioral functioning; (2) Enable youth and young adults to resume age-appropriate social, academic and/or vocational activities; (3) Delay or prevent the onset of psychosis; (4) Minimize the duration of untreated psychosis for those who developed psychotic symptoms; and (5) Reduce occurrence of psychotic disorders in youth and young adults. Services will be provided by UNLV PRACTICE and the UNLV School of Medicine, in an interdisciplinary community mental health training setting where faculty and student clinicians provide evidence based, culturally- and linguistically-informed care to Southern Nevada and the Las Vegas community.

The Harris Center's Clinical High Risk Psychosis Program will implement a stepped-care model to expand the capacity for assessment and treatment of clinical high risk for psychosis in individuals under the age of 25 in Harris County (Houston), Texas. The program will be developed with elements that reflect cultural sensitivities and will target ethnic groups with greater service gaps. The establishment of an evidence-based CHRP program with services available in both English and Spanish is a priority need for individuals in Harris County. This project will implement evidenced-based screening and assessments by utilizing the Prodromal Questionnaire-Brief and the Structured Interview for Prodromal Symptoms and will include individuals who are identified as having one of three diagnosable high-risk syndromes, Attenuated Positive Symptom Prodromal Syndrome, Brief Intermittent Psychosis Prodromal Syndrome, or Genetic Risk and Deterioration Prodromal Syndrome. The program will serve 20 individuals in year one, increasing to 30 in year two and 50 in years three and four. The CHRP program will provide expanded community education and outreach and will offer a stepped care treatment decision making process, as well as, integrating evidence-based interventions of varying complexity, intensity, and duration that target symptoms, problems, and functional impairments that characterize different clinical high risk states. The four project goals are to delay or prevent the onset of psychosis by increasing community awareness of the clinical high risk for psychosis program and early identification and screening procedures; improve symptomatic and behavioral functioning in youth and young adults at clinical high risk for psychosis, enabling them to resume age-appropriate social, academic, and/or vocational activities; minimize the duration of untreated psychosis for youth and young adults who develop psychotic symptoms; and develop and implement capacity building strategies to provide sustained service delivery to youth, young adults, and their families.

The Utah Division of Substance Abuse and Mental Health (DSAMH) proposes to implement the Prevention and Recovery of Early Psychosis (PREP) program to prevent the onset of psychosis or lessen the severity of psychotic disorder among young people, not more than 25 years old, at clinical high risk for psychosis. The catchment area is the counties of Wasatch, Utah, Davis, and Weber-Morgan. Services will be provided by Wasatch Behavioral Health (WBH), Davis Behavioral Health (DBH), and Weber Human Services (WHS). PREP will implement a coordinated service system that provides community education, outreach, screening, assessment, and clinical care that is based on a stepped-care model. Utah's stepped-care model has four (4) levels of care: 1) Outreach and Engagement; 2) Low to Moderate Intensity and Risk; 3) High Intensity/High Risk; and 4) Transitioning out of CHR-P. The movement between levels is determined by assessment results, treatment response, and a shared-decision making framework that focuses on client-identified needs and preferences. Psychological intervention and recovery support services include: individual/family psycho-education, substance use risk reduction, Cognitive Behavioral Therapy for Psychosis (CBTp), skills training, and recovery support. Pharmacotherapy will be considered only when psychological interventions are ineffective and there are escalating attenuated psychotic symptoms. Goal 1: Throughout the grant period, improve the symptoms and behavioral functioning of 144 individuals, not more than 25 years old, who experience CHR-P so they may resume age-appropriate functioning. By 9/30/2026, provide stepped-care intervention to 144 eligible individuals. By 9/30/2026, 80% of enrolled individuals will demonstrate improved functioning. All individuals experiencing first episode psychosis (FEP) will be referred to a FEP specialty program within one week. Goal 2: Improve community awareness, understanding, and collaboration on CHR-P. For each year of the grant, a minimum of 150 community members will receive information on CHR-P. For each year of the grant, a minimum of 5 youth and 5 family members/natural supports will be engaged in leadership/advocacy activities. By 9/30/2023, develop a referral network of a minimum of 30 agencies/organizations. Goal 3: Enhance organizational infrastructure and community readiness to support individuals experiencing CHR-P By 3/1/2023, develop an interagency networking process to ensure the three Centers (DBH, WBH, and WHS) collaborate in implementing CHR-P services. By 3/1/2023, develop a standardized CHR-P workflow that outlines program components, critical activities, and staff core competencies in the stepped-care model. For each year of the grant, a minimum of 100 cross system staff, including the medical community, will receive training to improve their knowledge and skills on supporting individuals experiencing CHR-P and making referrals. By 3/1/2023, develop a communication strategic plan to promote community awareness through community education and social marketing. The anticipated outcomes are: 1) preventing the onset of psychosis, lessening the severity of psychosis, and helping individuals resume age-appropriate functioning; 2) developing a standardized workflow guiding the service delivery among the three providers; 3) increasing community awareness on CHR-P; 4) ensuring fast entry into CHR-P services through expanded referral network and evidence-based assessment; and 5) seamless referral into FEP program for individuals transitioning from clinical high risk to full psychosis.

The Department of Behavioral Health's (DBH) population of focus for the District's Community Programs for Outreach and Intervention with Youth and Young Adults at Clinical High Risk for Psychosis (Short Title: CHR-P) initiative is for transition-age youth (TAY) or young adults aged 16-25 year-olds, who are at high clinical risk for psychosis. In the District, this initiative will be known as OurTime_Community Programs- Early Interventions (OurTime_CP_EI). In the first year of the grant, 25 unduplicated at-risk for psychosis TAY will be served; in Years 2-4, it is estimated that 40 unduplicated at-risk for psychosis TAY will be served, for a total of 145 unduplicated TAY served. The initiative will offer early detection and evidenced-based intervention services to District young adults across all eight wards, who are at risk for their first episode of psychosis (FEP), but who have not fully experienced psychotic symptoms. Those who have already received a clear diagnosis of a psychotic illness, such as schizophrenia or schizoaffective disorder, or those who have experienced a clear first episode of psychosis, will be connected to a more intense coordinated care program designed to address FEP. A stepped care approach, where treatments of differing intensity will be offered, and young adults will learn to manage stress, anxiety, and uncertainty associated with psychosis. Resilience Trainers and Youth Development Leads (YDL/youth peers) will provide education and support in the community. Individual counseling, and therapeutic and skill building groups will be held on-site. The goals of the OurTime_CP-EI initiative are to create a FEP system of stepped care that defines the protocols and processes necessary to assess, diagnose and refer young adults at risk for psychosis to the appropriate level of treatment; offer early access to evidence-based treatments to minimize the duration of untreated psychosis (DUP) and SUD; help CHR-P young adults build resiliency and skills (including educational, occupational, and social functioning) that are vital to their recovery; and to educate young adults, their families, and the community at large on SMI, SUD, and psychosis. DBH will leverage and enhance the TAY system of care created through the Substance Abuse and Mental Health Service Administration (SAMHSA) State Adolescent Treatment Enhancement and Dissemination (SAT-ED), the Now is the Time Health Transitions, and the Healthy Transitions grants by using the existing supported practice, Transition to Independence Process (TIP), coupled with the evidenced-based practice, Acceptance and Commitment Therapy for Psychosis (ACTp). The OurTime_CP-EI will engage TAY in the planning for their own future and help them reduce the frequency or severity of unpleasant internal experiences. At-risk young adults will simultaneously increase their involvement in meaningful life activities and improve social relationships. Lastly, the Adolescent Community Reinforcement Approach (A-CRA) will support recovery from substance abuse and dependence and Appreciative Inquiry (AI) will guide person-centered change interventions, that help young adults uncover existing strengths, advantages, and/or opportunities within themselves and in their communities.

Young people at clinical high risk for psychosis (CHR-P) constitute a newly-recognized population in clinical need. New Haven County, Connecticut can be considered a demographic microcosm of the US and has only recently gained its first specialized treatment clinic for CHR-P. In this project, the PRIME Clinic (est. 1996) at Yale and the Connecticut Mental Health Center will continue to provide Stepped Care to clients ages 12-25 at CHR-P and their families while strengthening ties to its co-located sister First Episode Psychosis (FEP) STEP Clinic and other clinics within New Haven County to maximize its impact in the region. Through partnerships with three organizations providing mental health care to our target demographic, we will institute universal screening of all new mental health clients in participating clinics in New Haven County. Clients identified will be identified as being at CHR-P using the Structured Interview for Psychosis-risk Syndromes (SIPS). Those eligible and willing to participate will be provided with evidence-based Stepped Care. Stepped Care will consist of three evidence-based steps. In Step One, brief supportive psychoeducation will be offered to all clients. In Step Two, clients who have still not achieved remission will be considered for antipsychotic medication. Transition across steps will be guided by standardized clinical diagnostic assessments. Therapies will be flexibly administered in individual- and/or family-therapy format based on client preference. All clients will be offered evidence-based adjunctive care for co-occurring conditions as well as peer support from young peers with lived experience of CHR-P. The goals of the project are to: 1) improve symptomatic and behavioral functioning, 2) enable resumption of age-appropriate activities, 3) delay onset of psychosis, and 4) minimize duration of untreated psychosis (DUP) in youth and young adults with CHR-P within the catchment area. Care will be delivered with cultural and linguistic competence and awareness of issues of diversity and disparity and with consideration of family and youth input. Measurable objectives are: 1) by 8/30/23 and annually thereafter, PRIME will improve symptomatic and behavioral functioning at the 180-day and 360-day assessments compared to at enrollment; 2) by 8/30/23 and annually, PRIME will enable age-appropriate activities at 180-days compared to at enrollment; 3) by 8/30/24 and annually, PRIME will reduce the incidence of conversion to first episode psychosis at the 360-day assessment compared to average individual predicted risk at enrollment; 4) by 8/30/24 and annually, PRIME will reduce DUP among CHR-P clients who convert to psychosis as compared to first episode clinic enrollees. PRIME will conduct 100 outreach presentations a year to school, mental health, primary care, and social services. Through partnerships with three community organizations, we will conduct universal, self-report screenings of roughly 1000 new clients yearly, leading to in-person SIPS evaluation in those who are eligible. The cumulative number of individuals contacted through outreach efforts will be 200 by the end of year one and increase by 400 annually thereafter. The cumulative numbers of individuals referred to PRIME for screening will be 125 by the end of year one and increase by as many annually thereafter. A total of 120 new, unduplicated clients (30 per year) will be served across the 4-year award period.