PRIME Clinic: Stepped Care for Youth and Young Adults at Clinical High Risk for Psychosis
Young people at clinical high risk for psychosis (CHR-P) constitute a new population in clinical need. New Haven, Connecticut, and its ring of nine towns can be considered a demographic microcosm of the US but contain no specialized treatment clinics for CHR-P. In this project the PRIME Clinic (est. 1996) at Yale and the Connecticut Mental Health Center will extend its research mission to provide Stepped Care to 175 clients ages 12-25 at CHR-P and their families.
Eligible clients will be identified by the Structured Interview for Psychosis-risk Syndromes (SIPS) as part of a bidirectional referral process with our established sister first episode clinic. 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 not achieved remission will be offered cognitive behavior therapy. In Step Three 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 or prevent the 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 in awareness of issues of diversity and disparity and with consideration of family and youth input. Measurable objectives are: 1) by 09/30/19 and annually thereafter, PRIME will improve symptomatic and behavioral functioning at the 180-day assessment compared to at enrollment; 2) by 09/30/19 and annually, PRIME will enable age-appropriate activities at 180-days compared to at enrollment; 3) by 09/30/20 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 09/30/19 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. The cumulative number of individuals contacted through outreach efforts will be 200 by end of year one and increase by 400 annually thereafter. The cumulative numbers of individuals referred to PRIME for screening will be 100 by end of year one and increase by 200 annually thereafter, and the numbers of CHR-P clients and families served in Stepped Care will be 25 by end of year one and increase by 50 annually thereafter.