Thursday, April 25, 2024
4/25/2024
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.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
