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.