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.
