SWAY: Supporting Wellness for Adolescents and Young adults at clinical high risk for psychosis - Project Abstract - SWAY: Establishing a CHR-P Center of Excellence SWAY (Supporting Wellness for Adolescents and Young Adults at Clinical High Risk for Psychosis) at Northwell Health's Zucker Hillside Hospital will provide evidence-based stepped-care services to 25-30 youth and young adults per year ages 12-25 at clinical high risk for psychosis (CHR-P) and their families across the NYC metro and Long Island. Through this renewal, SWAY will innovate our existing stepped-care model and establish a CHR-P Center of Excellence - a scalable training and clinical resource hub developed by the SWAY team for community clinicians, youth, and families. Project name: SWAY (continuation of SAMHSA award 1H79SM086136 / SM-22-008; renewal under SM-26-012). Geographic area: Zucker Hillside Hospital, Queens, NY, serving the five NYC boroughs and Long Island (current cohort: 41% Nassau, 38% Queens, 13% Suffolk, 6% Westchester, 3% Brooklyn). Under SM-22-008, SWAY has served 60 unduplicated participants since December 2022, with 27 actively enrolled at submission. Service population: Youth ages 12–25 at CHR-P and their families. Current cohort: 53% male, 31% female, 16% Other; racially/ethnically heterogeneous (31% White, 28% Black, 22% Asian, 16% multiracial; 19% Hispanic/Latino); 23% non-English language at home. Clinically: 67% meet Attenuated Psychosis Syndrome criteria; 53% lifetime trauma exposure (30% probable PTSD); co-occurring depression and anxiety highly prevalent. Number served: Year 1: 25 participants; Years 2–4: 30/year = 115 total. Year 1 continues the 27 actively enrolled under SM-22-008 without a gap. The CoE further reaches 30+ community clinicians and 7,500+ youth/families per year via a web platform, modules, and a video library. Strategies and interventions: Multi-pillar stepped-care model (Breitborde et al., 2020; Hamilton et al., 2024): Yale Phone Screen and PQ-B → SIPS-V5/Mini-SIPS; modular CBT for CHR-P (co-developed with Strong365, youth, families, clinicians, and Dr. Jason Schiffman); TF-CBT, Unified Protocol, CBT-I, DBT-informed skills; motivational interviewing; Family Focused Therapy for CHR-P; IPS-model supported education/employment; peer and family support; pharmacotherapy; individualized crisis plans (Stanley-Brown + C-SSRS + Youth-Nominated Support Teams). CoE built with Strong365 Lab (digital infrastructure, 10–15 CBT modules) and Modern Epic (18 brief testimonial and training videos), with video efficacy verified via crowdsourcing QA (Prolific, CloudResearch). Goals and measurable objectives (aligned to five NOFO grantee-level indicators): • Training: Establish the CoE by end of Year 1; train newly hired SWAY clinical staff in SIPS-V5/Mini-SIPS within 4 months of award; train 30+ community clinicians by end of Year 4. In addition, at least one member of our team (Program Coordinator) will achieve SIPS-certified trainer status by the end of year 4. • Screening: Formalize the CHR-P screening pathway across Northwell entry points; screen 100+ individuals annually. • Education/prevention: Primary outreach to 250+ providers at 40 agencies; secondary outreach to 80+ staff at 15 community-based, faith-based, and youth-serving organizations; 7,500+ youth/caregivers/yr via digital channels. • Peer support: Convene Youth and Family Advisory Council (leveraging SWAY's existing Strong365 youth council) within 3 months of award. Stepped care: Serve new 25 unduplicated participants in Year 1 and 30/year in Years 2–4 (115 total); 100% receive psychiatric consultation within 6 months; 60%+ engage Individual Placement and Support (IPS) services; 100% have a written crisis plan within 30 days of enrollment; 100% receive psychoeducation and care coordination; routine progress monitoring for treatment decision making (e.g., step-up or down SWAY team supports).
