iEDAPT-CHR-P: An Integrated Stepped-Care Program for Youth at Clinical High Risk for Psychosis in Orange County - The University of California, Irvine will establish iEDAPT-CHR-P, a countywide stepped-care program that will identify and treat 155 youth and young adults ages 12-25 at clinical high risk for psychosis (CHR-P) in Orange County, California, with the goal of preventing or delaying psychosis and restoring school, work, and social functioning. Housed within UCI Psychiatry's iEDAPT first-episode psychosis clinic as the credentialed clinical home, the program integrates outreach, evidence-based screening and diagnostic assessment, modular psychotherapy, psychiatric care, supported education and employment, peer and family support, and individualized crisis planning, with warm handoffs to first-episode psychosis care when needed, creating a coordinated CHR-P-to-FEP continuum where none currently exists. The program advances SAMHSA's priorities in early intervention for serious mental illness, suicide and crisis response, prevention of substance use, and family engagement. Geographic area served: Orange County, California, a large urban and suburban region of 3,170,435 residents, served countywide. Population size and number served: Orange County includes over 500,000 youth and young adults ages 10-34, the age band of greatest CHR-P risk. The program will serve approximately 25 youth in Year 1, 35 in Year 2, 45 in Year 3, and 50 in Year 4, for 155 unduplicated individuals over the lifetime of the project, supported by approximately 500-600 CHR-P screens and 25-35 counted diagnostic assessments per year. Age range and distribution: Youth and young adults ages 12-25, with an anticipated near-even male/female distribution and enrollment spanning adolescence through transition-age young adulthood. Clinical characteristics: Individuals meeting SIPS-defined CHR-P criteria (attenuated positive symptoms, brief intermittent psychotic symptoms, or genetic risk with functional decline), commonly with co-occurring anxiety, depression, trauma-related symptoms, substance use, suicidal ideation or self-harm risk, family conflict, and academic or occupational disruption. Strategies and interventions: PQ-B screening; Mini-SIPS and SIPS diagnostic assessment; a measurement-based stepped-care model grounded in Modular Treatment for Youth at CHR (MTY-CHR) and CBT for CHR-P; psychoeducation; substance use screening and brief intervention; supported education and employment (InVEST); peer and family support; psychiatric consultation and medication management; and individualized crisis planning, including a Youth-Nominated Support Team adaptation. Project goals: Establish an integrated, sustainable countywide CHR-P stepped-care pathway; reduce symptoms and support functioning among youth at CHR-P; engage families and youth as partners in care; and ensure rapid escalation to first-episode psychosis care when clinically indicated. Measurable objectives: Train 100% of project staff in required screening, assessment, and stepped-care procedures by Month 4; launch full outreach, screening, assessment, bidirectional FEP referral, crisis planning, and stepped-care delivery by Month 6; serve 155 unduplicated youth over four years; provide psychoeducation, substance use screening, crisis planning, and measurement-based treatment planning to 100% of enrolled clients; and collect and report all required SPARS and grantee-level performance data within SAMHSA timelines.
