Feasibility of a Stepped-Care Intervention for Those at Clinical High Risk for Psychosis in the United States

Abstract

Aim: This study assessed the feasibility of a stepped-care model for those at clinical high-risk for psychosis (CHRp) within a coordinated specialty care clinic in the United States.

Methods: Youth aged 12-30 completed a 12-month, three-step intervention where persistent or worsening symptoms received increasingly intensive treatment including Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor.

Results: Of 32 CHR youth admitted to the clinic over 18 months, 12 were eligible for the study, 10 consented (83.3% consent rate at 0.56 recruitment rate), eight participated, and five completed (62.5% completion rate). Reasons for ineligibility were mostly unrelated to the treatment, including disengagement before recruitment, pressing comorbid concerns that required other specialty care, and medication preferences. Those who completed treatment showed clinically significant improvements in social functioning, depression, and attenuated psychosis symptoms by 12-month follow-up, but sample size precluded statistical analysis. Three discontinued due to medication needs (more intensive care, perceived side effects).

Conclusions: This small preliminary study supports larger scale trials of stepped-care interventions for CHRp in the US, but also illuminates key features of the US healthcare system that must shape implementation. The stepped-care intervention appeared tolerable and feasible in those who were eligible and engaged; clinical outcomes were promising. Comorbid treatment needs in this heterogenous population, including medication needs/preferences, and disengagement during referral to psychosis specialty care precluded participation for many. Future studies should evaluate larger samples, account for needs and preferences for medication, and place screening and early steps in general outpatient mental health services to evaluate real-world effectiveness.

Keywords: CBCM; attenuated psychosis syndrome; clinical high‐risk; early intervention; non mesh: stepped‐care; psychosis.