The STEP Learning Collaborative: A statewide Learning Healthcare System (LHS) for first episode psychosis

The STEP Learning Collaborative (STEP-LC) is Connecticut's statewide learning healthcare system (LHS) for individuals aged 16-35 with recent-onset schizophrenia-spectrum disorders. The goal of the STEP-LC is to ensure that all individuals with schizophrenia have the opportunity to lead fulfilling lives by facilitating rapid access to high-quality treatment during the critical early stages of illness. STEP-LC emphasizes improving local pathways to care, reducing the Duration of Untreated Psychosis, and enhancing population health outcomes. The STEP-LC is a model implementation of a statewide learning health system for recent-onset schizophrenia spectrum disorders. This paper provides a detailed account of the rationale, design and ongoing implementation of the LHS. Several core workstreams organize the activities of the statewide system: workforce development, early detection, informatics, stakeholder engagement, sustainability and care model refinement. The STEP-LC has demonstrated notable initial success in creating a robust system of care for early psychosis across Connecticut. It has implemented comprehensive workstreams to address critical gaps in workforce readiness and information. By leveraging informatics and continuous quality improvement workflows, STEP-LC aims to meet or exceed international benchmarks for access and outcomes of care. Ongoing efforts are focused on further refining care models, sustaining best practices, and strengthening integration with state services through targeted policy advocacy and coordination. This paper serves as a practical guide for those planning to build LHSs in their regions, offering detailed implementation insights to take readers 'behind the scenes' and providing accessible tools for operationalization.