Stepped Care Interventions for Psychosis Risk: Findings From Clinical High Risk for Psychosis Grantee Programs

Interventions for individuals at clinical high risk for psychosis (CHR-P), including psychotherapeutic and pharmacological treatments, have shown promise for alleviating symptom severity and preventing the progression to psychosis. In 2018, the Substance Abuse and Mental Health Services Administration introduced a CHR-P grant initiative that expanded the availability of CHR-P programs in the United States. This study aimed to assess changes in key client outcomes of CHR-P grantee program participants.

This study used secondary analysis of National Outcome Measures assessment data collected from 1,071 clients served by CHR-P grantee programs. The authors performed longitudinal analyses to test for changes in (and cross-lagged effects between) life functioning, social connectedness, and psychological distress; in rates of psychiatric hospitalization and emergency department visits; and in the likelihood that individuals would develop first-episode psychosis.

Individuals participating in CHR-P programs experienced improvements in life functioning and social connectedness; decreases in psychological distress; and low rates of psychiatric hospitalizations, emergency department visits, and onset of first-episode psychosis. After psychological distress was controlled for, cross-lagged analysis showed that social connectedness was associated with improved life functioning over time (p<0.05).

Findings offer preliminary evidence that CHR-P grantee programs are beneficial across several key client outcomes. Furthermore, social connectedness enhanced life functioning over the course of treatment, underscoring the importance of program components such as peer and family support services. More rigorous evaluation of CHR-P programs, with control or comparison conditions to establish effectiveness, is needed.