Expanding Coordinated Specialty Care to Early-Stage Bipolar Disorder: Development and Implementation of the STRIDE...

Coordinated specialty care (CSC) is the gold-standard early intervention model for schizophrenia-spectrum disorders. Similar models for bipolar disorder (BD) are lacking. This paper describes the development and implementation of STRIDE, an adaptation of the NAVIGATE CSC model for early-stage BD.

Adaptations were developed based on literature review, international expert consultation and engagement with patient, family and clinician advisory groups. STRIDE was designed to be integrated with schizophrenia-spectrum CSC services to build on existing expertise and infrastructure. Demographic and clinical data were collected at enrollment to characterise an initial STRIDE cohort of 19 participants between October 2023-June 2025.

A detailed model of CSC for BD was developed and implemented. Many components of NAVIGATE, including a recovery focus, shared decision making and the coordinated services of individual psychotherapy, medication management, family psychoeducation and supported education and employment were maintained. Key adaptations for BD included modification of individual psychotherapy modules to address prevention and treatment of mood episodes, addition of modules on circadian and social rhythms, affect regulation and managing common psychiatric comorbidities, development of an early-stage BD prescriber's manual and tailored family psychoeducation. Of 19 patients in the STRIDE cohort (mean age 25 years, 52.6% female), 89.5% were diagnosed with bipolar 1 disorder and 94.7% had a history of psychosis. Anxiety, depression, functional impairment and sleep disturbances were commonly reported at baseline.

STRIDE is a comprehensive adaptation of CSC for early-stage BD. Further work is needed to assess STRIDE's feasibility, acceptability and effectiveness.