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Published on: November 21, 2013
Stepped Care for Youths at Clinical High Risk for Psychosis
Alexander Broekhuijse1, Abhishek Saxena1, Barbara Walsh1
1Connecticut Mental Health Center, Yale University School of Medicine, New Haven.
Psychiatric Services (Washington, D.C.)
|July 22, 2026
Summary
A stepped care model using a psychosis risk calculator effectively improved symptoms in youths at clinical high risk (CHR) for psychosis. This approach showed feasibility and broad symptom reduction in an outpatient setting.
Area of Science:
- Psychiatry
- Clinical Psychology
- Adolescent Mental Health
Background:
- Youths at clinical high risk (CHR) for psychosis benefit from stepped treatment, but detailed models and outcomes are scarce.
- Specialized outpatient clinics are crucial for delivering effective interventions to this population.
Purpose of the Study:
- To describe the preliminary effectiveness of a stepped care model for CHR youths.
- To evaluate a model informed by an empirically grounded psychosis risk calculator.
Main Methods:
- Seventy-one CHR individuals (ages 12-25) were treated over 2 years using a stepped care model.
- Clinical assessments were conducted at six time points.
- Linear mixed-effects models analyzed symptom changes; sensitivity analyses compared completers and noncompleters.
Main Results:
- Significant improvements were observed in positive, negative, general, disorganized, and depressive symptoms.
- Positive symptom improvements were evident by 6 months and sustained.
- Clinical trajectories did not significantly differ between treatment completers and noncompleters, though noncompleters showed more variability.
Conclusions:
- A stepped care model guided by individualized risk scores is feasible and beneficial for CHR youths.
- The model demonstrated broad symptom improvement in a specialized outpatient setting.
- Further research is needed to confirm efficacy and identify active treatment components.
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