Stepped Care for Youths at Clinical High Risk for Psychosis

Despite recommendations that youths at clinical high risk (CHR) for psychosis receive stepped treatment, few programs have published details of their clinical models or outcomes. This study aimed to describe the preliminary effectiveness of a stepped care model informed by a psychosis risk calculator that was used at a specialized outpatient clinic for youths at CHR.

Seventy-one individuals (ages 12-25) at CHR enrolled in Yale's PRIME (Prevention Through Risk Identification, Management & Education) Clinic during the first 4 years of the treatment program. Participants completed clinical assessments at six time points over 2 years of treatment within a care model informed by an empirically grounded psychosis risk calculator. Linear mixed-effects models were fit to examine changes in clinical symptoms over time, and sensitivity analyses evaluated differences in clinical trajectories between those who completed treatment and those who did not.

Individuals engaged in treatment demonstrated significant improvements in positive, negative, general, disorganized, and depressive symptoms. Improvements in positive symptoms emerged by 6 months and continued across most subsequent time points (12, 18, and 24 months). Pattern mixture analyses suggested that clinical trajectories did not significantly differ between treatment completers and noncompleters, although noncompleters' trajectories were more varied.

A stepped care model informed by individualized risk calculator scores was feasible for delivery in a specialized outpatient setting and was associated with broad symptom improvement for youths at CHR. Additional studies with scores masked from raters are needed to further support the efficacy of these models and isolate the active components of treatment.