3 - (SYM 67) Enhancing Equitable Access to Specialized Care for Individuals at Clinical High-risk for Psychosis (CHR-P) Through Intake Screening in Community Mental Health Clinics

The PRIME clinic in New Haven, CT, employs a stepped-care approach, funded by SAMHSA, to treat individuals at CHR-P. This model, comprising three flexible steps tailored to psychosis risk, includes brief supportive psychoeducation, personalized CBT for early psychosis, and consideration of antipsychotic medication. Despite encouraging preliminary evidence supporting the rationale and feasibility of stepped-care and CBT for CHR-P, community awareness and stigma remain barriers to early intervention. These barriers contribute to under-identification and limited treatment access for the estimated 2,595 individuals at CHR-P within our catchment area alone. Moreover, sociodemographic disparities in CHR-P identification suggest a selection bias, impeding efforts to evaluate the effectiveness of stepped-care in underserved groups. This presentation will briefly delineate PRIME's care model, with emphasis on a screening initiative in community mental health clinics aimed at enhancing equitable access to specialized care.

Beginning February 2023, screening for CHR-P was instituted at intake in three community-based psychiatric clinics in New Haven County utilizing the PRIME screen. Eligible individuals were offered an evaluation for CHR-P and specialized care. Sociodemographic and clinical data were collected for those evaluated at PRIME, allowing for a comparison between those referred through screening vs. traditional referrals.

Of the 254 screens completed in the first year, 102 were positive, leading to 26 scheduled evaluations, 12 completed evaluations, 7 met criteria for CHR-P, and 3 enrolled in care. While sociodemographic differences did not reach statistical significance, trends emerged between the screened (n=12) vs. traditionally referred (n=50) groups. A higher percentage of those identified through intake screening were female (92% >48%), non-White (58% >38%), and Hispanic (50% >23%).

This preliminary evidence indicates that screening for CHR-P in community mental health clinics is feasible and offers a promising solution for enhancing the identification of underserved individuals. Notably, challenges to implementation were elucidated through discussions with community clinicians and individuals who screened positive. Future work aims to address stigma surrounding CHR-P, limited resources, insufficient community awareness about CHR-P signs, and divergent views on the utility of intervention of the early warning signs of serious mental illness.