2 - (SYM 67) Portland Identification and Early Referral (PIER) Program- community Hope and Resources for Psychosis (CHRP)- findings After One Year

Abstract Body
The PIER Program of Portland, ME implemented a stepped care model for patients at clinical high risk (CHR) for psychosis with five levels of care (LOC). The team screens referrals by phone and invites appropriate referrals for a psychiatric assessment including the positive symptom section of the Structured Interview of Psychosis Risk Syndromes (SIPS). Based on positive symptom severity, functional challenges, and safety concerns, patients are recommended to a LOC: 1 = non-psychosis care in community; 2 = community care with CHRP team consultation; 3 = selective CHRP team-based care; 4 = full CHRP team-based care; 5 = first-episode care.  Only patients with moderate to severe CHR syndromes, functional challenges or safety concerns (LOC 3 and 4) are treated by the CHRP program. All patients identified with CHR (LOC 2-4) are re-assessed at six-month intervals to determine if a change in LOC is warranted.
During the first year, the CHRP team consisted of a child/adolescent psychiatrist, a program director, two masters-level clinicians, a case manager, a supported education/employment specialist, a peer with lived experience, and a clinical psychologist. Team members participated in training, supervision, and fidelity monitoring in CBT for Psychosis (CBTp), the Structured Interview for Psychosis-Risk Syndrome (SIPS), and Multi-Family Group (MFG) services. Thirty-three intake assessments were completed (Mage = 15.2 years; 67% assigned female at birth; 85% white) resulting in three patients assigned to LOC 1, three to LOC 2, six to LOC 3, twelve to LOC 4, and nine to LOC 5. Six-month re-assessments have been completed for 10 patients, of which five remained at the same LOC assigned at intake, four stepped down to a lower LOC and one moved to a higher LOC. Notably, there was a significant (p=.006) reduction in the severity of patients’ total positive symptoms on the SIPS between intake (M = 11.50, SD = 3.98) and six months (M=8.00, SD=4.04). Scores on the WHODAS, GAD-7, PHQ-9, and Modified Colorado Symptom Index trended (non-significantly) downward at six months.
Challenges of implementing this stepped care model include establishing LOC criteria, using a collaborative decision-making process within the team, shifting from full team-based care to triaging and dosing of care, and identifying community providers willing to engage in consultation and/or treat mild CHR symptoms. We will discuss inter-disciplinary progress in addressing these challenges, refining program definition and priorities, and adapting to increased caseloads and staffing turnover.