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Evaluation ViewAttendees 2

Schizophrenia / Psychotic Disorders
Symposia

Symposium 67 - Innovative Stepped-Care Implementation Models for Community-Based Identification and Treatment of Individuals at Clinical High Risk for Psychosis: Implementation Strategies, CBT, Common Challenges

Saturday, November 16, 2024
8:30 AM – 10:00 AM EST
Location: Regency Ballroom A, Second Floor Mezzanine, Loews Hotel
CE: 1.5

Keywords: Early Intervention, Psychosis / Psychotic Disorders, Implementation
Level of Familiarity: All
Recommended Readings: Hamilton SA, Wastler HM, Moe AM, Cowan HR, Lundin NB, Guirgis HH, Parris CJ, Stearns WH, Manges ME, Holmes AC, Blouin AM, Breitborde NJK. Symptomatic and Functional Outcomes Among Individuals at High Risk for Psychosis Participating in Step-Based Care. Psychiatr Serv. 2023 Dec 13:appips20230188. doi: 10.1176/appi.ps.20230188. Epub ahead of print. PMID: 38088038.,   Hartmann JA, McGorry PD, Destree L, Amminger GP, Chanen AM, Davey CG, Ghieh R, Polari A, Ratheesh A, Yuen HP, Nelson B. Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach. Front Psychiatry. 2021 Jan 8;11:553578. doi: 10.3389/fpsyt.2020.553578. PMID: 33488413; PMCID: PMC7819892.,   Millman ZB, West ML, Thibeau H, Sanders AS, Guyer M, Keshavan M, Lilly M, Friedman-Yakoobian M, Woodberry KA, Johnson KA, Kline ER. Changes in community providers' screening behaviours, referral practices, and clinical confidence following participation in an early psychosis educational campaign. Early Interv Psychiatry. 2022 Jul;16(7):744-751. doi: 10.1111/eip.13215. Epub 2021 Sep 16. PMID: 34532946; PMCID: PMC10591393.,  

Fusar-Poli, P., et al., Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry, 2012. 69(3): p. 220-9.

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Loewy, R.L., et al., Psychosis risk screening with the Prodromal Questionnaire--brief version (PQ-B). Schizophr Res, 2011. 129(1): p. 42-6.

Intervention in those identified as at clinical high risk for psychosis (CHRP) holds exciting potential for improving outcomes in those who do and do not develop. However, individuals at CHRP are under-recognized in the community settings where those with appropriate tools and awareness could initiate pathways to care. Once identified and/or engaged in community care, specialized resources and expertise for assessment and treatment of the diverse needs and outcomes of these individuals are often limited. Stepped-care approaches present a solution by triaging clinical resources and involvement of psychosis-specific expertise. In stepped-care, broadly applicable screening and generalist interventions can be implemented with the broad population of those at-risk at lower steps, while increasingly specific, complex, costly, and tailored interventions can be applied at higher steps. Models can be tailored to move people into different steps depending on individual factors like changes in symptoms, functioning, and need, and on systems factors like organizational structures, workforce capacity, and expertise. Systems-level stepped-care programs have developed around the world but have been difficult to implement in the United States (US) due to a number of barriers, some unique to the US and some common across borders. This symposium will present four different active stepped-care programs, each designed to overcome a common implementation barrier in real-life community mental health settings. Such solutions are likely useful in other nations and health systems. Each panelist will describe their stepped-care model and local context, specific challenges faced in implementing stepped care, strategies they have developed to address these commonly present challenges, and program evaluation data. Barriers include: institutional challenges of implementing a stratified stepped-care approach within a larger health system, limited awareness in key community members and providers across disciplines (e.g., primary care doctors, teachers, nurses, etc.) of the signs and symptoms of CHRP, a limited number of mental health providers trained in CBT, staff turnover, and challenges with the paradigm shift from coordinated specialty care to stepped care. The discussant is a federal leader from the Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States Department of Health and Human Services.  SAMHSA  has funded four nationally representative cohorts of clinical high risk for psychosis grants.  The discussant will summarize the value of stepped-care approaches and its appeal to funding agencies. The aim of this panel is to explore implementation of stepped-care as an innovative solution to common difficulties in sustaining real-life CHRP clinical programs and to preview models that are currently being evaluated.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Explain the rationale for using stepped-care models for identifying and providing care for youth at clinical high risk for psychosis.
  2. Describe different models for identifying and treating those at risk for psychosis who seek care in community-based settings
  3. Name the foundational tenets of CBT for those at clinical high risk for psychosis (CHRp)
  4. Describe common problems that arise in implementation of stepped-care for CHRp an innovative solutions for addressing these problems.
  5. Think critically about how to apply the innovative implementation strategies for overcoming common barriers in other settings and populations

Presentations:

  • 8:30 AM – 10:00 AM EST
    (SYM 67) Testing an Assessment and Cbt-based Stepped-care Intervention for Youths at Clinical-high Risk for Psychosis in Four Generalist Community Settings: The SCIP Step Program

    Speaker: Daniel I. Shapiro, Ph.D. – University of California, Davis

    Co-author: Sabrina Ereshefsky, Ph.D. – University of California, Davis

    Co-author: Shirley Yau, BS/BA (they/them/theirs) – UC Davis Early Psychosis Programs; Dept Of Psychiatry And Behavioral Sciences

    Co-author: Yen-Ling Chen, Ph.D. (she/her/hers) – University of California Davis

    Co-author: Alvaro Gonzalez, AMFT (he/him/his) – UC Davis Early Psychosis Programs; Dept Of Psychiatry And Behavioral Sciences

    Co-author: Tara a. Niendam, Ph.D. – UC Davis Department of Psychiatry

  • 8:30 AM – 10:00 AM EST
    (SYM 67) Portland Identification and Early Referral (PIER) Program- community Hope and Resources for Psychosis (CHRP)- findings After One Year

    Speaker: Merelise Ametti, Ph.D. (she/her/hers) – MaineHealth Institute for Research

    Co-author: Sarah Lynch, LCSW (she/her/hers) – MaineHealth

    Co-author: Kristen Woodberry, PhD, MSW (she/her/hers) – MaineHealth Institute for Research

    Co-author: rebecca Jaynes, LCPC (she/her/hers) – MaineHealth

  • 8:30 AM – 10:00 AM EST
    (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

    Speaker: Emily A. Farina, Ph.D. (she/her/hers) – Yale University School of Medicine

    Co-author: Emily A. Farina, Ph.D. (she/her/hers) – Yale University School of Medicine

    Co-author: Onyi Okeke, M.D. – Yale University School of Medicine

    Co-author: Barbara Walsh, Ph.D. (she/her/hers) – Yale University School of Medicine

    Co-author: Scott Woods, M.D. (he/him/his) – Yale University School of medicine

    Co-author: Albert Powers, M.D., ph.D. (he/him/his) – Yale University school of Medicine

  • 8:30 AM – 10:00 AM EST
    (SYM 67)Partnering with Community Stakeholders to Increase Pathways to Stepped Care for Youth at Clinical High Risk for Psychosis: Initial Findings from Supporting Wellness for Adolescents and Young Adults

    Speaker: Elaina Montague, Ph.D. (she/her/hers) – Northwell Health Zucker Hillside Hospital

    Co-author: Timothy Michaels, Ph.D. – The Zucker Hillside Hospital

    Co-author: Michael Birnbaum, MD – Northwell Health

    Co-author: Doron Amsalem, MD – Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute

    Co-author: Ilana Nossel, M.D. – Columbia University

    Co-author: Iruma Bello, Ph.D. – Columbia University

    Co-author: Rufina Lee, MSW, PhD – Hunter College

    Co-author: Samantha Jankowski, MA – Department of Psychology, Hofstra University

    Co-author: Mili Mehta, MPD – Strong365Lab

    Co-author: Chantel Garrett, MPH – Strong365Lab