Stepped care involving cognitive behavioral therapy for young people at clinical high-risk for psychosis in community settings: longitudinal intervention study protocol

Early intervention for psychosis is associated with better clinical outcomes. The clinical high-risk for psychosis (CHRP) state is pluripotent with heterogenous outcomes. Early intervention for CHRP must focus on identifying and treating both psychosis-continuum and non-psychosis concerns. Despite the increasing focus on treatment development, accessibility of specialized interventions for CHRP is limited. Implementation of interventions for CHRP in real-life community-based settings can be challenging. Barriers include general access to affordable and affirming mental health care, limited resources and specialized workforce available in community mental health (CMH) settings, lack of community knowledge about early signs of CHRP, and difficulties engaging youth with CHRP in psychosis specialty clinics. Stepped care is a promising approach to address the above limitations. To bridge the current gap in research and practice, the SCIP-Step Program implements universal screening and a stepped-care intervention involving Cognitive Behavioral Case Management (CBCM) to identify CHRP syndromes and treat individuals presenting for care at CMH clinics. Stepped care is provided by community clinicians, starting with lower intensity treatment targeting more generalized, non-specific clinical concerns. Those who do not respond to initial stages “step up” to more intensive treatments that typically require specialized training. The SCIP-Step Program aims to: 1) increase capacity of non-psychosis-specialty CMH agencies to identify and treat individuals with CHRP, and 2) to evaluate the clinical utility of a stepped-care intervention embedded in community settings. In this protocol paper, we outline our innovative stepped-care intervention for CHRP, approach to community partnership, and evaluation plan. ClinicalTrials.gov, identifier: NCT06640803; registered 10/11/2024.