Designing Youth Early Intervention in Psychosis Services: A Secondary Framework Synthesis of Organisational Recommendations

AIM: Early intervention in psychosis (EIP) is increasingly framed as a youth-oriented model of care, but its translation into reproducible service structures remains uneven across healthcare systems. Although clinical practice guidelines and quality standards address clinical high risk for psychosis (CHR-P) and first-episode psychosis (FEP), their organisational recommendations have received limited focused synthesis. This study examined the service-architecture recommendations embedded in international early psychosis guidance. METHODS: We conducted a secondary framework synthesis of a completed systematic review of 26 international guidance documents, comprising 24 clinical practice guidelines and two quality standards. Recommendations concerning service configuration and organisation were retained and mapped onto four service-design domains: access and entry, team model and service setting, coordination and continuity of care and youth-friendly delivery context. Endorsement frequencies and harmonised grading patterns were summarised descriptively at document level. RESULTS: Organisational recommendations were identified in 17 CHR-P-relevant and 22 FEP-relevant documents. The strongest convergence concerned specialised service structures, including multidisciplinary CHR-P services or dedicated pathways in 16/17 documents and specialised outpatient EIP teams in 20/22 FEP documents. Coordination and continuity components were also recurrent, particularly inter-service integration and assertive community treatment or intensive case management for FEP. Access arrangements, transition policies and youth-friendly delivery contexts were frequently mentioned, but were less consistently operationalised or supported by directive grading. CONCLUSIONS: International early psychosis guidance converges on a recognisable organisational architecture, but service-design domains are specified with unequal consistency. By reorganising recommendations already embedded in existing guidance, the framework may support service planning, benchmarking, pathway redesign and policy development, while identifying areas requiring more operational guidance.