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Youth aged 12–30 completed a 12-month, three-step program with increasing intensity for persistent or worsening symptoms, including Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor. Among eligible participants, treatment was tolerable and completion supported clinically meaningful improvements in social functioning, depression, and attenuated psychosis symptoms at 12-month follow-up, though small sample size prevented statistical testing.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/feasibility-of-a-stepped-care-intervention-for-those-at-clinical-high-risk-for-psychosis-in-the-united-states-article/450974/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/feasibility-of-a-stepped-care-intervention-for-those-at-clinical-high-risk-for-psychosis-in-the-united-states-article/450974.png","ImageObject",300,407,{"name":92,"@type":93},"Aditya","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-03","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the study’s main aim?","Question",{"text":112,"@type":113},"To assess the feasibility of a stepped-care model for people at clinical high risk for psychosis (CHRp) in a coordinated specialty care clinic in the United States.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the stepped-care intervention work over 12 months?",{"text":117,"@type":113},"Youth aged 12–30 completed a three-step, 12-month intervention where treatment intensity increased for persistent or worsening symptoms, using Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor.",{"name":119,"@type":110,"acceptedAnswer":120},"What outcomes were observed among those who completed treatment?",{"text":121,"@type":113},"Participants who completed treatment showed clinically significant improvements in social functioning, depression, and attenuated psychosis symptoms at the 12-month follow-up, although the small sample size prevented formal statistical analysis.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},450974,1790764232,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41},962085564549,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Early Intervention in Psychiatry   \n ORIGINAL ARTICLE  OPEN ACCESS   \nFeasibility of a Stepped-Care Intervention for Those at Clinical High Risk for Psychosis in the United States  \nDaniel I. Shapiro1  | Rebecca E. Grattan1,2  | Jill R. Laquidara1,3 | Paula Wadell1 | Rachel S. Suk1 | Karina Muro1 | Ryan Shickman1,4 | Jessica Salmonsen1,5 | Valerie L. Tryon1 | Tyler Lesh1 | Rachel Loewy6 | Rebecca Canfield1 | Jessica Spark7  | Melissa J. Kerr7 | Barnaby Nelson7 | G. Paul Amminger7  | Patrick McGorry7 | Cameron Carter1,8 | Tara A. Niendam1  \n1Department of Psychiatry and Behavioral Sciences, University of California-Davis, Sacramento, California, USA | 2School of Psychology, Victoria University of Wellington, Wellington, New Zealand | 3Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA | 4Kaiser Permanente-Vacaville, Vacaville, California, USA | 5School of Psychology, Fielding Graduate University, San Diego, California,  \nUSA | 6Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, California, USA | 7Australia and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia | 8Department of Psychiatry & Human Behavior, University of California-Irvine, Irvine, California, USA  \nCorrespondence: Daniel I. Shapiro ([dishapiro@health.ucdavis.edu](dishapiro@health.ucdavis.edu))  \nReceived: 6 June 2025 | Revised: 8 December 2025 | Accepted: 18 December 2025  \nKeywords: attenuated psychosis syndrome | CBCM | clinical high-risk | early intervention | non mesh: stepped-care | psychosis  \nABSTRACT  \nAim: This study assessed the feasibility of a stepped-care model for those at clinical high-risk for psychosis (CHRp) within a coordinated specialty care clinic in the United States.  \nMethods: Youth aged 12–30 completed a 12-month, three-step intervention where persistent or worsening symptoms received increasingly intensive treatment including Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor.  \nResults: Of 32 CHR youth admitted to the clinic over 18 months, 12 were eligible for the study, 10 consented (83.3% consent rate at 0.56 recruitment rate), eight participated, and five completed (62.5% completion rate). Reasons for ineligibility were mostly unrelated to the treatment, including disengagement before recruitment, pressing comorbid concerns that required other specialty care, and medication preferences. Those who completed treatment showed clinically significant improvements in social functioning, depression, and attenuated psychosis symptoms by 12-month follow-up, but sample size precluded statistical analysis. Three discontinued due to medication needs (more intensive care, perceived side effects) .  \nConclusions: This small preliminary study supports larger scale trials of stepped-care interventions for CHRp in the US, but also illuminates key features of the US healthcare system that must shape implementation. The stepped-care intervention appeared tolerable and feasible in those who were eligible and engaged; clinical outcomes were promising. Comorbid treatment needs in this heterogenous population, including medication needs/preferences, and disengagement during referral to psychosis specialty care precluded participation for many. Future studies should evaluate larger samples, account for needs and preferences for medication, and place screening and early steps in general outpatient mental health services to evaluate real-world effectiveness.  \nThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.  \n© 2026 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.  \nEarly Intervention in Psychiatry, 202","cbCaifwKYDmX7RuZ","https://ap.wps.com/l/cbCaifwKYDmX7RuZ","pdf",1135193,12,"English","# Introduction\n## Background and rationale for stepped-care\n## Clinical high risk for psychosis (CHRp) and treatment challenges","[{\"question\":\"What was the study’s main aim?\",\"answer\":\"To assess the feasibility of a stepped-care model for people at clinical high risk for psychosis (CHRp) in a coordinated specialty care clinic in the United States.\"},{\"question\":\"How did the stepped-care intervention work over 12 months?\",\"answer\":\"Youth aged 12–30 completed a three-step, 12-month intervention where treatment intensity increased for persistent or worsening symptoms, using Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor.\"},{\"question\":\"What outcomes were observed among those who completed treatment?\",\"answer\":\"Participants who completed treatment showed clinically significant improvements in social functioning, depression, and attenuated psychosis symptoms at the 12-month follow-up, although the small sample size prevented formal statistical analysis.\"}]","Feasibility of a Stepped-Care Intervention for Those at Clinical High Risk for Psychosis in the United States - Article | PDF",1790734147]