Youth Mental Health Screening and Linkage to Care

Screening for Early Emerging Mental Experiences: Feasibility of Psychosis Screening in Integrated Care Settings

OBJECTIVE

This study aimed to assess the feasibility of the screening for early emerging mental experiences model, which is designed to screen for psychosis in settings with integrated primary and mental health care.

METHODS

Psychosis screening, triage, and engagement processes (July 2021-June 2022) were implemented in four integrated care practices serving approximately 7,000 patients in the targeted age range (14-26 years). Practice and community stakeholders participated in the project's design and development. Psychosis care specialists provided training and case consultation to general medical providers and behavioral health clinicians (BHCs). The BHCs screened all patients referred for selective screening. One practice aimed to universally screen patients ages 14-26 attending well visits.

RESULTS

Training sessions were attended by 100% (N=6) of the BHCs and by 79% (N=27 of 34) of the primary care providers. The BHCs selectively screened and triaged 266 patients (89% of their new patients). Providers conducted universal screening of 606 patients (67% of that site's well visits). The screening samples were >90% White and >55% rural, consistent with the clinics' populations. Rates of positive selective screens were consistent with published rates in similar populations. Of the recorded screening-related activities, 92% (146 of 159) were completed within the billable intake time, and 11% (N=17) of these patients were engaged in a psychosis-relevant discussion. The providers reported that the project was important and positive.

CONCLUSIONS

Systematic assessment of psychosis symptoms, followed by triage and engagement, appeared to be feasible and acceptable to patients and providers in integrated care settings.

Development and Validation of a Brief Age-Normed Screening Tool for Subthreshold Psychosis Symptoms in Youth

BACKGROUND AND HYPOTHESIS

Improvements in screening tools for early subthreshold psychosis symptoms are needed to facilitate early identification and intervention efforts, especially given the challenges of rapidly differentiating age-appropriate experiences from potential early signs of emerging psychosis. Tools can be lengthy and time-consuming, impacting their utility and accessibility across clinical settings, and age-normed data are limited. To address this gap, we sought to develop and validate a brief, empirically derived, age-normed, subthreshold psychosis screening tool, for public use.

STUDY DESIGN

Computerized adaptive test simulation was used to derive a 5-item short form with age norm equivalencies from a 12-item PRIME-Screen-Revised (PRIME-12) administered to 7053 youth (Mage = 15.8, SD = 2.7; 54% female; 33% Black). Concurrent validity was assessed (n = 758) using contemporaneous administration of the PRIME-5 and the Structured Interview for Prodromal Syndromes. Comparability of criterion-related validity of the PRIME-5, PRIME-12, and Scale of Prodromal Symptoms (SOPS) was assessed by relating scores to psychosis-risk-relevant criteria. Finally, self-report versus assessor-administered PRIME total scores were compared (n = 131) to assess their concurrent validity.

STUDY RESULTS

Correlations among PRIME-5, PRIME-12, and SOPS were comparable and moderate, supporting their convergent validity. The PRIME-5 also showed comparable criterion-related validity, demonstrating similar relationships with psychosis-risk indicators as the other tools. Self-reported and assessor-administered PRIME-5 were moderately correlated.

CONCLUSIONS

Public availability of a brief, age-normed, and validated screening tool-which can be assessor or self-administered-will expedite and improve early identification of youth (age 11 and older) at risk for psychosis.

Co-production of a state-funded centralized psychosis and psychosis risk screening, assessment, and referral service

Learning Health Systems (LHSs) strive to continuously integrate innovations and evidence-based practices in healthcare settings, thereby enhancing programmatic and patient outcomes. Duration of untreated psychosis (DUP) is a variable worthy of empirical attention, as the construct has been identified as a leading predictor of psychotic spectrum disorder prognosis and, despite the proliferation of early intervention for psychosis (EIP) teams across the U.S., remains longer than the recommended maximum established by the World Health Organization. Pathways to care are causally implicated as a DUP reduction rate-limiting factor. This paper illustrates a balanced care model, wherein resource-intensive community and clinical services are centralized to support a more efficient, standardized, and direct pathway to EIP care; identification of psychosis and psychotic risk states is made by highly-trained diagnosticians; and measurement-based care across the Learning Health System (LHS) is supported by a central assessment team. The Central Assessment of Psychosis Service (CAPS) streamlines core front-end EIP functions across the LHS, thereby alleviating the burden on EIP teams while enhancing access, equity, efficiency, and quality of the initial psychodiagnostic assessment. CAPS represents an innovative application of the balanced care model that preserves the core functions of the EIP team while task sharing or task shifting resource-intensive activities to an academic medical center partner. We review the five core functions of a centralized referral, screening, and assessment service. Given the potential for centralization to reduce DUP and enhance equity and access across the LHS, this paper will include concrete recommendations for policymakers considering centralizing core functions.