The Support, Treatment, and Resilience (STAR) Program for Youth at Clinical High-Risk for Psychosis
Halle R. Singer (a), Zachary B. Millman (a, b*), P. Esra Guvenek-Cokol (a,b), Hyun Jung Kim (a,b), Dost Öngür (a,b), Emily E. Carol (a,b)
a. Psychotic Disorders Division, McLean Hospital
b. Department of Psychiatry, Harvard Medical School
Abstract
Background: Early intervention of psychosis has increased nationwide resulting in a recent increase in clinics that treat initial stages of psychotic disorders. The Support, Treatment, and Resilience (STAR) clinic was established in 2019 at McLean Hospital in response to the need for services specifically for youth at Clinical High Risk (CHR) for psychosis. The clinic’s mission is to provide high-quality, insurance-based, outpatient care to youth ages 14-25 at increased risk for psychosis through utilization of a flexible CHR framework and stepped care model.
Methods: Information related to client referrals, intakes, psychosis risk assessments, and discharges were tracked to evaluate effectiveness in recruiting CHR youth, the clinical need for STAR’s services in the community, and progress as a growing clinic.
Results: From fall 2019-spring 2022, the STAR clinic received 121 referrals and 38 (31.4%) were evaluated with the Structured Interview for Psychosis-risk Syndromes (SIPS). 34 (28.1%) youth presented with psychosis risk symptoms following assessment and received ongoing STAR clinical services. 83 (68.6%) referrals were not evaluated with the SIPS due to not meeting inclusion criteria. Each year, the STAR clinic has experienced a 50% increase in intakes. There has been a total of 16 clinic discharges thus far, and 50% of discharged clients transitioned to later-stage psychopathology.
Conclusion: Results suggest the clinical need for the STAR clinic’s specialized CHR services. Three factors may contribute to the on-going success of the STAR clinic: (1) the program’s placement within a tertiary psychiatric hospital, (2) utilization of a flexible CHR inclusion framework and treatment model, and (3) providing insurance-based clinical care. The STAR clinic’s goal is to continue its contribution to early intervention of psychosis and help support Massachusetts’s statewide system of services for early psychosis through ongoing integrated clinical data collection.