Insights from the STAR Program at McLean Hospital: Creating a Standardized Clinical Assessment Battery for a Clinical High Risk for Psychosis (CHR-p) Early Intervention Program

Joey Rodriguez (1,2,3,4), Halle R. Singer (1), P. Esra Guvenek-Cokol (1,2), Hyun Jung Kim (1,2), Tamara Welikson (1,2), Lola Nedic (3), Dost Öngür (1,2), Zachary B. Millman (1,2), Emily E. Carol (1,2)

1. Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478
2. Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114
3. Psychosis Research Program, Beth Israel Deaconess Medical Center,
4. Northeastern University, Boston

Abstract:

Background: Clinical assessment batteries are a core component of measurement-based care within learning healthcare systems. Early intervention services (EIS) for early psychosis in Massachusetts have established a learning healthcare approach that utilizes integrated clinical assessments to systematically inform individualized care and program development. While EIS are becoming increasingly common for treatment of individuals at clinical high risk for psychosis (CHR-p), the field lacks guidance on standardized symptom and treatment monitoring. Developing a standardized clinical assessment battery for CHR-p EIS that emphasizes a bi-directional feedback loop between clinic and client may (1) augment treatment planning, (2) enhance response monitoring, and (3) improve understanding of clinical profiles and outcomes in CHR-p populations.
Methods: The purpose of this clinical QI project was to assess current assessment batteries utilized across local CHR-P and First Episode Psychosis EIS to inform the development of a STAR clinical assessment battery. The QI project was organized in three phases: (1) program identification and assessment battery collection; (2) comparison of assessments across batteries; (3) identification of gaps and solution prototyping.
Results: Six assessment batteries were collected . Seventy-one measures were identified and compared. Gaps lacking clear guidance in assessment batteries were identified. Notable gaps include: (1) assessment battery organization; (2) client perception of consultation; (3) influences of social media ; (4) perception of discrimination and stigma; (5) ambivalence towards medication adherence ; (6) identity formation. Proposed solutions to these gaps will be explored.
Conclusion: The results of this QI project provide preliminary insights into assessment battery standardization and suggest solutions for current gaps that inform a learning healthcare approach to CHR-p care. Additionally, the results highlight the primacy of client-clinic collaboration in shaping EIS for CHR-p. Future steps hope to inform guidelines that deepen the learning healthcare approach for outpatient specialized care in CHR-p populations, improve clinical utility, and support state-wide alignment.