First Year of WRAP Without Walls: Assertive Community Outreach for Young Adults with Substance-Induced Psychosis or Psychosis with Co-Occurring Substance Use Disorders

Ellie Reagan, BS (1,2), Anne Berrigan, LICSW (1,2), Nicholas Fisher (1), Agata Bereznicka, MPH (1), Emily Kline, PhD (1,2), Hannah E. Brown, MD (1,2), Amy Yule, MD (1,2)

1: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
2: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA

Background: Adolescents and young adults experiencing psychosis and substance use often have low motivation to engage in substance use or mental health treatment. In addition, young people and their families face systemic challenges in accessing office-based treatment including limited resources for transportation, restricted access to technology for telemedicine visits, and less availability to attend appointments due to work and family responsibilities. In its second year of operation, the WRAP without Walls (WWW) program has succeeded in overcoming many of the engagement barriers to provide mobile, community-based multidisciplinary treatment to a diverse population of teens and young adults living with psychosis and substance use.
Methods: Data on WWW program participants gathered from the BMC electronic health record system (EHR) were analyzed to provide a description of program engagement in the program’s first year of operation (6/1/22 through 7/31/23). The WWW program, an adaptation of the Assertive Community Treatment model, provides the following community-based services to young people in Boston: individual therapy; family support and psychoeducation; medication management; peer support and advocacy; and case management.
Results: EHR and patient-reported data provide demographic and diagnostic information of the population engaged in WWW program services. Data also show the range of services to which individuals have been referred, or engaged in during the program’s first year. These services include individual therapy; meetings with family and community supports; psychopharmacology treatment; case management; and peer recovery support.
Conclusions: Through the development and execution of a multidisciplinary mobile treatment team, a diverse cohort of young people with psychosis and substance use have engaged in an array of services in home and community settings. Further work on the WWW model will provide information and practice guidelines on engaging and treating young people at a critical point in their development.