U.S. Department of Health and Human Services: Community Programs for Outreach and Intervention with Youth and Young Adults at Clinical High Risk for Psychosis
The Community Programs for Outreach and Intervention with Youth and Young Adults at Clinical High Risk for Psychosis (CHR-P) Program works to identify youth and young adults, not more than 25 years old, at clinical high risk for psychosis and provide evidence-based interventions to prevent the onset of psychosis or lessen the severity of psychotic disorder. It is expected that this program will: (1) Improve symptomatic and behavioral functioning; (2) Enable youth and young adults to resume age-appropriate social, academic, and/or vocational activities; (3) Delay or prevent the onset of psychosis; and (4) Minimize the duration of untreated psychosis for those who develop psychotic symptoms. Partnerships are encouraged between service grant applicants and mental health researchers to evaluate the effectiveness of stepped-care intervention strategies for youth and young adults at clinical high risk for psychosis.
Grant funds must primarily be used to support direct services. These services must be delivered with cultural and linguistic competence and address issues of diversity and disparity. Required activities to be implemented with grant funds include:
- Identify an organization, agency, or other qualified entity to provide the required services. Services can be provided by the applicant or through a sub-award to an organization that has specialized expertise and is clinically qualified and credentialed to implement and manage the CHR-P program.
- Implement a stepped-care model for early psychosis that features lower intensity/lower risk treatments as first-line interventions, with decisions regarding treatment completion, maintenance therapy, or step-up to more intensive care based on objective measures of treatment response. Interventions included in the stepped-care model are: Standardized approaches to CHR-P screening, diagnosis, and psychosis risk assessment; psychoeducation for individuals and family members; substance use risk reduction; cognitive therapy and/or behavioral skills training; academic, vocational, peer, and family support; and evidence-based pharmacotherapy, as warranted, for youth and young adults who have co-occurring conditions.
- Develop and implement training/workforce development activities for providers/staff to implement the stepped-care model.
- Coordinate CHR-P services with other mental health services in the community, including clinics that provide treatment for a first episode of psychosis (FEP) (e.g., the Coordinated Specialty Care11 programs supported through SAMHSA’s Community Mental Health Services Block Grant 10% set-aside for evidence-based treatments for early serious mental illness).
- Develop and implement primary outreach strategies to engage specialty mental health services (e.g., community mental health clinics, coordinated specialty care clinics, psychiatrists, primary care, social service agencies) to provide education about the CHR-P program and early identification and screening procedures to assure rapid referral to CHR-P care and secondary outreach strategies to organizations and agencies that serve youth and young adults (e.g., schools, faith-based organizations, communities, local settings that serve youth and young adults).
- Establish bi-directional referral relationships with organizations/agencies that provide coordinated specialty care for FEP to allow for a seamless transition from clinical high risk for psychosis to first episode psychosis care should an individual convert to psychosis; or, to enroll individuals who seek services at coordinated specialty care clinics, but do not meet threshold criteria for first episode psychosis.
- Provide, coordinate, or link to the following services: 1) Screening, diagnostic, and evaluation services; Outpatient services, including individual, group and family counseling services, professional consultation, and review and management of medications for co-occurring conditions as warranted; 2) 24/7 emergency services; 3) Intensive home-based services for youth/young adults and their families when the youth is at imminent risk of out-of-home placement; 4) Respite care; 5) Therapeutic foster care and services in therapeutic foster family homes, individual therapeutic residential homes, or group homes caring for not more than 10 youth; 6) Assisting the individual in making the transition from services received as a child to the services to be received as an adult; and 7) Other recovery support services (e.g., supported employment, coordinated specialty care for FEP, family and peer support, primary care services) and focus efforts to provide early intervention for those youth in the clinical risk phase of psychotic illness. While specific treatment for this program is not specified, these other services must be available should the youth or young adult desire them.
Amount: A total of $11,200,000 is available to make up to 28 awards that range up to $400,000 per year for up to four years. Cost sharing (cash or in-kind) is required, as follows:
- For years 1, 2, and 3, applicants must provide at least $1 for each $3 of federal funds provided by the grant
- For year 4, applicants must provide at least $1 for each $1 of federal funds provided by the grant
Eligibility: The following public entities can apply:
- State governments and territories (the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands)
- Governmental units within political subdivisions of a state (e.g., county, city, town)
- Federally recognized American Indian/Alaska Native (AI/AN) tribal organizations
Applicants must also meet three additional requirements related to the provision of services:
- The provider of direct client services (e.g., mental health services, Coordinated Specialty Care Clinics) must be identified in the grant application.
- Each mental health treatment provider organization must have at least two years of experience providing relevant services to youth and young adults such as clinical assessments, psychoeducation for individuals and family members, cognitive and behavioral interventions, academic and vocational support, psychopharmacology, and medical management of side effects of medications (e.g., monitoring for metabolic syndrome with antipsychotic use)
- Each mental health treatment provider organization must comply with all applicable local (city, county) and state licensing, accreditation, and certification requirements
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