Building a Systems-Wide Coalition to Improve Long-Acting Injectable Antipsychotic Use in Massachusetts

1. Cheryl Yunn Shee Foo (Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital ; Department of Psychiatry, Harvard Medical School)
2. Corinne Cather, PhD (Massachusetts General Hospital; Harvard Medical School)
3. Sarah MacLaurin, PMHNP-BC (North Suffolk Community Services; Massachusetts General Hospital)
4. Michael Angelini, PharmD, BCPP (Massachusetts College of Pharmacy and Health Sciences)
5. David Hoffman, MD (Massachusetts Department of Mental Health)
6. Margaret Guyer, PhD (Massachusetts Department of Mental Health; Harvard Medical School)
7. Amam Saleh, MD (Massachusetts Department of Mental Health)
8. Massachusetts General Hospital LAI Working Group: Abigail Donovan, MD; Alex Keuroghlian, MD; Amir Hassan, MD; Carol Lim, MD, MPH; Collin O’Neill, RPh, MBA, BCNP (Massachusetts General Hospital); Eden Evins, MD, MPH; Kim Mueser, PhD (Boston University); Oliver Freudenreich, MD, Samuel Kohrman, MD (all affiliated with Massachusetts General Hospital; Harvard Medical School, except CO and KM)

Background: Long-acting injectable antipsychotics (LAIs) remain underutilized despite evidence demonstrating reduced relapse, hospitalizations, and mortality in psychotic disorders, including in early-phase illness. In Massachusetts, only 7% of Medicaid beneficiaries and 11% of early psychosis patients use LAIs. Persistent multi-level barriers to LAI use require innovative systems-wide solutions.

Methods: In 2025, the Massachusetts Department of Mental Health and the Massachusetts General Hospital Center of Excellence convened a cross-sector coalition to collaboratively improve community care settings’ capability to provide LAIs. Monthly Steering Committee meetings provided strategic guidance to iteratively identify partnerships and define goals. Group/statewide meetings with leaders and providers across community behavioral health centers (CBHCs), first-episode psychosis (FEP) programs, inpatient services, and pharmacy administrators scoped LAI administration pathways and major barriers, and generated buy-in. A Working Group of research and practice experts proposed evidence-informed tools and an implementation plan to begin addressing barriers.

Results: The Coalition united state agency leaders, clinical leadership and frontline providers from diverse behavioral health settings, advocates, and interdisciplinary clinical and research experts. Most providers understood the advantages of LAIs, but were constrained in prescribing them by three major barriers: 1) patient reluctance; 2) knowledge gaps about LAI administration services or locations; 3) limited clinical sites capable of LAI administration. We are developing tools to address patient and provider barriers, including: 1) a statewide LAI administration site directory through the Massachusetts Behavioral Health Help Line; 2) an evidence-informed LAI Treatment Decisions Provider Pocket Card; and 3) a LAI decision aid tool to facilitate shared decision making. To better understand and prioritize site-specific barriers to LAI administration, we will conduct a landscape analysis of resource and training needs in CBHCs and FEP programs. Through a collaborative process of selecting and tailoring feasible solutions, including the potential implementation of developed tools, we aim to create a roadmap for expanding LAI access and use in the community.

Conclusions: Community-engaged coalition-building facilitates cross-learning, resource-sharing, and coordinated action across diverse settings to improve systems-wide LAI use. Ongoing work will deploy and evaluate these strategies with service user feedback and implementation science methods, and extend approach to other underutilized treatments such as clozapine.

Evaluating Trauma Assessment Methods in Psychosis

Haniya Rizwan (1), Brittany Gouse MD MPH (1,2), Julia Browne PhD (1), Amelia Blanton BA (1), Janice Weinberg ScD (1,2), Hannah E. Brown MD (1,2)
1. WRAP Research Program, Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian & Avedisian School of Medicine

Background: Accurately identifying individuals’ experience of trauma is critical, since trauma is an often-overlooked comorbidity with psychosis that significantly influences treatment and recovery outcomes. Trauma exposure is often underreported and under-assessed among individuals with psychosis. This study evaluated the extent of agreement and consistency between two methods of assessing trauma exposure in young adults with first-episode psychosis (FEP).
Methods: We extracted data from the Wellness and Recovery After Psychosis (WRAP) FEP Battery Repository. Trauma assessment methods consisted of a formal PTSD diagnosis in the chart captured by Demographics Form 1 and patient-reported trauma exposure on the Life Events Checklist. Each measure was coded as a binary trauma exposure variable, and the percentage of individuals where 0, 1, or both assessment methods indicated trauma exposure was calculated.

Results: Among individuals who completed the Life Events Checklist, 12.5% showed no evidence of trauma on either assessment, 80% had trauma identified by only one method (predominantly the checklist), and 7.5% had trauma indicated by both methods.

Conclusions: These findings highlight that trauma exposure is often detected via self-report and may not always be documented as a PTSD diagnosis. Therefore, having several consistent and accurate trauma assessment methods is critical to identifying clinically relevant information in individuals with psychosis. Improving the identification of trauma exposure can inform treatment planning, support trauma-informed care, and ultimately prevent adverse outcomes.

Faces, Virtual Spaces, and Social Functioning: Early Markers of Impairment in Psychosis Risk Syndrome

Tisha Chatterjea, Lauren Utter, MGB, Sajel Shah, MGH, Megan Good, BIDMC, Nicole Detore, MGH, Daphne Holt, MGH, Jacqueline Clauss, MGH

Background: Individuals who meet criteria for clinical high-risk for psychosis (CHR-P) have 20-fold increased risk for psychotic disorders. CHR-P is also associated with negative symptoms of psychosis, including social anhedonia and withdrawal. Understanding the underlying abnormalities contributing to social impairment in CHR-P may provide novel opportunities for treatment and intervention.

Methods: Participants ages 14-30 (CHR-P, psychosis-spectrum illness, and controls) were recruited via clinical services and online advertisements. They completed a battery of self-report clinical measures, an online behavioral task to assess emotion recognition accuracy, an open-ended interview task to quantify facial affect and linguistic complexity, a virtual-reality based personal space task, and clinician-rated interviews social and role function. As a preliminary analysis, Pearson correlations between self-report of social functioning, emotion recognition accuracy, and personal space measures were calculated. Accuracy of emotion recognition was calculated using the Penn ER40 (emotion recognition 40).

Results: Data collection is ongoing, with 12 participants enrolled to date (4 CHR, 4 POPS, 4 help-seeking). Preliminary analysis showed that across all three groups, individuals who self-reported more loneliness were less accurate in discriminating between different emotions and ages of faces (p < 0.05). More self-reported childhood trauma was related to less accuracy in identifying neutral faces (p=0.003).

Conclusion: This study leverages modern, cutting-edge methodologies to characterize social dysfunction in CHR-P. By coupling traditional self-report and clinician-rated measures with innovative technology to quantify behavior, we aim to illuminate mechanisms driving persistent social impairment in psychosis risk syndromes.

Relationships Between Employment and Loneliness in Psychosis

Francesca de Marneffe (1), Robert Sawdey (2), Nicole DeTore (2,3), Kim T Mueser (4)
1. Department of Psychiatry, Massachusetts General Hospital
2. Department of Occupational Therapy, Boston University
3. Department of Psychiatry, Harvard Medical School
4. Center for Psychiatric Rehabilitation, Boston University

Background: Loneliness is highly prevalent in people with psychotic disorders, but few interventions have been found to decrease loneliness in this population. While employment is generally associated with improvements in self-esteem and quality of life, the impact of employment on loneliness in those with psychosis has not been thoroughly investigated. Therefore, we evaluated whether obtaining competitive work is associated with reduced loneliness over time in people with psychotic disorders.

Methods: In 152 adults with a primary psychotic disorder, we assessed loneliness (single item from the Social Adjustment Scale-II), work functioning (employment status), psychotic symptoms (Positive and Negative Syndrome Scale), self-esteem (Rosenberg Self-Esteem Scale), social network (Social Support Network Inventory), and life satisfaction (Abbreviated Quality of Life Interview). We collected these measures at baseline, 6-, 12-, 18-, and 24-months.

Results: Baseline loneliness was significantly correlated with more severe positive (r=.38, p<.001) and depressive symptoms (r=.47, p<.001). Loneliness was also negatively correlated with overall quality of life (r=-.33, p<.001), self-esteem (r=-.37, p<.001), and number of social contacts (r=-.17, p=.037). Furthermore, loneliness at 24 months was associated with employment status at 24 months (X2=3.86, p=.049). To better understand the causal relationship between loneliness and employment, we plan to conduct two mixed effects linear regression models predicting loneliness at 6-, 12-, 18-, and 24-months, including baseline loneliness as a covariate and competitive work status (binary work status of yes/no at each follow-up assessment) as a time-varying covariate.

Conclusions: These results confirm associations between loneliness and other correlates of psychotic disorders previously reported in the literature, including more severe symptoms, lower quality of life and self-esteem, and more social dysfunction. While preliminary results show a possible relationship between work functioning and reduced loneliness at two years, the planned analyses will help us better understand the causal effects of employment on loneliness.

Socioeconomic Influences on Engagement in Coordinated Specialty Care: Perspectives from Publicly Insured Patients on Disengagement and Re-Engagement

Brittany M Gouse MD MPH (1), Samantha LaMartine PsyD, BreeOna Namukowa MD MPH, Amelia Blanton BS, Haniya Rizwan, Sonya Abdalla, Peggy Williams, Julia Browne PhD, Hannah E. Brown MD
WRAP Program, Boston Medical Center

Background: Despite the benefits of coordinated specialty care (CSC), 30-50% of patients drop out within two years, leading to adverse outcomes, such as unemployment, impaired functioning, and reduced quality of life. Socioenvironmental factors (e.g., urbanicity and poverty) are linked to risk for psychotic illness, and socioeconomic (SES) drift often follows illness onset. However, less is known about how patient-level SES and systems-level structural factors interact to influence CSC dropout. Further, the factors related to re-engagement in care after treatment dropout is not well understood.

Methods: We conducted 18 semi-structured interviews of publicly insured patients who engaged in CSC between 2019-2024 who had at least one 90 day gap in treatment and re-engaged in care. Semi-structured interviews explored treatment disengagement factors, with specific prompts. Analysis used an inductive thematic approach with a codebook iteratively refined from the first three transcripts. Coding was triple-checked, with discrepancies resolved by consensus. We examined themes across three phases of care: initial engagement, disengagement, and re-engagement.

Results: Seventeen initial themes were refined to 13, validated by an independent auditor. Themes varied across phases of treatment engagement. Participants often described early care as disempowering, with several feeling distrustful of providers due to “feeling like a guinea pig.” Lack of perceived need for treatment and structural barriers (e.g., transportation) were common factors related to CSC disengagement. Family, social supports, and provider rapport were pivotal for re-engagement in care. Patients suggested community-building (e.g., social gatherings), integration of spiritual leaders into care, enhanced transparency in clinical decision making as strategies to promote sustained engagement in care for their peers.

Conclusion: For individuals with psychosis, early mistrust, =dehumanizing treatment experiences, and structural barriers contribute to disengagement from care. Programs can reduce dropout by improving access, embedding trauma-informed, recovery-oriented care, and fostering consistent, supportive provider relationships to rebuild trust and sustain engagement.

Developing a Manual for Family Members in a First Episode Psychosis Program

Niharika Jhingan (1), Kit Cali (1), Drew Madore (1)
1. RISE Program, Cambridge Health Alliance, Department of Psychiatry, Cambridge, MA

Background: Family members and loved ones of individuals experiencing early psychosis in our FEP program have reported a lack of clear and straightforward information, especially about navigating systems of care and responding in crisis situations. While there exist several resources aimed at providing information to family members, they either tend to focus on information about psychosis, symptoms and treatment, or are spread out across the internet, which can be difficult to navigate. Furthermore, this information often doesn’t include location or state specific information. This points to the need for a family manual that is specific to the FEP program and its catchment location, as part of support for family members.

Methods: Key informant interviews were conducted with several groups in order to identify gaps in information provided to family members, including family members and clinicians in the FEP program, and family therapists at other Massachusetts FEP programs. These interviews yielded several key domains of information, which were used to develop a family manual.

Results: Informant interviews yielded the following key domains: 1) identifying and responding to a crisis situation, and crisis safety planning, 2) patient and family rights during hospitalization and what to expect, 3) legal concerns, such as criminal charges, 4) self-care for the caregiver and 5) local resources. A manual for family members was developed to include these domains, along with information specific to the FEP program, including an orientation to the team and important contacts.

Conclusions: A family manual may be a helpful source of support for family members in FEP programs, especially for information that is typically more difficult to access. Further work includes investigating the extent to which family members utilize the manual, translating the manual into multiple languages, and considering how this process of manual development may be scaled for use in other FEP programs.

Academic-Clubhouse Partnership to Promote Psychosis Recovery

Victoria Loosigian (1), Sherry Yuan, Lisa Brennan (2), Ruth Osterman (2), Abaigeal Grant (1), Xiaoduo Fan (1)
1. UMass Chan Medical School
2. Genesis Club

Background: Psychosis is associated with loss of independence, social isolation, and stigma, which contribute to overall decline in functioning and poor quality of life. While medications and therapy are helpful, building social support systems and community connections are important to facilitate recovery. Clubhouses are egalitarian, voluntary communities that provide a non-stigmatizing space to build connections and promote recovery; participation - open to anyone in the community with mental illness - is correlated with reduced hospitalization and improved quality of life. We propose a unique academic-clubhouse partnership, to enhance early intervention, foster support networks, and develop collaborative interventions for people with psychosis.

Methods: UMass Mind partnered with Genesis Club, a nonprofit clubhouse in Worcester. The collaborative process includes these steps: 1) Conduct focus groups to determine the interests and needs of the clubhouse members; 2) Develop an evidence-based project to address a specific need; 3) Present the program to the clubhouse and receive feedback; 4) Adjust, then run a pilot program, collecting both quantitative and qualitative data; 5) Based on the findings, adapt the program further; 6) Run additional iterations to receive further feedback and data and ensure it is addressing the real-world challenges people with psychosis face in our community.

Results: Lifestyle education and arts-based programming were identified as areas of interest; as such, cooking demonstrations, brush painting, the Food4Thought Nutrition Program, and the Expressive Arts Program, were developed. The involvement of medical trainees was essential in creating and sustaining these programs. The ongoing collaborative work has led to eight programs, two publications, and four national conference presentations with more in development.

Conclusions: The Academic-Clubhouse partnership is a promising, sustainable approach to support people with psychosis during their recovery. Further, the collaboration offers medical trainees real-world exposure to the challenges and stigmas faced by individuals with psychosis.

Addressing risk factors for criminal legal involvement in treatment: The effects of training on state hospital clinicians’ knowledge and attitudes

Faith Scanlon PhD (1,2), Quinn Lewis BA (1,2,3), Isabella Monroe BS (1,2), Corinne Cather, PhD (1,2)
1. Massachusetts General Hospital
2. Harvard Medical School
3. Tufts University

Background: Estimates suggest that 9 to 25% of people experiencing early psychosis in the U.S. are involved in the criminal legal system (Rolin et al., 2019; Webster et al., 2024). For people with first episode psychosis (FEP), past criminal legal involvement (CLI) is predictive of future CLI (e.g., Scanlon et al., 2025) which is associated with a range of poorer outcomes including unstable housing and employment, mental illness, substance use, and suicide. It is therefore critical for clinicians working with the FEP population to have the knowledge and skills necessary to provide interventions targeting risk factors for CLI.
Methods: We delivered an 8-hour, one-day live training to 23 clinicians at Worcester Recovery Center and Hospital on a 9-session cognitive behavioral therapy-based intervention (Changing Lives and Changing Outcomes-9; CLCO-9). CLCO-9 was created for people with serious mental illness and CLI with the goal of improving illness self-management and risk factors for CLI (e.g., substance use, thoughts conducive to crime). Before and after the training, we administered self-report measures on clinicians’ knowledge of risk factors and best practices for treatment, as well as attitudes on the importance of addressing patients’ risk factors for CLI (N = 15).
Results: Paired samples t-tests showed clinicians’ knowledge of risk factors significantly increased from before to after completing the training, with a medium to large effect size (t[14] = 2.98, p = .01, d = 0.77). Similarly, clinicians’ ratings of the importance of addressing risk factors for legal involvement also significantly increased from pre- to post-training with a large effect (t[14] = 4.94, p < .001, d = 1.28).
Conclusions: Findings provide preliminary evidence that completing a training on a treatment program that targets risk factors for CLI helps clinicians develop skills to decrease the likelihood of future legal involvement and hospitalization for their patients.

Is Quality of Life in Early Course Psychosis Driven More by Personal Empowerment Than by Symptom Reduction

Family Experiences with Psychosis and Substance use Stigma

Catherine Haskell (1), Patrick Y. Kelly (1), Nicole Biggi (1), Emmett T. Adams (1), Matthew Doherty (1), Julie M. McCarthy (1,2)
1. Division of Psychotic Disorders, McLean Hospital
2. Department of Psychiatry, Harvard Medical School

Background: Previous research examines the negative impacts of stigma on psychosis and substance use, yet data on families’ experiences and the resulting impact on a loved one’s ability to engage in care for co-occurring concerns remains limited. Stigma is often associated with reduced willingness to engage in treatment; however, greater family support correlates with less stigma and improved emotional well-being. This project characterizes family experiences with stigma pertaining to psychosis and substance use, including its role in pathways to care, with the goal of identifying future treatment targets.

Methods: Participants were family members (N=39) of individuals with early psychosis (first episode psychosis <6 years) and past 30-day substance use. We conducted a thematic analysis on focus group and interview data to assess family member experiences with stigma involving psychosis and/or substance use and their support needs. Descriptive statistics characterize demographic characteristics and the frequency of code endorsement within themes.

Results: Participants reported the following themes for family experiences with stigma: 1) psychosis and substance use stigma – within the family, 2) psychosis and substance use stigma – beyond the family, 3) kernels of truth and fear of the unknown reinforcing stigma, 4) stigma and social isolation, 5) family stigma resistance efforts, and 6) shared understanding and community support. Participants also identified themes about stigma and pathways to care: 1) fear, misunderstanding, and trauma with law enforcement systems, 2) harm through help seeking with health care systems, and 3) appreciation and opportunities for change.

Conclusion: The data highlighted extents to which stigma exists within patients, families, legal and healthcare systems, and the public; stigma was also linked to social isolation and treatment barriers. There is a continued need to expand support and education on psychosis and substance use and what different community and family members can do to reduce stigma and enhance recovery.

Shared and Unique Clinical Characteristics among Individuals at Clinical High Risk for Psychosis vs. Help-Seeking Controls: Systematic Review and Meta-Analysis

Eleanor Lynch (1), Elif Ozan (1), Katerina Konstas (1), Jonah Loshin (1), Halide Bilge Turkozer (1), Zachary B. Millman (1)
1. Division of Psychotic Disorders, McLean Hospital

The clinical high-risk (CHR) paradigm is used to identify and treat individuals with pre-psychosis symptoms. Systematic description of clinical characteristics among CHR youth vs. help-seeking controls (HSCs)–those who seek CHR assessment but fail to meet criteria–is essential for refining diagnostic criteria and improving risk prediction. Despite numerous individual studies addressing this topic, no systematic review is available. We are conducting a PRISMA-compliant and PROSPERO-registered systematic review on clinical similarities and differences between CHR individuals and HSCs. Of 1678 records identified, 903 abstracts were screened, 94 full-texts reviewed, and 34 included. An additional 7 were identified through bibliographies of related reviews, yielding k = 41 studies. Two independent reviewers are rating study quality and risk of bias using the Newcastle-Ottawa scale. Quantitative data, including symptom severity, global functioning, and differences across HSCs and individuals who do vs. do not transition to psychosis (k = 12) are being extracted and will be meta-analyzed using Hedge’s g effect sizes, Egger’s test and funnel plots for bias, and Q and I2 for heterogeneity. Initial qualitative review of results indicates that positive, negative, disorganized, general, depressive, and anxiety symptom severity is higher in CHR individuals compared to HSCs. This pattern suggests CHR individuals tend to exhibit more severe symptomatology than patients initially suspected of being CHR but who test negative. These results highlight the distinctive challenges CHR youth face and raise questions about the degree of symptom specificity captured by CHR status. We will present our current results and quantitative analyses at the convention.

Well-Space and Peer Led Groups in FEP

Steve Fedele (1), Lisa Charland (1), Hassan Ramadan (1), Alison Nelson-Eliot (1), Mike Murphy (1)
1. McLean Hospital

Well-Space is a peer-led program where we offer groups and individual peer support along with Vocational support for young adults ages 18-30 who have had psychosis. In Well-Space, the multitude of groups offered and peer principles by which they’re offered in collaboration with clinical support has led to tremendous results in changing the lives of participants within functional recovery outcomes and in many dimension of wellness. This poster aims to highlight peer principles, peer skills and abilities, peer group facilitation, and peer/clinical group work in the context of First Episode Care and Mental Health Recovery.

The relationship between visual abnormalities and psychotic like experiences in young individuals with and without mental health symptoms

Nathaniel Weiler (1), Jonah Loshin (1), Elif Ozan (1), Grace Owens (1), Zachary B. Millman (1), Dost Ongur (1), Halide B. Turkozer (1)
1. McLean Hospital

Background: Psychotic disorders cause significant suffering for individuals and major challenges to our healthcare system. First episode psychosis is preceded by a clinical high-risk (CHR) prodromal period. Perceptual impairments are frequently seen in this period and are associated with higher rates of transition to psychosis. This study explores the relationship between visual perception and clinical symptoms in a transdiagnostic sample of young individuals with and without mental health symptoms.

Methods: The study recruited three groups of participants (ages 15-30): healthy controls (HC, n=11), clinical controls with depression or anxiety symptoms (CC, n=5), and individuals experiencing subthreshold psychotic symptoms (CHR, n=3). Psychotic-like experiences were assessed by the Prodromal Questionnaire, Brief (PQ-B). Audio-Visual Abnormalities Questionnaire (AVAQ) was used to examine auditory and visual symptoms. Contour integration function was assessed using the Jittered Orientation Visual Integration (JOVI) task. Biological motion perception was assessed using point-light animations. Face perception was assessed using the Mooney Faces Task.

Results: AVAQ total and visual subscores were both found to be correlated with PQB distress scores [(r = 0.67, p = .0026), (r = 0.68, p = .0021)], and PQB total scores [(r = 0.67, p = .0023), (r = 0.68, p = .0021)], respectively. Higher AVAQ visual subscores were correlated with lower performance in face present (r = –0.463, p = .0458) and face inverted conditions (r = –0.457, p = .049).

Conclusions: These results indicate that (1) there is a strong positive correlation between self-report visual abnormalities and psychosis risk symptoms, and (2) lower performance on visual processing tasks is linked to distressing psychotic experiences. However, further research with larger sample sizes is needed to replicate these findings and assess their clinical applications.

Designing Relational AI to Address Social Isolation in Early Psychosis and Mental Health Recovery

Hana Abbasian (1), Hessan Sedaghat (2), Hamid Dahoue (3)i, Brandi C. Fink (4)
Institutions:
1. Harvard Medical School, Boston, MA, United States
2. Harvard Graduate School of Design, Boston, MA, United States
3. Harvard Kennedy School, Boston, MA, United States
4. Department of Psychiatry and Behavioral Sciences, The University of Oklahoma College of Medicine, Oklahoma City, OK, United State

Social isolation is a pervasive and modifiable risk factor across the spectrum of mental health conditions, and is particularly consequential in the context of early psychosis. It compounds emotional dysregulation and stigma, and also interferes with engagement in care, recovery trajectories, and quality of life. Despite the proliferation of digital health tools, few interventions center the relational and somatic dimensions of isolation in ways that are trauma-informed, user-driven, and emotionally resonant.

We present findings from an ongoing mixed-methods study of a novel behavioral health device and mobile platform designed to support individuals experiencing social withdrawal, emotional dysregulation, and distress. The system, named ENSO, integrates focusing-based somatic journaling, mindfulness-based interventions, and an AI-driven conversational mode that reflects and grounds users in real time. A core feature allows users to hear messages from loved ones, introducing warmth, familiarity, and human connection into moments of internal overwhelm.

This work is informed by a literature review on social isolation in psychosis and related disorders, which shows the urgency of interventions that are both scalable and person-centered. Our study combines behavioral tracking, user interviews, and survey-based experience assessments, with participants representing a range of psychiatric diagnoses and recovery journeys. Preliminary feedback suggests increased emotional clarity, perceived support, and reduction in distress following device use. This project explores how relational AI can contribute to broader systems of early intervention and recovery, offering a low-barrier, emotionally intelligent complement to existing mental health care models. . As part of broader efforts to expand access and improve early intervention, ENSO may contribute meaningfully to statewide systems of care, particularly in addressing social isolation and emotional dysregulation in under-engaged populations. Ongoing work will further evaluate implementation potential and user outcomes across diverse care settings.

Understanding Motivators for Cannabis Use in First Episode Psychosis: A Qualitative Study

Jamie Baik (1), Gil Grunfeld (1), Lynn Delisi (1)
1. Cambridge Health Alliance, Recovery in Shared Experiences (RISE) Program

Background: It is well established that cannabis use is strongly associated with the emergence and worsening of psychotic symptoms. However, little has been done to understand the qualitative experience of cannabis use and why one might be motivated to continue using despite known risks.

Methods: Within the Pathways to Loneliness in Early Psychosis study, we included a section of questions focusing on cannabis use in a qualitative interview of first episode psychosis (FEP) interviewees. A concerted effort was made to ask questions that go beyond the standard clinical interview questions of quantity, frequency, and method of cannabis use. We were especially interested in probing the positive motivators for cannabis use beyond common reasons such as sleep and anxiolysis.

Results: We present qualitative results from interviews with individuals with recent FEP who described their experiences of using cannabis. A number of themes were unearthed, including the prosocial benefits of using cannabis, cannabis as a facilitator for personal reflection, and the relationship between cannabis use and self-esteem.

Conclusions: Through this qualitative study, we can better understand some of the complex reasons that patients may continue to use cannabis despite the risks of worsening mental health and psychosis. Using this information, we can deepen our screening and evaluation of cannabis use. A more nuanced qualitative understanding of use could help tailor interventions to patients to improve adherence to medications and reduction of cannabis use in FEP patients.

Mental Health First Aid for Spanish-Speaking Communities: Bridging Language Gaps and Expanding Capacity for the Non-clinical Crisis Workforce

Melanie Maldonado (1,2), Joey Rodriguez (1,2), Olivia Helfrich-Tapia (1,2), Steve Erazo Vasquez (1,2), Michelle Friedman-Yakoobian (1,2)
1. Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA
2. Department of Psychiatry, Harvard Medical School, Boston, MA

Background: Massachusetts’ Mental Health First Aid (MHFA), in partnership with the Spanish Advisory Board for Linguistic Development, seeks to expand mental health education for underserved, Spanish-speaking communities. Despite Spanish being the second most spoken language in Massachusetts, speakers face barriers accessing resources. Offering free MHFA certification aims to equip individuals to recognize early signs of mental health and substance use challenges, reduce stigma, and connect youth and families to supports. Training Spanish-speaking MHFA instructors through bilingual workshops builds capacity for early intervention and addresses disparities.

Methods: A community-driven outreach strategy, prioritizing relationship-based engagement, was implemented to connect with Spanish-speaking communities statewide. By first connecting with personal contacts, we extended reach through referrals, collaborating with youth-serving agencies, schools, law enforcement, legal aid, the Department of Child and Family Services, and faith-based organizations. Free Youth Mental Health First Aid (YMHFA) training will be offered for the next year. Pre- and post-training questionnaires measure instructor candidates’ and participants’ reactions and learning.

Results: So far, 20 individuals have been certified in YMHFA; five became bilingual Spanish/English instructors. Attendees have included teachers, social workers, peer specialists, and students. After training, 93% reported moderate/high ability to recognize signs, 93% felt confident initiating supportive conversations, and 86% felt comfortable asking about suicide. In post-training evaluations, 90% reported they could access the Massachusetts Behavioral Health Help Line, and 80% were likely to use it. Referral tasks were rated “easy” by 90% for resources and 80% for health professionals. Qualitative feedback indicated improved responsiveness through relationship-based outreach, safe spaces to support immigrants, youth agencies, and bilingual college-age participants are highly interested in training.

Conclusion: Relationship-based outreach and culturally responsive facilitation enable equitable identification and linkage to early intervention. Interest in continued training is strong. We aim to certify a minimum of 80 individuals and 15 instructors statewide.

A Scoping Review of Substance Use Treatment in Early Intervention Programs for Psychosis

Leo Bernstein (1), Delbee M Martin (1), Whitney Sourey (1), Dave Flynn MS(LIS) (2), Amy Yule M.D. (1)
1. Psychiatry Department at Boston Medical Center
2. BU Chobanian & Avedisian School of Medicine

Background: Co-occurring substance use and substance use disorders are common in first episode psychosis (FEP) patients, yet integration of substance use treatment into early intervention services (EIS) is not well established or researched. We therefore aimed to conduct a scoping review to describe substance use interventions within EIS, and barriers and facilitators to integrating substance use treatment into these programs.

Methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, and PsycINFO were searched from 1996 to 2025. Eligibility criteria included manuscripts written in English that discussed substance use treatment in EIS for individuals at clinical high-risk (CHR) and FEP. At least two reviewers independently screened abstracts and full texts and extracted data. Any conflicts were discussed as a group with the PI.

Results: A total of 1273 publications were identified and 35 met inclusion criteria. One publication focused on CHR and 34 focused on FEP. All publications discussed cannabis and alcohol as the two most used substances within these populations, with 13 focusing only on cannabis use. Ten of the studies evaluating substance use treatment were randomized controlled trials, 4 of which demonstrated significant reductions in substance use. Motivational interviewing (MI) was a common substance use intervention described in 17studies. Barriers to integrating substance use treatment included differing training and funding streams for substance use professionals and EIS providers, clinician time and familiarity with integrated substance use and mental health care models, and patient and family acceptability of as well as access to substance use treatment.

Conclusions: In the limited studies focusing on substance use interventions within EIS, MI was the most frequently used intervention. Given the high prevalence of substance use in CHR/FEP populations, additional research on substance use interventions for this population is needed.

Promoting Early Psychosis Identification and Psychosis-Informed Care: Characterizing the Statewide Impact of M-PATH in Massachusetts

Heather Muir, PhD (1), Emily Gagen, PhD (1,2), Rebecca Wleck, BA (1), Charlene Flynn, LMHC (1), Natalia Nodiff (1), Amanda Weber, PhD (1,2), Henry White, MD (1)
1. Brookline Center for Community Mental Health, Brookline, MA
2. Harvard Medical School Department of Psychiatry, Boston, MA

Background: The Massachusetts Strategic Plan for Early Psychosis (Mass-STEP) outlines priorities to build a high-quality system of care for people with psychosis. A key goal is to promote early identification and intervention through support for community members likely to encounter those experiencing psychosis. In alignment with this goal, the Massachusetts Psychosis Access and Triage Hub (M-PATH) was created to provide centralized triage and navigation, offering rapid consultation and support for early psychosis.

Methods: Since launching in late 2022, M-PATH has engaged almost 700 young people, families, and providers with support, education, resources, and referrals to specialized early psychosis programs. Its family partner and young adult peer mentor have drawn on lived experience to support families and youth through more than 50 sessions. M-PATH has also delivered over 100 presentations and trainings statewide to almost 3900 individuals, including to primary care and pediatric practices (with an emphasis on community health centers) and to non-behavioral health youth-facing state agencies (e.g., DCF, DYS). These efforts disseminate the principles of psychosis-informed care, which, similar to trauma-informed care, equips providers with skills, information, and confidence to discuss psychosis without requiring specialized expertise.

Results: We will present quantitative and qualitative data on M-PATH’s statewide impact since 2022. Findings include referral patterns (e.g., provider consultations, family consultations, peer mentorship, family partnership), referral sources, ages of youth served, sessions completed, response times, and organizational presentations delivered. Additionally, we will report qualitative themes of feedback from young people, families, and organizations on their experiences working with M-PATH. Finally, we will describe the principles of psychosis-informed care as well as future directions for M-PATH.

Conclusion: In under three years, M-PATH has significantly expanded access to early psychosis support by centralizing triage and navigation while promoting psychosis-informed care across diverse systems. Despite rapid growth and impact, opportunities remain for further expansion.

Psychosocial Treatments to Improve Community Functioning in Schizophrenia: Results of a Cluster-Randomized Comparative Effectiveness Trial

Russell K. Schutt (1,2), Matthew Killam (1), Diane K. Beckman (1,6), Raquelle I. Mesholam-Gately (1,2), Shaun Eack (3), Kim Mueser (4), Sarah Pratt (5), Meghan Santos (5), Jonathan Delman (7), Laura R. Golden (1,6), Tracy Reed (1,6), Matcheri S. Keshavan (1,2)
1. Psychosis Research Program, Dept. of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
2. Department of Psychiatry, Harvard Medical School, Boston, MA
3. Department of Social Work, University of Pittsburgh, Pittsburgh, PA
4. Sargent College of Rehabilitation, Boston University, Boston, MA
5. Dept. of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
6. Dept. of Sociology, University of Massachusetts Boston, Boston, MA
7. University of Massachusetts Medical School, Worcester, MA

Background: Schizophrenia-spectrum disorders create substantial burdens for individuals, families, communities, and health care systems. Psychopharmacological treatments can lessen psychotic symptoms but do not improve the social and cognitive deficits that most impair community engagement and functional recovery. With funding from the Patient-Centered Outcomes Research Institute (PCORI), we compared the effectiveness of two evidence-based psychosocial interventions to improve social and community functioning among those with schizophrenia-spectrum disorders and tested age and baseline cognitive functioning as moderators of treatment effects.

Methods: We randomized 15 treatment sites to deliver Cognitive Enhancement Therapy (CET) or Helping Ourselves Pursue and Experience Success (HOPES, a form of social skills training) for one year in weekly sessions led by two clinicians. CET also included weekly cognitive remediation sessions and progress reviews, while HOPES also included a monthly meeting with a clinician and a Community Support Person. Sites recruited 186 adults with schizophrenia or schizoaffective disorder. Project staff conducted remote assessments at baseline, 6 and 12 months, and 18 months (post-treatment) and 24 months (some sites). Primary outcomes: quality of life, social adjustment, social functioning. Secondary outcomes: neurocognitive functioning, social cognition. Symptoms: Positive and Negative Symptom Scale (PANSS-6). Process measures: attendance, retention, satisfaction, other services used. Qualitative interviews about treatment experience with randomly selected clients.

Results: Functioning improved on multiple primary and secondary outcome measures, with some different CET and HOPES treatment effects. Qualitative interviews indicated positive treatment experiences. Attendance, retention, and satisfaction were high. Treating clinicians found the treatment valuable and many hoped to continue providing it.

Conclusions: Cognitive, symptomatic, and functional gains indicate the value of both treatments, while some selective benefits of CET and HOPES suggest clients should be matched with the best treatment for them. Successful project implementation indicates the potential for more adoption in community settings.

Implementing Clozapine Point-of-Care Fingerstick Testing in Outpatient Psychiatric Care: A Mixed Methods Study

Catherine Leonard (3), Cheryl Y. S. Foo (1,2,3), Carol Lim (1,2,4), Sarah MacLaurin (1,2,4), Corinne Cather (1,2,3), Abigail L. Donovan (1,2,3,5), Oliver Freudenreich (1,2,3)
1. Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
2. Harvard Medical School, Boston, MA
3. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
4. Freedom Trail Clinic, North Suffolk Mental Health Association, Boston, MA
5. Acute Psychiatry Service, Massachusetts General Hospital, Boston, MA

Background: Despite clozapine's superior efficacy for treatment-resistant schizophrenia, it remains underutilized in part due to the burden from blood work needed to use it safely. While point-of-care fingerstick testing is an option for streamlining blood monitoring, empirical data on implementation in psychiatric settings is lacking. This study assessed its real-world uptake, patient acceptability, and associated implementation factors across two outpatient clinics in Massachusetts.

Methods: We conducted a two-site, mixed-methods study. Clozapine-treated patients receiving venipuncture or point-of-care fingerstick bloodwork were eligible to complete a survey that evaluated patient satisfaction regarding their current blood monitoring method and interest in the point-of-care fingerstick device. Rate and frequency of fingerstick testing use were extracted from electronic health record data. Interviews with clinic staff were conducted to evaluate feasibility and implementation factors impacting the use of a point-of-care fingerstick device.

Results: 28% of survey respondents (n=86) developed psychosis symptoms in the past 10 years. 22% (10/45) of clozapine-treated patients at a specialized psychosis treatment program and 60% (120/199) at a community mental health center used fingerstick testing at least once. Among survey respondents, 36% were infrequent users and 56% were non-users; these groups cited reluctance to change care, and perceived greater pain/inconvenience with fingerstick testing versus venipuncture. Non-users had taken clozapine for about seven years longer than those who tried fingerstick testing. Survey respondents had taken clozapine for a mean of 10.7 years (SD=8.1). Clinic staff cited provider burden, lack of reimbursement mechanisms, and staffing challenges as barriers to implementation; facilitators included having designated personnel for test administration.

Conclusions: When implementing point-of-care fingerstick testing, providers encountered logistical barriers related to patient acceptance, workflow, and reimbursement limitations. Programs seeking to implement point-of-care fingerstick devices should carefully consider patient preferences, duration of clozapine treatment, and staff workflow and develop a systematized patient education and shared decision-making strategy.

The Relationship Between Childhood Trauma, Abnormal Visual Experiences, and Visual Perceptual Functions in Young Individuals

Doğa Öge (1), Jonah Loshin (1), Nathaniel Weiler (1), Elif Ozan (1), Grace Owens (1), Zachary Milman (1), Dost Öngür (1), Halide Bilge Türközer (1)
1. McLean Hospital

Background: Childhood trauma is a well-established risk factor for the development of psychotic disorders and is associated with psychotic symptoms. While visual perceptual abnormalities are common in the clinical high-risk (CHR) stage of psychosis, the relationship between trauma exposure and visual perception remains understudied. This study examines the relationship between childhood trauma, abnormal visual experiences, and visual perceptual functioning in a transdiagnostic sample of young individuals with and without mental health symptoms.

Methods: Participants (ages 15–30, N = 19) included healthy controls (n = 11), clinical controls with depression or anxiety (n = 5), and individuals at clinical high risk for psychosis (n = 3). Trauma exposure was assessed using the Maltreatment and Abuse Chronology of Exposure (MACE) scale. Abnormal sensory experiences were assessed using the Audio-Visual Abnormalities Questionnaire (AVAQ). Visual processing was evaluated with the Mooney Faces Task (upright, inverted, and scrambled conditions) and the Jittered Orientation Visual Integration (JOVI) task, which measures contour integration. Spearman correlations were conducted between trauma and perceptual outcomes.

Results: MACE scores were positively associated with AVAQ visual subscores at a trend level (ρ = 0.441, p = 0.059). Higher MACE scores were significantly associated with face perception accuracy. Greater trauma burden was related to better performance on detecting upright faces (ρ = 0.578, p = 0.0095), but poorer performance on inverted faces (ρ = –0.507, p = 0.027). No significant associations were observed between MACE scores and JOVI performance (ρ = 0.156, p = 0.52).

Conclusions: In this preliminary analysis, childhood trauma was significantly associated with alterations in face perception and showed a trend-level association with abnormal visual experiences, but not with contour integration. These findings suggest that trauma-related developmental disruptions might be linked to visual processing deficits in psychosis. These relationships should be further examined in larger samples.

Improving Care for First Episode Psychosis (FEP): Challenges and Recommendations

Drew Madore (1), Yveton Isnor (1)
1. RISE Program, Cambridge Health Alliance

Coordinated Specialty Care (CSC) is the standard of care for individuals with first episode psychosis (FEP). It includes individual therapy, small caseloads (Heinssen et al., 2014), medication management (often low dose antipsychotics), case management, employment and education support, family education and support, and peer support (Heinssen and Azrin, 2022). Although CSC improves functional and clinical outcomes for FEP, it has several limitations. Powell and colleagues (2021) outline several barriers to CSC including stigma, cultural competence, disengagement, workforce development, measurement and evaluation, implementation in rural settings, and financial constraints.

This poster synthesizes the literature on domains that are insufficiently addressed by standard CSC interventions, particularly regarding psychotherapy interventions. These domains include: trauma, suicidality, identity formation, interpersonal challenges (e.g., domestic violence), and existential concerns. Evidence indicates that trauma exposure and instability in living environments are linked to poorer prognosis and elevated suicide risk (Conus et al., 2007; Phalen et al., 2024). While participating in CSC programs reduces suicidal ideation by up to 77% within six months, no standardized interventions that address suicidality in FEP exist, which highlights a need for individualized approaches (Breitborde et al., 2021; Anderson et al., 2018; Phalen et. al., 2024).

We critique the medical approach widely used in CSC, noting that psychotherapy’s relational, humanistic approaches are underemphasized (Elkin, 2009). We propose that alternative approaches (e.g., relational, humanistic, and mentalization-based interventions) offer unique opportunities to address clients’ complexities and heterogeneity. Given that FEP often emerges during critical developmental stages, a flexible, trauma-informed, and culturally-sensitive approach could be beneficial. By highlighting clients’ complexity through composite cases, the researchers demonstrate the necessity of multimodal, individualized interventions to improve outcomes. We propose that addressing the identified gaps will increase the effectiveness of CSC and improve long-term outcomes for individuals who experience FEP.

Peer Assessment and Monitoring Utilizing a NOISIE Model for Internal Qualitative Data Collection and Analysis in MAPNET’s Early Psychosis Clinic Fidelity Monitoring

Developing Standardized Pathways for Early Psychosis Risk Clinics: A Stepwise Framework for Outreach, Referral, and Evaluation Processes

Ashley Buchanan-Nguyen (1,2,3,4), Jordan Zimmerman (5), John Knutsen (6), Drew Madore (7), Alexandria Volpacchio (8), Erin Sunderland (9), Catherine Klapatch (9), Emily Carol (10), Lauren Utter (5), Amanda Weber (11)
1. Beth Israel Deaconess Medical Center
2. Massachusetts Mental Health Center
3. Harvard Medical School
4. CEDAR Clinic
5. Massachusetts General Hospital; RE-SET Clinic
6. PREP West/ServiceNet
7. Cambridge Health Alliance; RISE Program
8. Massachusetts General Hospital; RE-SET Clinic
9. The Edinburgh Center
10. Harvard Medical School; STAR Clinic
11. Brookline Center for Community Mental Health; CEDAR Clinic

Background: Clinical high-risk for psychosis (CHR-P) services remain heterogeneous in their outreach, referral, and evaluation procedures, leading to challenges in scalability, replication, and dissemination. While several clinics have developed local practices, there is not a widely shared, stepwise framework for guiding programs from community outreach through evaluation.

Methods: The M3P Learning Collaborative has developed a framework to standardize decision-making across four phases of program development: (1) outreach and community engagement, (2) referrals, (3) screening procedures, and (4) comprehensive evaluation. The framework integrates decision points related to access to resources (e.g., digital infrastructure, operational supports), inter-agency partnerships (e.g., community mental health centers, schools, state-level initiatives such as M-PATH), and staff training requirements. The framework was developed from clinical consensus across multiple CHR-P program leaders and reflects real-world challenges in balancing liability, clinical care, infrastructure, and accessibility.

Results: The resulting flowchart provides a practical, adaptable framework for CHR-P clinics at varying stages of development. Key innovations include: (a) branching logic for clinics with and without digital infrastructure; (b) accelerating access to care; (c) explicit attention to liability and data security in referral handling; (d) delineation between “consultation-only” and “initial evaluation” service models; and (e) integration of feedback and deliverables to stakeholders and clients.

Conclusions: A stepwise framework for CHR-P program development offers a replicable template that can reduce heterogeneity across clinics, strengthen referral pipelines, and promote consistency in evaluation practices. Disseminating such tools may facilitate the scaling of CHR-P services, increase access for at-risk youth, and support cross-site comparability for research initiatives.

GLP-1 Receptor Agonist Prescription Among Individuals with Schizophrenia

Sarosh Khan DO (1,2), Julia Browne PhD (1), Brittany Gouse MD (1,2), Amelia Blanton BS (1), Rayah Touma Sawaya MD (1,2), Faris Katkhuda MD (1,2), Hannah Brown MD (1,2)
1. Wellness and Recovery After Psychosis (WRAP) Research Program. Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian and Avedisian School of Medicine

Background: Schizophrenia is associated with an up to 20-year reduction in life expectancy due to cardiometabolic disease1. Glucagon-like peptide 1 receptor agonists (GLP-1 RA) are increasingly being used for weight loss, and are shown to lower BMI and reduce risk of metabolic disorders among the general population2. GLP-1 RAs are safe and tolerable among individuals with schizophrenia3. Prescription patterns, clinical and sociodemographic factors associated with GLP-1 RA prescription among individuals with schizophrenia in clinical practice are not well understood.

Methods: We utilized Slicer Dicer within EPIC to conduct a retrospective chart review of individuals with ICD-10 codes (F.20, F.29 and F.25) for schizophrenia, schizoaffective disorder and unspecified psychosis, with concurrent prescription for a GLP-1 RA at Boston Medical Center, between August 2020 and August 2025.

Results: Between 2020 and 2025, the number of individuals with a primary psychotic disorder prescribed a GLP-1 RA increased by nearly 4-fold (from 127 to 513 individuals). 81.4% of individuals prescribed a GLP-1 RA were also taking an antipsychotic medication, with the most commonly co-prescribed antipsychotic medication being Aripiprazole (19.7%), Olanzapine (15.9%) and Risperidone (15.2%). Between January and August 2025, the demographic breakdown of individuals with a primary psychotic disorder and concurrent GLP-1 RA prescription was as follows: N = 513, 51% female, 59% Black; and breakdown by age: 5% younger than 27 years old, 46% between age 27 to 54; 48% between ages 54 and 82, and 1% older than 82 years. 37% of individuals received a diagnosis of Diabetes Mellitus Type II. 47% of individuals received a diagnosis of Class I, II or III Obesity.

Conclusions: Future work is needed to elucidate GLP 1 RA prescription patterns in schizophrenia in addition to metabolic outcomes among individuals with schizophrenia based on concurrent antipsychotic medication with GLP-1 RAs.

Violence Risk in First Episode Psychosis: Predictors, Practice Gaps, and Ethical Assessment Guidelines

Yveton Isnor (1)
1. Cambridge Health Alliance

First episode psychosis (FEP) is associated with an elevated risk of violence, particularly before treatment begins. Despite growing evidence linking violence risk in FEP to clinical, psychosocial, and historical factors (e.g., childhood trauma, substance use, delinquency), assessment and documentation practices remain inconsistent. This systematic literature review synthesizes current research on the prevalence and predictors of violence in FEP, examining patterns of delinquency, trauma exposure, symptom severity, and systemic risk factors. The review identifies gaps in clinical practice, emphasizing the limitations of unstructured assessments and the underutilization of validated tools. Findings show that while clients and caregivers support transparent discussions about violence, stigma and limited clinician training often hinder thorough evaluation. This review underscores the need for trauma-informed, culturally sensitive, and standardized approaches to violence risk assessment in FEP. Recommendations and ethical considerations are discussed

Development and preliminary testing of a transdiagnostic intervention for adolescents with psychotic experiences

Hannah Olson (1), Francesca de Marneffe (1), Mitchell Chan (1), Elizabeth Eberlin (1), Kim T. Mueser (2), Randi M. Schuster (1,3), Daphne J. Holt (1,3), Nicole R. DeTore (1,3)
Institutions:
1. Department of Psychiatry, Massachusetts General Hospital
2. Center for Psychiatric Rehabilitation, Boston University
3. Department of Psychiatry, Harvard Medical School

Background: Psychotic experiences (PEs) represent a transdiagnostic risk factor for mental illness in adolescents. However, few psychosocial interventions aim at preventing transdiagnostic outcomes for teens experiencing PEs. Resilience Training for Teens (RTT) is a 6-week, group-based intervention, developed for high school students with PEs. This study aimed to assess the feasibility, acceptability, and preliminary impact of RTT.

Methods: Twelve students with at least one PE rated on the Adolescent Psychotic-Like Symptom Screener, through a school-based mental health screener, completed RTT and pre and post assessments including the Structured Interview for Psychosis-Risk Syndromes (SIPS); Global Assessment of Functioning (GAF); Brief Negative Symptom Scale (BNSS), Hinting Task, Prodromal Questionnaire-Brief (PQ-B); and the Reflective Function Questionnaire for Youth (RFQ-Y).

Results: A total of 12 adolescents, (Mage=15.67, 60% female, 31% identified as Asian, 31% as more than 1 race, 31% White, 7% Black/African American, and 31% as Latino/Hispanic) participated from three Massachusetts high schools. 72% of the students completed all six sessions and all students rated the intervention as enjoyable, with 75% endorsing that they enjoyed it “a lot.” All students also rated it as beneficial, and that they would recommend it to a friend. Significant improvements were seen on the Hinting Task (t=-2.54, p=.027), and both scales of the RFQ-Y (t=-2.62, p=.024; t=-2.48, p=.030) following RTT. PEs significantly decreased (PQ-B: t=2.99, p=.012) and SIPS items: unusual thought content (t=4.52, p<.001) and perceptual abnormalities (t=2.27, p=.043). Significant decreases in negative symptoms (BNSS: t=2.98, p=.007) and increase in GAF (t=-4.74, p<.001) were seen.

Conclusions: This study provides evidence that RTT may be feasible and acceptable in adolescents with PEs and may increase global functioning and improve symptoms, although as a single-arm study, efficacy cannot be reliably determined. A large randomized controlled trial is currently underway in several high schools across Massachusetts.

Food Insecurity Screening and Resource Provision Among Young Adults with Schizophrenia Spectrum Disorder

Amelia Blanton (1), Keerthana Karthik (1), Julia Browne (1), Sonya Abdalla (1), Haniya Rizwan (1), Aviva Schwarz (1), Brittany Gouse (1), Hannah Brown (1)
1. WRAP Research Program, Department of Psychiatry, Boston Medical Center

Background: Food insecurity is prevalent among individuals with schizophrenia spectrum disorders (SSD) and has been associated with poor social support, lower household income, and higher risk for co–occurring conditions. Yet, there is a lack of research on food insecurity screening and resource allocation among young adults with SSD. This study examined the prevalence of food insecurity in young adults with SSD. in an urban safety net hospital.

Methods: We retrospectively analyzed electronic medical record data of patients with SSD between 18-29 years old who had received care at an urban safety-net hospital in Massachusetts between 2019-2024. Patients were screened for social determinants of health (including food insecurity) at least once using the THRIVE social determinants of health screening tool. Food insecurity was measured with two validated items about concerns regarding food running out or not lasting due to financial reasons in the past 12 months. Encounters to the hospital’s preventive food pantry were also obtained. Descriptive statistics were calculated to evaluate the percentage of individuals (a) who screened positive for food insecurity and (b) who accessed the preventive food pantry.

Results: Out of 1,212 young persons, 225 (18.56%) screened positive for food insecurity within the past 12 months. Of patients reporting food insecurity, 37 (16.44%) reported that they did not have enough money for food the day of assessment. Of those reporting past-year food insecurity, 31 (13.77%) attended the hospital food pantry at least once.

Conclusion: Among young adults with SSD who experienced food insecurity, a small subset of individuals accessed the hospital food pantry. This gap between young adults who screened positive for food insecurity and those who visited the food pantry indicates that not all eligible patients are benefiting from the hospital’s resources. Further research is needed to understand barriers and facilitators to food insecurity resource provision among young adults with SSD.

Mapping Pathways to Early Psychosis Care Following Interactions with Crisis Services

Samantha Bullock

An Evaluation of Patient Outings in a Community-Based CSC Program for Youth with Psychosis and Frequent Substance Use

Morgan Ellis, MHS (1), Agata Bereznicka, MPH (1), Julia Browne, PhD (1, 2), Christian Wulff, LCSW (1), Anne Berrigan, LICSW (1), Jennifer Lancet, MBA, MS (1), Hannah E. Brown, MD (1, 2), Amy M. Yule, MD (1, 2)
1: Department of Psychiatry, Boston Medical Center (BMC), Boston, MA
2: Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA

Background: Social isolation is common in adolescents and young adults (AYA) with psychosis and has been correlated with prolonged duration of untreated psychosis. Moreover, AYA with substance use and psychosis often struggle to find positive prosocial activities that do not involve using substances. To address this, the WRAP Without Walls (WWW) Community-Based Coordinated Specialty Care Program introduced program-led group outings within the community to increase social engagement.

Methods: We analyzed participation and the cost of social outings that occurred in the programs' third year (06/24-07/25). Participation data was collected from the medical record and a prosocial rewards tracker. Cost data was collected from receipts from outings and rideshares. We categorized outings into recurring events (i.e., basketball) and non-recurring events (e.g., movies, ice skating, etc.)

Results: During this period, 16 patients attended at least one outing which included 5 recurring events and 10 non-recurring events. Of the 36 active patients during this time period, 61% were Black/African American and 26% Hispanic/Latino, with an average psychosis onset at age 18.2 and WWW enrollment at age 21.9. There were no statistically significant differences in these variables between attendees and non-attendees of the outings. Among the patients who attended outings, 29% went to 5+ events. Non-reoccurring events averaged 4 participants per outing, with a median of $49.83/patient/event and 54% of patients requiring rideshare services the events, with a median of $30.39 roundtrip per patient per event. For recurring events the event itself was associated with minimal cost but 75% of participants used rideshare services, with a median of $18.85 roundtrip/patient.

Conclusion: Offering group outings in the community is viable within a program for youth with psychosis and frequent substance use. Participation in outings and the costs associated with outings vary.