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.