Nov
2
9:30 AM09:30

Developing a Sustainable Long-Acting Injectable Clinic in an Academic Psychiatric Hospital: A Clinical Implementation Model

Developing a Sustainable Long-Acting Injectable Clinic in an Academic Psychiatric Hospital: A Clinical Implementation Model

Elischa Jamal Sanders, MD, PhD,Massachusetts General Hospital/McLean Psychiatry Residency Program, Boston, MA, Harvard Medical School, Boston, MA
Tucker Avra, MD, DVM: Massachusetts General Hospital/McLean Psychiatry Residency Program, Boston, MA, Harvard Medical School, Boston, MA
Cheryl Yunn Shee Foo, PhD: Harvard Medical School, Boston, MA, Massachusetts General Hospital, Boston, MA

Background: Long-acting injectable (LAI) medications can improve medication adherence and reduce relapse and hospitalization risk for individuals with serious mental illness (SMI). However, access to LAIs is often limited by systems-level barriers, including fragmented workflows for medication procurement, insurance authorization, storage, administration, and patient follow-up. Consequently, many patients who may benefit from LAIs are unable to initiate or maintain treatment, including after a psychiatric hospitalization. A sustainable LAI clinic therefore requires an integrated clinical and operational model.

Methods: We systematically identified implementation needs and core components of an LAI clinic through a stakeholder-engaged process. The Massachusetts General Hospital (MGH) Wang outpatient injection clinic was used as a reference model and adapted for an academic psychiatric hospital providing inpatient and outpatient care of people with SMI who currently rely on external referral pathways for LAI administration. Psychiatry leadership, residents, and pharmacy services assessed feasibility, identified required resources, and mapped integration with existing clinical workflows.

Results: Stakeholders identified six essential components, including: 1) reliable medication procurement and onsite storage systems, 2) streamlined processes for insurance/benefits and financial assistance navigation; 3) billing and reimbursement processes; 4) clearly defined pharmacy and clinical responsibilities, 4) dedicated staffing and physical space; and 5) coordinated patient-provider follow-up for medication continuation and monitoring. A resident-supported staffing model was identified as a potential capacity building strategy that could simultaneously provide structured training in LAI prescribing, shared decision-making, and team-based psychiatric care. The proposed model specifies six key steps, with an accountable role assigned at each: 1) patient referral and intake, 2) shared decision-making, 3) insurance authorization and financial assistance navigation, 4) medication procurement/delivery, 5) LAI administration, and 6) longitudinal follow-up and monitoring.

Conclusion: A structured implementation model may facilitate translation from clinical interest to sustainable practice and provide a replicable model for academic psychiatric settings seeking to improve access to LAI treatment.

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Nov
2
9:30 AM09:30

Developing a Statewide Implementation Blueprint to Expand Access to Long-Acting Psychiatric Medications in Massachusetts Community Behavioral Health Centers

Developing a Statewide Implementation Blueprint to Expand Access to Long-Acting Psychiatric Medications in Massachusetts Community Behavioral Health Centers

1. Cheryl Y. S. Foo
2. Kim T. Mueser, Center for Psychiatric Rehabilitation, Department of Occupational and Brain Sciences, Boston University
3. Catherine J. Leonard, Massachusetts General Hospital Center of Excellence for Psychosocial and Systemic Research
4. Sarah A. MacLaurin, Massachusetts General Hospital; North Suffolk Community Services
5. Michael C. Angelini, Massachusetts College of Pharmacy and Health Sciences University
6. Ryann Abrams, Greater Lawrence Family Health Center; Massachusetts Pharmacists Association
7. Massachusetts General Hospital Treatment Resistant Schizophrenia Advocacy, Clinical Consultation, Education, and Support Service (TRS ACCESS) Network
8. Deirdre Calvert, Massachusetts Department of Public Health
9. David Hoffman, Massachusetts Department of Mental Health
10. Margaret Guyer-Deason, Massachusetts Department of Mental Health
11. Donna Frates, Massachusetts Behavioral Health Partnership
12. Lee Robinson, MassHealth Office of Accountable Care and Behavioral Health
13. Jessica Zeidman, Massachusetts Department of Public Health
14. Amam Saleh, Massachusetts Department of Mental Health
15. Corinne Cather, Massachusetts General Hospital Center of Excellence for Psychosocial and Systemic Research; Harvard Medical School

Background: Long-acting antipsychotic medications reduce relapse and hospitalization for people with schizophrenia spectrum disorders, with greatest benefit early in illness, yet utilization among people with early psychosis remains low (US: 4%; MA: 11%). SMI-REACH is a statewide initiative expanding long-acting psychiatric medication (LAM) access and use across Massachusetts’ 29 community behavioral health centers (CBHCs), which increasingly serve as the entry and continuing care setting for young people after a first episode.

Methods: Phase 1 (2025) built a cross-sector coalition of state agencies, CBHCs, and clinical/research experts aligned on the principle of “no wrong door” to LAM treatment. Phase 2’s landscape analysis (2026) surveyed all 29 CBHCs on ability to prescribe, administer, and store LAMs onsite, yielding a typology of capability stages. Listening tours with 15 purposively sampled CBHCs identified multilevel barriers and facilitators. At a September summit, agency and CBHC stakeholders prioritized barriers and refined candidate strategies to inform a statewide implementation blueprint.

Findings: Sites spanned five capability stages: Fully Capable (21%; routine prescribing, onsite administration and storage of all LAMs); Capable (28%; onsite administration without storage, limited same-day treatment); Partly Capable (17%; onsite administration of long-acting antipsychotics only); Referral-Based (21%; prescribe but refer for administration); and Not Capable (14%; not prescribing due to absent administration workflows). Fewer Southeast (25%) and Western Massachusetts sites (38%) had onsite administration. Listening tours revealed leadership commitment, provider willingness, and patient need were high, while barriers experienced were primarily systemic: licensing requirements delaying onsite administration, non-billable nurse-led care coordination, and fragmented hospital-to-CBHC transitions. Facilitators included whole-team training on discussing LAMs, nurse champions for administration, and pharmacy collaboration for ease of access.

Conclusions: SMI-REACH applies implementation science at the scale of a state behavioral health system to bridge practice gaps in schizophrenia pharmacotherapy across the care continuum beyond coordinated specialty care. Multilevel barriers necessitate use of strategy bundles combining policy action, expanded access, provider training, and patient-facing supports. A capability typology enables stage-tailored strategy deployment, while state agency partnership enables structural change. An actionable blueprint will be finalized in December 2026.

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Nov
2
9:30 AM09:30

The effects of commercialized legal cannabis on criminal legal involvement and hospitalizations in first episode psychosis

The effects of commercialized legal cannabis on criminal legal involvement and hospitalizations in first episode psychosis

Michael W Flores (CHA/HMS)
Danta Bien-Aime (CHA/HMS)
Alice Gelman (CHA/HMS)
Julie Johnson (Massachusetts Cannabis Control Commission)
A. Eden Evins (MGH/HMS)
Dost Ongur (McLean/HMS)
Benjamin Le Cook (CHA/HMS)

Background/Objectives: Individuals with first episode psychosis (FEP) are disproportionately likely to experience adverse effects from cannabis use, and cannabis legalization and commercialization has been associated with a rise in both cannabis use and emergency department visits among individuals with established psychosis. The present study sought to ascertain cannabis policy effects on young people with first episode of psychosis by examining the impact of the opening of cannabis dispensaries on clinical and criminal-legal outcomes.

Methods: We utilized longitudinal data from the Early Psychosis Intervention Network, a network of early psychosis clinics from states with a variety of cannabis policy regimes. 3,607 individuals contributing 7,409 responses were included. The exposure was the opening of cannabis dispensaries in a state. Outcomes included 30-day use of cannabis, recent psychiatric hospitalization, and recent legal issues. Panel fixed effect logistic regression models were utilized to ascertain associations between exposure to dispensaries and outcomes, with both year and individual fixed effects included.

Results: After adjusting for individual and year fixed effects, there was a no significant change in 30-day cannabis use after exposure to dispensaries (OR=2.4, 95% CI 0.86-6.53, p=0.09). Exposure to dispensaries was associated with both an increase in psychiatric hospitalization (OR=1.8, 95% CI 1.2-2.8, p=0.005) and increased criminal-legal involvement (OR=8.6, 95% CI 2.3-32.4, p=0.001).

Implications: Young people with first episode psychosis had increased rates of both psychiatric hospitalization and criminal legal involvement after cannabis dispensaries opened. Increased availability of cannabis and wider availability of high-potency cannabis products may be partially responsible for these adverse consequences. FEP clinicians should engage in systematic assessment and treatment of problematic cannabis use as well as encourage harm reduction practices such as the reduction in use of high potency products, while programs diverting individuals with psychosis from jails and prisons into treatment may need to be strengthened after cannabis legalization.

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Nov
2
9:30 AM09:30

Loneliness in early psychosis: a mixed-methods study

Loneliness in early psychosis: a mixed-methods study

Niharika Jhingan (Psychosis Research Lab, RISE Program, Cambridge Health Alliance)
Lynn DeLisi (Psychosis Research Lab, RISE Program, Cambridge Health Alliance)
Daniel Fulford (Department of Psychological & Brain Sciences, Boston University)

Background: Loneliness, the subjective experience of social disconnection, is prevalent across the psychosis spectrum, with negative consequences for physical health, symptom trajectory, and overall wellbeing. Loneliness is particularly salient for youth at the earliest stages of illness, given unique contributions of developmental (e.g., identity formation), social (e.g., stigma), and illness related factors (e.g., psychosis symptomatology). Despite its relevance for early intervention, little is known about correlates of loneliness in the daily lives of youth recovering from early psychosis, and few studies have explored the lived experience of loneliness in this population.

Methods: Data were drawn from the Pathways to Loneliness in Early Psychosis study at Cambridge Health Alliance’s Recovery in Shared Experiences (RISE) Program [F31MH140381]. Analyses include ecological momentary assessment (EMA) data in 30 participants over two weeks. EMA questions captured experiences of social connection, disconnection, and related phenomena (e.g., stigma, belongingness). Participants also provided real-time qualitative reflections on loneliness and a subset completed full qualitative interviews following the EMA period.

Results: Descriptive analyses reflected heterogeneity of loneliness in daily life. For some participants, momentary loneliness fluctuated substantially across the two-week period, while others reported more persistent disconnection. We will also present follow-up analyses of our intensive longitudinal data using multilevel modeling to elucidate between- and within- participant differences in loneliness across the study duration. Preliminary qualitative reflections illuminated proximal contributors to loneliness, including stigma, social rejection, and unmet needs for belonging, as well as structural challenges.

Conclusions: The current project is the first to explore loneliness through a dynamic, mixed-methods, intensive longitudinal approach in youth with early psychosis. We suggest structural, developmental, social, and symptom-related factors interact to contribute to the subjective experience of disconnection in youth with psychosis spectrum diagnoses. We discuss avenues for addressing loneliness and it correlates in the context of early intervention.

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Nov
2
9:30 AM09:30

Clinical, cognitive, and premorbid functioning correlates of autistic traits in early psychosis: Findings from the BICEPS study

Clinical, cognitive, and premorbid functioning correlates of autistic traits in early psychosis: Findings from the BICEPS study

Nicolas Raymond (1), Megan Good (1,2), Kathryn E. Lewandowski (2,3), Lynn DeLisi (4), Elliot Gershon (5), Sarah Keedy (5), Jennifer E. McDowell (6), Brett Clementz (6), Godfrey Pearlson (7,8), Carol Tamminga (9), Matcheri S. Keshavan (1,2)
1. Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA
2. Department of Psychiatry, Harvard Medical School, Boston MA
3. Division of Psychotic Disorders, McLean Hospital, Belmont MA
4. Psychiatry Research Office, Cambridge Health Alliance, Cambridge MA
5. Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
6. Department of Psychology, University of Georgia, Athens, GA
7. Department of Psychiatry, Yale University, New Haven, CT
8. Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare, Hartford, CT
9. Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX

Background: Approximately 75% of genes associated with autism are also implicated in schizophrenia. Phenotypically, there is overlap between psychosis symptoms and autistic behaviors. However, research understanding how autistic traits impact outcomes of in early psychosis (EP) is lacking.

Methods: 104 participants (39.4% female, mean age (standard deviation)=24.04 (4.27) years, 39.4% identifying as a racial minority) with EP (<4 years from symptom onset) were enrolled and eligible. Participants completed the brief assessment of cognition in schizophrenia (BACS), positive and negative syndrome scale (PANSS), premorbid adjustment scale (PAS), and social responsiveness scale-2 (SRS-2). The SRS-2 quantifies autism traits, yielding total scores and two- (social communication/interaction (SCI), restricted/repetitive behavior (RRB)) and five-factor subscale scores (emotion recognition (ER), social avoidance, interpersonal relatedness, insistence on sameness, repetitive mannerisms (RM)). Spearman correlations were computed between the SRS-2 total and subscales with the BACS, PANSS, and PAS scores. The false discovery rate (FDR) corrected P-values.

Results: The PAS correlated significantly with the SRS-2 total (ρ=0.29, p=0.0056, FDR-p=0.025), SCI (ρ=0.29, p=0.0060, FDR-p=0.025), and ER scores (ρ=0.28, p=0.0078, FDR-p=0.027). The RM subscale correlated with the symbol coding (ρ=0.29, p=0.0080, FDR-p=0.027), verbal fluency (ρ=0.30, p=0.0069, FDR-p=0.027), and composite BACS scores (ρ=0.28, p=0.013, FDR-p=0.041), which the RBB score also correlated with (ρ=0.28, p=0.013, FDR-p=0.041). We found the SRS-2 total and all its subscales correlated significantly with PANSS total (ρ>0.27, p<0.0077, FDR-p<0.027) general (ρ>0.40, p<0.000048, FDR-p<0.00046) and positive scores (ρ>0.25, p<0.015, FDR-p<0.045). Additionally, the ER subscale correlated significantly with the PANSS negative subscale (ρ=0.27, p=0.0091, FDR-p=0.03). Other correlations were not significant (FDR-p>0.05).

Conclusions: Greater prevalence of autism-like traits in a sample of individuals with EP related to poorer premorbid functioning, more severe symptoms, but better cognition. While future work must evaluate the significance of baseline autism-like traits on longitudinal outcomes, results indicate the import of autistic traits to the presentation of EP.

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Nov
2
9:30 AM09:30

Preliminary clinical cohort outcomes of a brief, hybrid care clinic model for individuals with psychosis

Preliminary clinical cohort outcomes of a brief, hybrid care clinic model for individuals with psychosis

Victoria Lisowski *, Andrew Jin Soo Byun *, Kathryn Taylor Ledley *, Brian Sampson, Maddalena Cipriani* , Matcheri Keshavan*, Michelle Friedman-Yakoobian*, John Torous*
* Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Background: With limited access to evidence-based psychological treatments for individuals with psychosis, hybrid digital care models are promising yet remain under-explored in naturalistic psychosis populations. Our BEACON model adapts an established hybrid care model (with clinician-delivered therapy, the mindLAMP smartphone app, and Digital Navigator coaching) for individuals with psychosis. Having presented previously on the development and adaptation of the BEACON model, this poster reports preliminary feasibility and clinical outcome data from its initial real-world implementation.

Methods: A preliminary clinical cohort (N=23) spanning the psychosis spectrum (Clinical High Risk, First Episode, and Chronic Psychosis; ages 18–56) completed the 8-week BEACON program. Primary clinical outcomes (attenuated psychosis symptoms, anxiety, depression, sleep disturbance), secondary measures (recovery, quality of life, disability, emotion regulation, etc.), and passive digital phenotype data (steps, screen time, GPS mobility) were collected from intake to completion.

Results: Patients demonstrated 78.5% app engagement and 92% program satisfaction. From intake to completion, patients showed medium-to-large improvements in attenuated psychosis symptoms (d_z=+0.75), anxiety (d_z=+0.68), and depression (d_z=+0.61), with no significant change in sleep disturbance. Secondary measures moved in favorable directions, most notably self-worth/recovery (d_z=+0.75) and quality of life (d_z=+0.69). Passive sensing data revealed coherent behavioral patterns (diurnal activity rhythms, expected phone-use trends), and exploratory associations linked greater sleep continuity and GPS mobility diversity to lower symptom burden.

Discussion: These preliminary, single-arm findings suggest BEACON is feasible and acceptable for individuals with psychosis in real-world clinical settings, with encouraging clinical improvement and interpretable digital phenotyping signals. Further controlled trials are necessary to establish efficacy of the program, and key implementation barriers should be addressed.

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Nov
2
9:30 AM09:30

Narrative-Based Peer Group Interventions for Clinical High Risk for Psychosis: Early Observations from a Feasibility and Acceptability Study at the CEDAR Clinic

Narrative-Based Peer Group Interventions for Clinical High Risk for Psychosis: Early Observations from a Feasibility and Acceptability Study at the CEDAR Clinic

Allison Slocum, CEDAR Clinic/BCCMH
Tamara Welikson, STAR Clinic/McLean Hospital
Janina Scarlet, creator of Superhero Therapy; consulting psychologist with CEDAR and STAR
Amanda Weber, CEDAR Clinic/BCCMH

Background: Coordinated Specialty Care (CSC) clinics for clinical high risk for psychosis (CHR-P) serve a population with substantial unmet needs in social connectedness, identity development, and treatment engagement, yet peer group-based psychosocial interventions targeting these domains remain underdeveloped. The CEDAR Clinic is a specialized CHR-P CSC program and is part of the Massachusetts Psychosis Prevention Partnership (M3P), a statewide consortium funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). In response to the need for developmentally appropriate and culturally responsive approaches to these domains, CEDAR has offered a Superhero Therapy/Anime Group (ST/AG) for adolescents ages 14–18. The ST/AG integrates Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), and superhero/anime-based narrative frameworks to promote identity development, intrapersonal meaning-making, and social connectedness through engagement with culturally resonant media. Given the limited availability of peer group-based interventions within CHR-P CSC, this study examines whether the ST/AG's culturally resonant and evidence-informed format is feasible and acceptable for implementation in CHR-P CSC settings.

Methods: This retrospective and prospective secondary data analysis examined feasibility and acceptability of the ST/AG delivered as routine clinical care at CEDAR. Feasibility was indexed by enrollment, session attendance, and completion rates. Acceptability was assessed using a group-specific questionnaire and participants were provided with the opportunity to provide qualitative feedback regarding their group experience.

Results: Data collection is ongoing. This poster will present the study design, rationale, and measurement approach as well as observed facilitators and barriers to feasibility and acceptability in a CHR-P CSC setting.

Conclusions: This project aims to address a gap in developmentally appropriate, culturally engaging peer group interventions for CHR-P populations. By generating foundational feasibility and acceptability data, the study aims to inform future regional dissemination of these models, supporting statewide goals of early intervention and evidence-based care.

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Oct
19
4:00 PM16:00

Shared Decision Making in Early Psychosis Care: A Nationwide Survey of Provider Practices and Training Needs

Shared Decision Making in Early Psychosis Care: A Nationwide Survey of Provider Practices and Training Needs

1. Catherine J. Leonard, Massachusetts General Hospital Center of Excellence for Psychosocial and Systemic Research
2. Lisa B. Dixon, Columbia University Medical Center; Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute
3. Kim T. Mueser, Center for Psychosocial Rehabilitation, Departments of Occupational Therapy and Psychological & Brain Sciences, Boston University
4. Corinne Cather, Massachusetts General Hospital Center of Excellence for Psychosocial and Systemic Research; Harvard Medical School
5. Yaara Zisman-Ilani, Department of Social and Behavioral Sciences, Temple University's College of Public Health

Background: Shared decision making (SDM) is a recommended approach for enhancing patient-provider communication about psychiatric treatment and is embedded as a core principle in early psychosis coordinated specialty care (CSC) guidelines. Yet how providers apply SDM across early psychosis treatment decisions, and where their training gaps lie, remains unclear.

Methods: Providers working with people with early psychosis, recruited through nationwide early psychosis and EPINET hub listervs, completed a self-report online survey. On a 6-point scale, providers rated their likelihood of using SDM for 21 treatment decisions grouped into psychosocial intervention and recovery-oriented decisions (10 items), pharmacologic and medical decisions (8 items), and higher level of care and legal decisions (3 items; hospitalization, discharge planning, guardianship). Providers also rated perceived barriers and training and decision support tool needs. Ordinal mixed models with provider random intercepts tested SDM likelihood by decision type and provider role.

Results: Of 159 eligible providers across 29 states (75% in CSC; 41% individual therapists; 18% prescribers; 13% peer or family peer specialists), 69% described typically practicing SDM, 26% implementing client preferences, and 4% a paternalistic approach. While 92% involved care partners in treatment decisions, only 35% reported considering care partners’ own preferences. Within the same provider, SDM likelihood significantly differed by decision type (p<.001): relative to psychosocial decisions, odds of endorsing SDM were roughly halved for medication decisions (OR=0.55) and reduced 88% for hospitalization and guardianship decisions (OR=0.12). No role endorsed using SDM more than another overall, but prescribers and therapists reported being least likely to use SDM for higher-level-of-care decisions compared to other decisions, whereas peer/family peer specialists did not differ in SDM use across decision types. Limited client insight (72%) and insufficient medication knowledge (50%) were top barriers. Although 61% did not use decision support tools, 86% expected them to benefit care.

Conclusions: Early psychosis providers reported least likelihood of using SDM for hospitalization and guardianship decisions. Findings support whole-team SDM training addressing attitudinal and knowledge barriers and the balance of client autonomy and care partner involvement in higher-level-of-care decisions, alongside the development and use of decision aids for early psychosis care.

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