CHR-P Training Toolkit

What is CHR-P?

Clinical High Risk for Psychosis (CHR-P) refers to a set of symptoms and experiences that suggest a person may be at increased risk of developing a psychotic disorder, such as schizophrenia. Individuals at CHR-P often experience subtle changes in thinking, perception, or functioning—like unusual thoughts, mild perceptual disturbances, or social withdrawal—that are distressing but not yet fully psychotic. Identifying and supporting individuals in this early stage provides a critical opportunity for prevention and early intervention to reduce the likelihood of progression to full psychosis and improve long-term outcomes.

What is coordinated specialty care?

Coordinated Specialty Care (CSC) is a team-based, multi-element approach designed to provide comprehensive, evidence-based services to individuals experiencing early psychosis. For youth at Clinical High Risk for Psychosis (CHR-P), CSC offers tailored support including psychotherapy, family education, medication management, school and work coaching, and case coordination. This model is especially important for CHR-P populations because early, integrated care can help prevent or delay the onset of full psychosis and promote recovery. Stepped care is an approach within CSC that matches the intensity of services to a person’s current needs—starting with lower-intensity interventions and stepping up care only if needed—ensuring that treatment is both effective and efficient.

Massachusetts CHR-P Care Model

Massachusetts uses a “stepped care” model to provide mental health support to youth across Massachusetts. These “steps” provide a tiered approach based on a person’s needs, from youth with few to no mental health needs to those experiencing a first episode of psychosis (FEP).

Our partners at the Massachusetts Psychosis Prevention Partnership (M3P) each provide one of three essential services to make this system work. M-PATH at the Brookline Center directs outreach and triage to help youth find the right resources. Our CHR-P treatment teams provide clinical services to youth if needed. Lastly, MAPNET provides training & consultation to each of these programs to make sure that our partners can provide high-quality, evidence-based services.

 

Screening & Assessment for CHR-P

Assessment for CHR-P involves a comprehensive, multi-method evaluation to understand an individual’s current experiences, developmental background, and overall mental health. A key component of this process is the Structured Interview for Psychosis-Risk Syndromes (SIPS), a semi-structured interview that assesses subthreshold psychotic symptoms and functional decline to determine whether someone meets criteria for CHR-P. In addition to the SIPS, a full evaluation includes a developmental history, family interview, and assessment of co-occurring conditions—such as anxiety, depression, trauma-related symptoms, or neurodivergent traits—that commonly overlap with psychosis-risk presentations.

Across the M3P network, clinics are working together to implement a standardized assessment battery that includes both interview-based and self-report tools to guide diagnostic clarity and determine whether specialty CHR-P stepped care is appropriate. These tools are not only essential at intake, but are also repeated every six months to monitor progress and inform individualized treatment planning, ensuring that assessment is fully integrated into ongoing clinical care.

 

Asynchronous Training Materials

Below are some essential articles, background resources, and videos to help you learn more about CHR-P assessment and care.

Background CHR-P research and care articles

  • This article describes the development of the CEDAR Clinic in Massachusetts, a specialized program focused on early identification and treatment of youth at high risk for psychosis. It highlights the clinic’s personalized care approach and shares the cultural history of CEDAR’s development as a model early intervention program.

  • This comprehensive, state-of-the-art review explains what it means to be at high risk for psychosis. It covers symptoms, challenges, and recent research, highlighting implications for future studies and early intervention efforts.

  • This study compares early intervention services to standard treatments for people experiencing early signs of psychosis. The findings show that specialized early care can improve outcomes and quality of life, emphasizing why timely access and funding for these services matter.

  • This meta-analysis looks at how likely individuals identified as clinical high risk are to develop psychosis. It provides important information about risk levels, helping clinicians and families make informed decisions about monitoring and care.

 

Assessment and treatment of CHR-P

 

Evidence-Based Practices

  • Cognitive Behavioral Therapy for Psychosis (CBTp) is a structured, time-limited, and goal-based treatment modality that aims to enhance functioning in the context of psychotic symptoms. CBTp forms a collaborative treatment alliance in which patient and therapist can explore distressing experiences and the patient’s beliefs about these experiences, with the goal of reducing distress and disability.

    1. Complete Cognitive Behavioral Therapy for Psychosis (CBTp) ePrimer, a free 3-hour, self-guided course on CBT-p available through the Mental Health Technology Transfer Center (MHTTC).

    2. Watch the 3-part EASA Webinar Series on CBT for psychosis. This series gives an overview of CBTp, presents different CBTp models, and explores integration of these models and considerations when choosing which to implement. (Session 1 Slides / Session 2 Slides / Session 3 Slides)

    3. Watch the following video on Cognitive Behavioral Therapy for Clinical High Risk of Psychosis. This video provides an overview of CBT for CHR-P, recent research and clinical outcomes of this model, the need to consider addressing co-morbidities, and considerations for training and implementation.

    4. Read this meta-analysis that examines transition risk to psychosis in individuals at clinical high risk.

  • Acceptance and Commitment Therapy (ACT) is a psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.

    1. Watch Michelle Friedman-Yakoobian and Brandon Gaudiano’s introduction to ACT for psychosis here.

    2. Read more at actforpsychosis.com

 

Other Useful Resources

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