OBJECTIVE:To prepare evidence-based guidelines on psychosis prevention. METHODS:We reviewed evidence on risk factors for/age at onset of psychosis, tools to assess clinical high-risk of psychosis (CHR-P), transition rates, risk calculation/ethical considerations around risk communication, CHR-P biological/clinical correlates, efficacy/cost-effectiveness of interventions/psychosis prevention services. The World Federation of Societies of Biological Psychiatry framework was used to grade evidence regarding interventions/services, elaborating guidelines with evidence-/consensus-based clinical recommendations to prevent psychosis in CHR-P subjects. RESULTS:At the service organisation level, (i) psychosis indicated prevention services might be implemented in close collaboration with early intervention services for psychosis to minimise duration of untreated illness, (ii) intake age criteria should be between 14 to 35, (iii) services should allow access to persons with cannabis use disorder. At the assessment and risk communication level, in clinical settings: (iv) staff in mental health services should be trained in administering/rating CHR-P assessment tools, (v) administer them, (vi) be trained in using/interpreting risk calculators, and (vii) in communicating risk, (viii) only use validated risk calculators, keeping a human-to-human interaction. Also, (ix) prevention services should assess comorbid mental disorders. At the intervention level: (x) staff should offer treatment for abstinence from cannabis, (xi) offer evidence-based treatment for comorbid mental disorders, and (xii) offer treatment for CHR-P based on patient preference, following the 'first do no harm' principle. CONCLUSIONS:Prevention services should be implemented, including interventions for cannabis use, reducing the duration of untreated psychosis, and treating comorbid mental disorders.

BackgroundCognitive Behavioral Social Skills Training (CBSST) is a targeted psychological intervention designed to improve daily functioning and to address negative symptoms in individuals diagnosed with schizophrenia. Despite evidence from clinical trials suggesting beneficial effects of CBSST on functioning and negative symptoms, the overall efficacy of CBSST remains to be quantified. Furthermore, potential moderators and mediators of treatment outcomes remain elusive. This protocol outlines an individual participant data meta-analysis (IPD-MA) with the objective to examine the efficacy of CBSST on psychosocial functioning in schizophrenia.MethodIn accordance with the Preferred Reporting Items for a Systematic review and Meta-Analysis of Individual Participant Data (PRISMA-IPD) guidelines, we will conduct a systematic literature search and employ two-stage and one-stage meta-analytical approaches. The meta-analytical models will evaluate the overall effect of CBSST relative to control treatments in randomized-control trials, identify participant-level (e.g., age, cognitive impairment) and study-level (e.g., individual vs. group settings) predictors of change, and explore the mechanisms that mediate improvement in functioning, such as skills acquisition and cognitive restructuring of defeatist attitudes. Furthermore, the analysis will attempt to determine the optimal amount of CBSST sessions required to enhance functioning and evaluate the impact of patient-level factors driving delivered dosage.DiscussionThe objective of this study is to contribute to the existing literature by addressing the current gaps in understanding the efficacy of CBSST and identifying critical factors for treatment success. Our findings will have the potential to inform personalized treatment planning and the development of clinical guideline recommendations focusing on functional outcomes and negative symptoms in people with schizophrenia.Systematic review registrationPROSPERO CRD42024605353.

OBJECTIVE:Individuals with eating disorders (EDs) often present with maladaptive behaviours such as excessive exercise (EE). The consequences of EE include physical injuries, increased risk of anxiety and depression, and impaired social functioning. No systematic reviews have been conducted on the prevalence of EE in EDs. This study aimed to assess the prevalence of EE in EDs and by ED type. METHOD:An electronic database search of the peer-reviewed literature was conducted from inception to October 2024. Review eligibility was restricted to research studies reporting prevalence data for EE in individuals diagnosed with EDs. RESULTS:Fifty-six studies met the inclusion criteria (n = 21,518; mean age: 22.34 years). The current prevalence of EE in all EDs was 48%. Current prevalence was highest in AN (48%), followed by BN (45%), OSFED (38%), and BED (11%). The lifetime prevalence of EE in all EDs was 63%. Lifetime prevalence was highest in AN (72%), followed by BN (57%) and OSFED (21%). CONCLUSIONS:Nearly half of individuals with an ED engage in EE. High heterogeneity across the included studies likely influenced the prevalence found in this study. Data suggest clinical screening and longitudinal monitoring of EE in those with EDs. Future research into early intervention and treatment for EE in those with EDs is recommended. TRIAL REGISTRATION:PROSPERO: CRD42023464148; Open Science Framework: https://doi.org/10.17605/OSF.IO/MYVXW.

Executive functions are neurocognitive processes involved in regulating thought and action. It is unknown whether youth diagnosed with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have similar executive functioning. This review aimed to synthesize the literature directly comparing executive functioning in youth with ASD, ADHD, and their comorbidity (ASD + ADHD). In the 58 included articles, ADHD and ASD exemplified impaired response inhibition, working memory, and attention compared to controls. There is little support that ASD + ADHD showed the combined deficits of the ASD and the ADHD groups, and these three groups cannot be easily identified based on EF executive function profiles alone. Further standardization of tasks and performance metrics are necessary to facilitate future evidence synthesis.

BACKGROUND:Mental health concerns are common among university students and maybe elevated among those with specific risk exposures. The study examined the association between childhood adversities and mental health outcomes among undergraduate university students and assessed whether psychosocial and behavioral factors mediate those associations.METHODS:The Queen's University Student Well-Being and Academic Success Survey identified two large cohorts of first-year undergraduate students entering university in Fall 2018 and 2019 (n = 5,943). At baseline, students reported sociodemographic information, family-related mental health history, childhood physical abuse, sexual abuse, peer bullying, and parental separation or divorce. Baseline and follow-up surveys in Spring 2019, Fall 2019, and Spring 2020 included validated measures of anxiety (7-item Generalized Anxiety Disorder) and depressive symptoms (9-item Patient Health Questionnaire ), non-suicidal self-harm, and suicidality, along with psychological processes and lifestyle variables. Repeated measures logistic regression using Generalized Estimating Equations was used to characterize the associations between childhood adversities and mental health outcomes and examine potential mediation.RESULTS:Adjusting for age, gender, ethnicity, familial mental illness, and parental education, any childhood abuse (odds ratio: 2.89; 95% confidence interval, 2.58 to 3.23) and parental separation or divorce (odds ratio: 1.29; 95% confidence interval, 1.12 to 1.50) were significantly associated with a composite indicator of mental health outcomes (either 9-item Patient Health Questionnaire score ≥10 or 7-item Generalized Anxiety Disorderscore ≥10 or suicidality or self-harm). The association with childhood abuse weakened when adjusted for perceived stress, self-esteem, and insomnia (odds ratio: 2.05; 95% confidence interval, 1.80 to 2.34), and that with parental divorce weakened when adjusted for self-esteem (odds ratio: 1.17; 95% confidence interval, 1.00 to 1.36).CONCLUSION:Childhood abuse and parental separation or divorce were associated with mental health concerns among university students. Childhood adversities may impact later mental health through an association with stress sensitivity, self-esteem, and sleep problems. The findings suggest that prevention and early intervention focusing on improving sleep, self-esteem, and coping with stress while considering the individual risk profile of help-seeking students may help support student mental health.

Interventions for functional impairments in adolescents and young adults at clinical high risk (CHR) for psychosis are needed. Cognitive-Behavioral Social Skills Training (CBSST) has been found to improve functioning in patients with schizophrenia. The CBSST manual was adapted for CHR and implemented across 3 sites. The key changes that were made were to present a focus of normalization and destigmatization of attenuated psychotic symptoms and since CBSST has a major focus on role plays, problem solving and challenging thoughts, examples of these were changed to be more appropriate for this young CHR population. We describe the manual modifications and present fidelity data to examine the success of training and supervision methods in a multi-site randomized controlled trial of CBSST in CHR youth. Fidelity was high and comparable across sites. Case vignettes are presented to demonstrate how CBSST techniques were adapted for UHR individuals to target functional impairments.

Objective: To conduct a scoping review to identify programs and interventions to support youth with mental health conditions (MHCs) with their transition to postsecondary institution (PSI). Method: A database search of MEDLINE, PsycINFO, Embase, SocINDEX, ERIC, CINHAL, and Education Research Complete was undertaken. In this review, MHC was defined as a mental, behavioural, or emotional condition, or problematic substance use, and excluded neurodevelopmental or physical disorders. Two reviewers independently screened studies and extracted the data. Included studies are described and a risk-of-bias assessment was conducted on included studies. Results: Nine studies were included in this review, describing eight unique interventions. Sixty-two percent of interventions were nonspecific in the MHCs that they were addressing in postsecondary students. These interventions were designed to support students upon arrival to their PSIS. Peer mentorship, student engagement, goal setting, and interagency collaboration were some of the strategies employed. However, the overall quality and level of evidence in these studies was low and the effectiveness of these programs was not established. Conclusion: The volume of research identified was limited, no reliable nor policy informing conclusions can yet be made about the impact of these interventions as the evaluation methods, quality of the research methodologies, and the levels of evidence available were of low-quality. Future randomized control trials are required that are designed to target and improve transitions from secondary education to PSIS for those with MHCs.

ABSTRACT Aims: To estimate temporal trends in cannabis consumption in the Canadian household population using national survey data and map changes in cannabis consumption postlegalization in 2018. Methods: In a 2-step meta-analysis approach, we first analyzed each survey year separately by estimating the weighted past-year prevalence (%) of self-reported cannabis use (including just once) with its 95% confidence intervals (CIs). In the next step, to produce aggregate data for each survey year, we pooled prevalences using the DerSimonian and Laird random-effects (determined a priori) meta-analysis model packages in R to estimate the between-study variance (τ2) for the inverse variance method, and the Freeman-Tukey Double arcsine transformation. Results: In total, 29 Statistics Canada survey iterations met eligibility for inclusion in the meta-analysis. Reported past-year prevalences for cannabis use ranged from 4.2% in 1993 to 27% in 2021. The overall prevalence of past-year cannabis use was 11.4% (95% CI, 9.7%–13.3%; 22 surveys; 53,712/474,888 participants; I 2=99.8%; τ2=0.0048). There was a significant increase in cannabis past-year prevalence in subgroup meta-analyses (P<0.0001) comparing postlegalization [2018–2021: 25.0% (95% CI, 23%–27%), I 2=96%] to prelegalization [1985–2017: 9.9% (95% CI, 9%–11%), I 2=99%]. There was also a significant time trend, with a steady increase in the reported past-year cannabis prevalence over time from 1985 through 2021. Notably, the most recent national estimate of cannabis prevalence from 2021 was nearly 6 times the first estimate from 1985 (27% vs. 5%). Conclusions: The present study is the first to synthesize Canadian household survey data to estimate the temporal trends in cannabis consumption and is the first meta-analysis examining both the prevalence and changes postlegalization of cannabis use in Canada. The evidence indicates increasing past-year cannabis consumption and time, with a statistically significant increase postlegalization. The public health implications of these changes require further study. Objectifs: Estimer les tendances temporelles de la consommation de cannabis dans les populations des ménages canadiens à l’aide de données d’enquêtes nationales et cartographier les changements dans la consommation de cannabis après la légalisation en 2018. Méthodes: Dans une approche de méta-analyse en deux étapes, nous avons d’abord analysé chaque année d’enquête séparément en estimant la prévalence pondérée (%) au cours de la dernière année de la consommation de cannabis auto-déclarée (y compris une seule fois) dans ses intervalles de confiance à 95% (IC à 95%). Dans l'étape suivante, pour produire des données agrégées pour chaque année d’enquête, nous avons regroupé les prévalences à l’aide de la méthode d’effets aléatoires de DerSimonian et Laird (déterminé a priori) version de modèles de méta-analyse en R pour estimer la variance entre les études (2) pour la méthode de la variance inverse, et la transformation de Freeman-Tukey à double arc-sinus. Résultats: Au total, 29 itérations de l’enquête de Statistique Canada répondaient aux critères d’admissibilité à l’inclusion dans la méta-analyse. Les prévalences de consommation de cannabis signalées au cours de l’année précédente variaient de 4,2% en 1993 à 27% en 2021. La prévalence globale de la consommation de cannabis au cours de l’année précédente était de 11,4% (IC à 95%, 9,7-13,3%; 22 enquêtes; 53 712/474 888 participants; I 2=99,8%; 2=0,0048). Il y a eu une augmentation significative dans la prévalence du cannabis au cours de l’année précédente dans les méta-analyses de sous-groupes (valeur p;0,0001) comparant les périodes post légalisation (2018–2021: 25,0% [IC à 95%, 23%–27%], I 2=96%) à la période pré-légalisation (1985–2017: 10% [IC à 95%, 9%–11%], I 2=99,3%). Une tendance temporelle significative a également été observée, avec une augmentation constante du nombre de cas de consommation de cannabis au cours de l’année écoulée, de 1985 à 2021. Il est à noter que l’estimation nationale la plus récente sur la prévalence du cannabis en 2021 était près de six fois la première estimation de 1985 (27% contre 5%). Conclusions: La présente étude est la première à synthétiser les données d’enquêtes auprès des ménages canadiens afin d’estimer les tendances temporelles de la consommation de cannabis. C’est aussi la première méta-analyse examinant à la fois la prévalence et les changements après la légalisation de la consommation de cannabis au Canada. Les données indiquent une augmentation de la consommation de cannabis au cours de l’année écoulée, avec une augmentation statistiquement significative après la légalisation. Les implications de ces changements en matière de santé publique nécessitent une étude plus approfondie.

Background: Access to university mental health services is poorly characterized. Our objectives were to (1) assess patterns of access and (2) explore predictability of contact with student mental health services. Participants: Data derived from the U-Flourish study, which includes a survey of successive cohorts of incoming undergraduate students attending Queen's University, located in Ontario, Canada (Cohort 1: 2018, Cohort 2: 2019). Methods: Survey data sets were deterministically linked to administrative data provided by Student Wellness Services. Analyses included cross-tabulation, logistic and negative binomial regression. Predictive modeling used LASSO regression. Results: Baseline symptoms were robust determinants of access. For example, a PHQ-9 rating in the severe range (≥ 20) was associated with an OR of 9.71 (95% CI: 4.46-21.1). A predictive algorithm did not outperform cut point-based interpretation of PHQ-9 or GAD-7 ratings. Conclusions: Self-reported symptoms are consistently associated with service use, supporting the widespread use of symptom screens.

Mental health problems in school-aged youth are a risk factor for poor outcomes in adulthood. Although these poor outcomes are well established, most youth with mental health problems continue to experience barriers to receiving appropriate services. Tier 2 interventions are sometimes provided to students who are at risk of developing a mental illness. The aim of this scoping review was to synthesize the peer-reviewed research regarding Tier 2 mental health interventions in primary and secondary school settings. A systematic search of published research was conducted in CINAHL, Education Research Complete, Embase, ERIC, Medline, PsycINFO and SocINDEX electronic databases. This scoping review followed a two-level screening process where articles were screened in duplicate by two blinded reviewers. A total of 288 articles were included in this scoping review. Tier 2 mental health interventions in schools have significantly increased since 1965, increasing to about 24 research publications per year. Interventions mainly targeted youth with behavioural problems (51.04%), social difficulties (21.88%), emotional problems (20.49%), and substance abuse (18.06%). Tier 2 interventions were administered by teachers (58.33%) and most often delivered in a group setting (42.01%). This scoping review demonstrated that Tier 2 mental health interventions in schools are gaining prominence in the literature and primarily target children with externalizing behavioural problems. The flexibility of Tier 2 interventions allows them to be implemented in a variety of settings and treat several symptoms making them ideal for broad-based mental health support in schools.

Abstract Primary Subject area Mental Health Background The transition from high school to postsecondary is a critical milestone for independence and empowerment. This life stage frequently coincides with the emergence of most mental health conditions (MHCs). Without adequate support to assist with the transition to postsecondary education, the mental health of arriving students with existing MHCs is likely to decline or remain unmet. Declining mental health is strongly associated with students withdrawing from both secondary and postsecondary education. However, a scoping review of interventions aiming to support youth with MHCs transition to postsecondary has not been conducted. Objectives The objectives of this scoping review were to identify: (1) researched interventions that support youth with MHCs during the transition to postsecondary; (2) best practices used to support this transition; (3) methods of evaluating these interventions and any limitations; and (4) gaps where future research is warranted. Design/Methods A database search of MEDLINE, PsycINFO, Embase, SocINDEX, ERIC, CINHAL, and Education Research Complete was undertaken. Two reviewers independently screened studies and extracted the data. Thematic analysis and risk-of-bias assessment were conducted on included studies. Results Nine studies were included in this review, describing eight unique interventions (Figure 1). Sixty-two percent of interventions were nonspecific in the MHCs that they were targeting in postsecondary students. These interventions were designed to support students upon arrival to postsecondary. Peer mentorship, student engagement, and interagency collaboration were found to be beneficial approaches to supporting youth transitioning into postsecondary (Table 1). The overall quality and level of evidence in these studies was low. Three knowledge gaps were found: evidence was not generalizable to the diversity of MHCs, intervention studies were mostly cross-sectional in nature and lacked follow-up data, and sustaining intervention funding remained a challenge for postsecondary institutions. Conclusion The volume of research identified was limited but indicated overall that offering support during the transition to postsecondary was beneficial for students with MHCs. Further evidence is needed that is generalizable across the mental health spectrum, and that assesses intervention outcomes in relation to intervention costs.

BACKGROUND:Underreporting of harms in randomized controlled trials (RCTs) may lead to incomplete or erroneous assessments of the perceived benefit-to-harm profile of an intervention. To compare benefit with harm in clinical practice and future clinical studies, adverse event (AE) profiles including severity need to be understood. Even though patients report harm symptoms earlier and more frequently than clinicians, rheumatology RCTs currently do not provide a reporting framework from the patient's perspective regarding harms. Our objective for this meta-research project was to identify AEs in order to determine harm clusters and whether these could be self-reported by patients. Our other objective was to examine reported severity grading of the reported harms. METHODS:We considered primary publications of RCTs eligible if they were published between 2008 and 2018 evaluating pharmacological interventions in patients with a rheumatic or musculoskeletal condition and if they were included in Cochrane reviews. We extracted data on harms such as reported AE terms together with severity (if described), and categorized AE- and severity-terms into overall groups. We deemed all AEs with felt components appropriate for patient self-reporting. RESULTS:The literature search identified 187 possible Cochrane reviews, of which 94 were eligible for evaluation, comprising 1,297 articles on individual RCTs. Of these RCTs, 93 pharmacological trials met our inclusion criteria (including 31,023 patients; representing 20,844 accumulated patient years), which reported a total of 21,498 AEs, corresponding to 693 unique reported terms for AEs. We further sub-categorized these terms into 280 harm clusters (i.e., themes). AEs appropriate for patient self-reporting accounted for 58% of the AEs reported. Among the reported AEs, we identified medical terms for all of the 117 harm clusters appropriate for patient reporting and lay language terms for 86%. We intended to include severity grades of the reported AEs, but there was no evidence for systematic reporting of clinician- or patient-reported severity in the primary articles of the 93 trials. However, we identified 33 terms suggesting severity, but severity grading was discernible in only 9%, precluding a breakdown by severity in this systematic review. CONCLUSIONS:Our results support the need for a standardized framework for patients' reporting of harms in rheumatology trials. Reporting of AEs with severity should be included in future reporting of harms, both from the patients' and investigators' perspectives. REGISTRATION:PROSPERO: CRD42018108393.

OBJECTIVE:The Outcome Measures in Rheumatology (OMERACT) Safety Working Group objective was to identify harm domains from existing outcome measurements in rheumatology.METHODS:Systematically searching the MEDLINE database on January 24, 2017, we identified full-text articles that could be used for harm outcomes in rheumatology. Domains/items from the identified instruments were described and the content synthesized to provide a preliminary framework for harm outcomes.RESULTS:From 435 possible references, 24 were read in full text and 9 were included: 7 measurement instruments were identified. Investigation of domains/items revealed considerable heterogeneity in the grouping and approach.CONCLUSION:The ideal way to assess harm aspects from the patients' perspective has not yet been ascertained.

Persistent negative symptoms (PNS) are defined as enduring moderate negative symptoms while controlling for principal sources of secondary negative symptoms. PNS symptoms have been associated with poor functional outcomes in schizophrenia. Furthermore, in schizophrenia negative symptoms and poor functioning have been reportedly associated with defeatist beliefs (e.g., “I always fail”). Youth at clinical high risk (CHR) for developing psychosis often demonstrate negative symptoms, poor functioning, and defeatist beliefs. The goal of this study was to determine if negative symptoms were associated with poor functioning and defeatist beliefs in a CHR longitudinal cohort. CHR (N=764) participants were recruited for the North American Prodrome Longitudinal Study (NAPLS 2) at 8-sites across North America. Negative symptoms were rated on the Scale of Prodromal Symptoms (SOPS) at baseline, 6, 12, 18, and 24 months. For this study negative symptoms were restricted to social anhedonia (N1), avolition (N2), and expression of emotion (N3) based on recommendations from the NIMH-MATRICS consensus statement on negative symptoms. PNS were defined as having one of these three negative symptoms scored ≥4 (i.e., moderately severe to extreme) for a period of one year. Depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS). To assess defeatist beliefs the Brief Core Schema Scale (BCSS) was utilized as a proxy to evaluate negative self-beliefs (e.g., “I am worthless”) and positive self-beliefs (e.g., “I am valuable”). Generalized linear mixed models for repeated measures were used to examine changes over time between and within groups to accommodate for missing data and account for intra-participant correlations. Sixty-seven CHR individuals had PNS. Mixed-effect models demonstrated that the PNS group had significant global, social, and role functioning deficits at baseline, 6, 12, 18, and 24 months compared to CHR individuals without PNS (n=673). Moreover, functioning did not improve in the PNS group while functioning in the group without PNS significantly improved over time. There were no significant differences between the groups on depressive symptoms with the CDSS. The PNS group had significantly higher BCSS self-negative beliefs at 12 and 24 months compared to the group without PNS. Individuals without PNS had significantly higher positive self-beliefs (e.g., “I am valuable”) at baseline, 6 months, 12 months and 24 months compared to the PNS group. The results indicate that in the NAPLS cohort 10% of CHR individuals have PNS. Moreover, the PNS group demonstrated significant and persistent global, social, and role functioning deficits compared to those without PNS. The group without PNS had higher levels of positive beliefs (e.g., “I am successful”), which may indicate a protective factor against developing PNS.

Poor global functioning in youth at clinical high risk (CHR) for psychosis has been associated with sleep disturbances, neurocognitive impairments, and transition to psychosis. A recent meta-analysis demonstrated that the CHR state is characterized by large functional impairments similar to those with psychotic disorders and thus require treatment. However, the impact of different treatment types on global functioning remains unknown. Thus, the goal of this systematic review and meta-analysis was to determine the impact of interventions on global functioning in those at CHR for psychosis. We systematically searched the electronic databases PsycINFO, Embase, CINAHL, EBM, and MEDLINE with no date, geographical, or language restrictions. Studies were selected if they conducted a randomized control trial (RCT) in CHR for psychosis samples and reported changes in global functioning using either the Global Assessment of Functioning (GAF) or Social and Occupational Functioning Assessment Scale (SOFAS). Data were evaluated using random effects pairwise meta‐analyses, separated by treatment type, and stratified by time. Effect sizes were reported as the standardized mean difference (SMD) and 95% CIs for the comparison between control and experimental conditions. Heterogeneity was assessed using Tau2 and the I2 index. Fourteen studies met our inclusion criteria. Interventions included antipsychotics (k=2), cognitive behavioural therapy (CBT, k=6), cognitive remediation (k=1), family therapy (k=1), integrative psychosocial therapy (k=1), and omega‐3 (k=3). Meta-analyses could only be performed for CBT and omega‐3 trials. CBT did not significantly improve global functioning at 6-months (SMD = -0.08; 95% CI = −0.35, 0.19, I2= 48%;P=.58, 5 studies, N= 506), 12-months (SMD = 0.07; 95% CI = −0.10, 0.25, I2= 0%;P=.43, 6 studies, N= 501), 18-months (SMD = 0.09; 95% CI = −0.21, 0.39, I2= 0%;P=.56, 2 studies, N= 168), and long-term (24–48 months) follow-up (SMD = 0.01; 95% CI = −0.28, 0.29, I2= 0%;P=.96, 3 studies, N= 190). Omega‐3 did not significantly improve global functioning at 6-months (SMD = 0.35; 95% CI = −0.40, 1.09, I2= 91%; P=.36, 3 studies, N= 390) and 12-months (SMD = 0.52; 95% CI = −0.53, 1.56, I2= 94%; P=.33, 3 studies, N= 330). This systematic review and meta‐analysis established that neither CBT nor omega-3 significantly impacted global functioning versus controls in those at CHR for psychosis. The majority of trials utilized the GAF which is greatly influenced by impairment in psychiatric symptoms. Additionally, RCTs using the Comprehensive Assessment of At-Risk Mental States (CAARMS) criteria for CHR included functioning on the SOFAS as a diagnostic criterion. Future treatment studies may wish to use scales that specifically address social and role functioning to further elucidate the impact of treatment on functioning.

Few studies have sought to test the impact of psychosocial interventions on functional impairments in adolescents and young adults at clinical high risk (CHR) for psychosis. Moreover, reliable implementation of psychosocial interventions is costly, requiring years of advanced education and specialized training to adequately implement. Cognitive-Behavioral Social Skills Training (CBSST) combines elements of Cognitive Behavior Therapy with Social Skills Training, two evidence-based treatments for schizophrenia. In the current study, an existing CBSST manual was adapted to make content more appropriate for CHR age range and illness severity. The adapted manual was disseminated and implemented across 3 sites. Key changes to the published manual included a focus on normalization and destigmatization of attenuated psychotic symptoms, as well as examples and role plays that are appropriate for a young CHR sample. The aim of the current paper is to describe the manual modifications and present preliminary data demonstrating the success of training and supervision methods in this multi-site randomized controlled trial of CBSST in CHR youth. Case vignettes will demonstrate how CBSST techniques uniquely target functional impairments characteristic of emerging psychosis. Subjects were eligible if they met criteria for a prodromal syndrome measured by the Scale of Prodromal Syndromes, demonstrated a mild impairment in social or role functioning, and were between the ages of 12–30. Facilitators included bachelor’s level or above clinicians and trainees. Facilitator training on CBSST techniques was completed through a combination of in-person trainings and standardized training tapes. All sessions were audio recorded by facilitators. A random selection of recordings were systematically assessed by 2 raters, blinded to all participant data and tape selection procedure. Recordings were rated for CBT fidelity using the Cognitive Therapy Rating Scale for Psychosis (CTS-Psy) and the SST fidelity using the Social Skills Training Fidelity Scale. Recordings and ratings were used in weekly videoconference supervision to iteratively introduce technical modifications between sessions, address procedural errors, and provide facilitators with written feedback to improve fidelity. Weekly supervision served as a platform to discuss treatment manual revisions and effective strategies to engage youth in CBSST techniques. Fourteen audio recordings were evaluated per site. CTS-Psy and SST overall fidelity ratings were consistent across sites ([mean±SD] Site 1=43.6 ±5.2, Site 2=42.6±3.0, and Site 3=41.9±2.8). There were no site differences on total general skill (Site 1=22.6 ±2.3, Site 2=20.7±1.8, and Site 3=21.3±2.1) nor CBSST technical skill (Site 1=20.9±3.4, Site 2=21.9±2.5, and Site 3=20.6±2.1) ratings. Overall fidelity ratings were above the “adequate” range (>30). Thus, quantitatively, a high level of fidelity was achieved through this model of training and supervision. Qualitatively, case vignettes yield anecdotal evidence that CBSST provides a unique set of techniques, easily administered by bachelor’s level or above providers, that target functional impairments specific to CHR youth. Taken together, these results provide preliminary evidence that CBSST can be reliably implemented with high fidelity and low cost with target engagement of functional impairment in CHR youth.