InVEST: Individualized Vocational and Educational Support and Training for Clinical High Risk for Psychosis (CHR-P)

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Project Summary Despite emphasis on the importance of targeting functional impairments in early psychosis treatments, there is no current evidence-based intervention for academic functioning in the clinical high risk for psychosis (CHR-P) stage. Functional impairments should be a key treatment priority, given evidence that functional decline begins during the CHR-P stage, impacts treatment engagement, and may impact other symptoms. We seek to develop “InVEST” (Individualized Vocational and Educational Support and Training), an intervention focused on improving educational functioning in clients ages 12-18 that are exhibiting CHR-P. Conceptualized as a component of coordinated specialty care (CSC) for youth at CHR-P, InVEST builds on prior research on supported employment, along with real world experience helping youth at CHR-P to pursue educational/ vocational goals within a CHR-P specialty clinic. InVEST is implemented individually (in person or via videoconference) by bachelor's level clinician “coaches” who serve as members of a CSC team. InVEST is designed to engage the following mechanisms which are believed to interact and to negatively impact educational and vocational functioning during the CHR-P stage: 1) executive functioning difficulties (a cognitive mechanism), 2) stress sensitivity (an emotional mechanism), and 3) task initiation difficulties (a behavioral mechanism). InVEST is a novel intervention for a prioritized treatment outcome (i.e., role functioning) in a high-risk population, and is distinct from other empirically examined approaches during the CHR-P stage, including cognitive behavioral therapy for psychosis. InVEST takes into account the diverse needs of youth at CHR-P by 1) prioritizing client preferences in a personalized approach and 2) teaching strategies designed to be used independently to maximize broad access. The project will test InVEST in two phases: 1) an open trial with 8 participants, and 2) a small randomized control trial with 30 participants comparing InVEST against a treatment as usual waitlist control. Our treatment development objectives align with NIMH's strategic objectives 3.2 (“Develop ways to tailor existing and new interventions and to optimize outcomes”) and 3.3 (Test interventions for effectiveness in community practice settings). As recommended, we are specifically optimizing supported employment programs by targeting individuals earlier in their disease progression. Furthermore, we seek to study InVEST in a real-world community practice setting. Pilot data may support the basis for a future, larger study, adequately powered to examine efficacy of InVEST in improving functional outcomes and to examine potential mechanisms of change. This intervention is particularly timely during the COVID-19 pandemic, as youth at CHR-P may be particularly vulnerable to school failure and disengagement without the structure of in-person connection with school staff for supporting learning needs.