Development of a Boston Treatment Program for Youth at Clinical High Risk for Psychosis: Center for Early Detection, Assessment, and Response to Risk (CEDAR)

Abstract

Over the past two decades, increasing attention has been given to the importance of early intervention for psychosis. This article describes the development of the Center for Early Detection, Assessment and Response to Risk (CEDAR), which focuses on early identification and treatment of youth at clinical high risk for psychosis. There are relatively few models in the United States for such programs, and we present our developmental story, focusing mainly on the CEDAR Clinic, as a case study of how such a program can develop. We describe the rationale, infrastructure, and services provided at the CEDAR Clinic, and present some descriptive data from the CEDAR Clinic through 2016. A case example is provided to illustrate treatment at CEDAR. We hope that the cultural history of our program's development is informative for clinicians and policy makers as one model of how to build an early intervention service. We believe that this article is timely in view of the growing momentum in the United States for developing programs for intervening as early as possible for youth at clinical high risk for psychosis.

Figure 1

Early Psychosis Programs at MMHC Model representing CEDAR as part of an early psychosis center with capacity for research, training, community education, outreach, and integrated care across putative prodrome and early psychosis The inside shapes represent a connected series of research studies linked to treatment. PREP^® is Prevention and Recovery in Early Psychosis.

Figure 2. Social Functioning at Initial Assessment (N=128)¹

¹Data is missing for some participants

Figure 3. Role Functioning at Initial Assessment (N=127)¹

¹Data is missing for some participants