Background Development of new evidence-based interventions for youth who are at clinical high risk for psychosis (CHR-P) is needed. Health behaviors and lifestyle habits such as physical activity, sleep and substance abuse are modifiable risk factors for a variety of health outcomes. We assessed the feasibility and acceptability of a novel health behavior-focused psychosocial intervention for CHR-P youth. Methods In a non-randomized feasibility trial, youth aged 13-17 who met CHR-P criteria participated in a 9-week health behavior promotion group that provided psychoeducation and skills training regarding stress management, sleep, physical activity, nutrition, mitigating substance use, and health behavior goal setting. Primary outcomes included feasibility and social validity. Secondary outcomes were pre-to post-intervention change in health behaviors. Results Seven participants enrolled and five completed at least two thirds of the intervention, indicating good retention. There were no significant pre-post changes across measures of health behaviors or symptoms. Participants endorsed the goals of the intervention as meaningful and congruent with their treatment goals. The group format was described as acceptable, while the didactic style was less preferred. Discussion Findings support the intervention as acceptable and feasible. Changes in health behaviors and symptoms were not significant but trended in the expected direction. Future trials are needed to refine the intervention and assess effectiveness.

Treatment for youth at clinical high risk for psychosis (CHR-P) presents an opportunity for early intervention with the capacity to decrease the burden associated with a potential psychotic illness later in life. However, significant barriers prevent youth at CHR-P from accessing specialty mental health services. Few studies have examined the pathways to care for youth at CHR-P within the U.S. health system. The present study reports the results of a codebook thematic analysis of qualitative interviews conducted with 15 families of youth at CHR-P. We inquired about their experiences navigating the health system to eventually arrive at the CHR-P specialty program, including help-seeking events and referrals, attributions for CHR-P symptoms, and barriers and facilitators to care using a semi-structured interview guide. Caregivers reported confusion and uncertainty regarding symptom attributions. They also disclosed the significant challenges to obtaining mental health care including mental health literacy, illness stigma, provider availability and appropriateness, and adequacy of referrals. Notably, most youth at CHR-P had encounters with emergency services during their help-seeking journey. Our results help define targets for future policy, research, and clinical efforts to improve access to specialty care for youth at CHR-P in the U.S.