Aim This study assessed feasibility of a stepped-care model for those at clinical high-risk for psychosis (CHRp) within a coordinated specialty care clinic in the United States. Methods Youth aged 12-30 completed a 12-month, three-step intervention where persistent or worsening symptoms received increasingly intensive treatment including Supportive Problem Solving, Cognitive Behavioral Case Management and a Selective Serotonin Reuptake Inhibitor. Results Of 32 CHR youth admitted to the clinic over 18 months, 12 were eligible for the study, ten consented, eight participated, and five completed. Major reasons for ineligibility were loss to follow-up during engagement, pressing comorbid concerns that required other specialty care, and medication preferences. Those who completed treatment showed clinically significant improvements in multiple domains and no worsening. Three discontinued due to medication needs (more intensive care, perceived side effects) with the remainder of the sample showing small-to-moderate and moderate-to-large effect sizes in social functioning, depression, and attenuated psychosis symptoms by 12-month follow-up. Conclusions This preliminary study supports larger scale trials of stepped-care interventions for CHRp in the US, but also illuminates key features of the US healthcare system that must shape implementation. The stepped-care intervention appeared tolerable and feasible in those who engaged, but comorbid treatment needs in this heterogenous population, including medication needs/preferences, and disengagement during referral to psychosis specialty care precluded participation for many. Future studies will need to evaluate larger samples, account for needs and preferences for medication, and should place screening and early steps in general outpatient mental health services to evaluate real-world effectiveness.