Recruitment strategies for the detection of individuals at clinical high risk of developing psychosis.

Dear Editor Over the past decade, there has been an increase in studies of individuals at clinical high risk (CHR) of developing psychosis characterized by subthreshold psychotic symptoms and functional decline before the emergence of a diagnosable psychotic disorder. Typically, this research focuses on an improved understanding of the prodromal period, the predictors of developing psychosis as well as potential interventions (Addington & Heinssen, 2012). Conducting prospective research with young people at CHR of psychosis poses many challenges, including the recruitment of an adequate sample size to increase the power of the study (Heinssen et al. 2003). Based on the low incidence rates (<1 case per 10 000 persons per year in the general population) research centres that are involved in this research recruited 18–30 individuals per year (Addington et al. 2007). However, it should be noted that first these participants are help-seeking, and are not recruited through targeted screening and secondly since these individuals are help-seeking, sampling strategies will be different across CHR research centres. Although much of the research focuses on understanding the development of psychosis, of those who do not go on to develop psychosis, many remain disabled with poor functional outcome and potentially chronic subthreshold symptoms (Addington et al. 2011). Collaborative multi-site research, an alternative to the typical single-site, single principal investigator approach to early psychosis research, does address the issue of having adequately powered samples. However, from a public health perspective it fails to address the issue of population-based identification and treatment of those at CHR of developing psychosis. This paper describes the attempts at recruiting and engaging youth at CHR of psychosis through the joint efforts of an integrated research and clinical service in the Canadian health system. The research programme was conducted at the University of Calgary site of the North American Prodrome Longitudinal Study (NAPLS) and the PRIME clinic is for those at CHR for psychosis. Initial phone screening is done through NAPLS by an experienced clinician who screens and invites appropriate referrals for consultation. All sources of referrals are encouraged to call to discuss any young person whom they may have had concerns with respect to impending psychosis. Potentially suitable participants are offered an initial screening appointment through NAPLS within 1 week of referral. This screening is conducted by experienced clinical raters, under the supervision of J.A., who are trained in the Structured Clinical Interview for DSM Disorders (SCID) and the Structured Interview of Prodromal Syndromes (SIPS) which is one of the most widely used assessments to determine the prodromal status (McGlashan et al. 2010). Once it is established that individuals meet relevant criteria, they are invited to participate in the NAPLS project and to attend the PRIME clinic.