Inspired by the growing recognition that early intervention leads to better outcomes among people along a continuum for psychosis, efforts to identify people at clinical high-risk (CHR) for psychosis have seen exponential growth in the past decade. Gains in identification and assessment have been propelled by advanced statistically derived formulas based on large samples. Although this macro-level process has been productive for many, this approach has focused primarily on white people, evolving from a mental health system grounded in white supremacy. For example, typical CHR interview practices such as those employed with the Structured Interview for Prodromal Syndromes (SIPS) may in some cases not fully honor individual differences of those being evaluated. As a result, existing practices can both fail to identify some individuals from marginalized communities who are at risk for psychosis, while at the same time misdiagnose others. Evidence suggests that conditions associated with marginalized identities such as the stress of immigrant status, being "othered" as an ethnic/racial minority, and exposure to neighborhood crime and trauma increase risk for developing psychosis-spectrum disorders. Simultaneously, contextual or environmental factors can lead to endorsing items – particularly those related to suspiciousness – on CHR assessment tools when the underlying mechanism is unrelated to psychosis. Whether potentiating the development of psychosis, or creating a context where confounds lead to errors of measurement and subsequent over/mis-pathologizing, or both, accurate conceptualization of a person's situation through the use of psychometrically valid strategies across diverse populations is critical. 

After briefly describing the field's racially imbued historical context, this talk grapples with contemporary factors related to the disparate assessment of psychosis across racial/ethnic groups, discussing how responses to discrimination, crime, and/or trauma may be causally or concurrently (or concurrently that leads to causality) linked to psychosis risk symptoms. The validity of common assessment measures is described among Black people, and in the context of high-crime neighborhoods, with findings suggesting a need for focused attention towards intercultural and contextual responsivity. Further, assumptions inherent in certain risk assessment questions are scrutinized to assess if behaviors or beliefs considered problematic if observed among white people are equally predictive among minority groups (e.g., belief in superstitions, déjà vu, having special talents, religious convictions). Ultimately, this talk asserts that a lack of cultural/contextual consideration, as well as a lack of validated measures in marginalized groups, can lead to diagnostic confusion, false-positives, and large-scale health disparities, especially in the context of federal funding that is actively encouraging growth to scale in this area. The talk concludes with steps clinicians, researchers, and leaders can take to challenge the status quo in the service of making assessment of risk more inclusive and accurate. 

Action recommendations include more explicitly infusing cultural humility into risk assessment training (e.g., the role of clinician bias, considering socially mediated stress as a dynamic factor when establishing risk), increasing access for people of color to become both professionals and leaders in the field, rebuilding trust that has been violated through the marginalization of communities in and outside of the mental health care system, and using structured tools such as the Cultural Formulation Interview to garner a clearer perspective of a given individual's circumstances. Collectively, these steps may help reduce the risk of misdiagnosis as well as enhance detection in those who may be at risk for psychosis.

Format

Recorded webinar, non-interactive, self-paced distance learning activity with post-test.

This presentation was recorded on November 12, 2020 at the virtual conference, Third National Conference on Advancing Early Psychosis Care in the United States: Addressing Inequities - Race, Culture, and COVID. 

Learning Objectives

• Identify signs of psychosis-risk symptoms through exposure to risk assessment tools.
• Demonstrate awareness of psychosis-risk screening and assessment strategies, and recognize how attention to cultural and contextual factors inform these strategies.
• Describe actions that can be taken to change the status quo with respect to potential biases and health disparities in this field.

Outline

• Psychosis risk symptoms, screening, and assessment
• Social and cultural factors impact on screening and assessment
• Addressing potential biases and health disparities

Target Audience

Psychologists, Social Workers, and Other Mental Health Professionals

Instructional Level

Intermediate

Estimate Time to Complete

Estimated Duration: 1.0 hour
Program Start Date: March 15, 2021 
Program End Date: March 15, 2024

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™, CE credit for psychologists, CE credit for social workers, or a certificate of participation may do so by completing all sections of the course, including viewing the full video (≥60 minutes) and submitting an evaluation. A multiple-choice quiz is provided based on the content. A passing score of 75% must be achieved. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), CE certificate (social workers), or certificate of participation (other disciplines) showing the completion date and hours/credits earned.

Continuing Education Credit

Physicians

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The APA designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Psychologists

The American Psychiatric Association is approved by the American Psychological Association to sponsor continuing education for psychologists. American Psychiatric Association maintains responsibility for this program and its content.

Social Workers 

American Psychiatric Association, provider #1743, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. American Psychiatric Association maintains responsibility for this course. ACE provider approval period: 05/18/2020-05/18/2021 and 05/18/2021-05/18/2024. Social workers completing this course receive 1.0 (clinical) continuing education credits.

Continuing education requirements vary from state to state. Many state boards grant reciprocity with national accrediting organizations and other state boards. It is the responsibility of each professional to understand the requirements for license renewal or check with the state or national licensing board and/or professional organization to become more familiar with their policies for acceptable continuing education credit. Social workers and Psychologists should contact their regulatory board to determine course approval.

Faculty and Planner Disclosures

Instructor

• Jason Schiffman, Ph.D., is Professor of Psychology and Director of Clinical Training at UMBC. Dr. Schiffman co-directs the Maryland Early Intervention Program's Strive for Wellness clinic, a research, training, and services program designed to improve the lives of young people at risk for psychosis and their families. Dr. Schiffman holds numerous grants and has published over 135 scientific articles related to the identification and treatment of early psychosis. His research seeks to refine the identification of, and treatment strategies for, young people at risk for psychosis, while addressing issues of racial inequity and health disparities. Reports no financial relationships with commercial interests. 

Program Planners

• Steven Adelsheim, M.D. Reports no financial relationships with commercial interests.
• Catherine Adams, L.M.S.W., A.C.S.W., C.A.A.D.C. Reports no financial relationships with commercial interests.
• Susan T. Azrin, Ph.D.  Reports no financial relationships with commercial interests.
• Iruma Bello, Ph.D.  Reports no financial relationships with commercial interests.
• Gary Michael Blau, M.S., Ph.D.  Reports no financial relationships with commercial interests.
• Teri S. Brister, Ph.D., L.P.C.  Reports no financial relationships with commercial interests.
• Nybelle An-Vi Caruso, B.S.  Reports no financial relationships with commercial interests.
• Amy N. Cohen, Ph.D.  Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D.  Dr. Cotes discloses the following relationships: Consultant: Saladax Biomedical, American Psychiatric Association Grant/Research: Ostuka, Lundbeck, Roche, Alkermes
• Judith Dauberman, M.A., Ph.D.  Reports no financial relationships with commercial interests.
• Steven P. Dettwyler, Ph.D.  Reports no financial relationships with commercial interests.
• Lisa B. Dixon, M.D., M.P.H.  Reports no financial relationships with commercial interests.
• Melissa Edmondson Smith, Ph.D.  Reports no financial relationships with commercial interests.
• Chantel Garrett. Ms. Garrett discloses the following relationships: Stock: Invitae, stockholder Livongo, stockholder Color, private equity holder Consultant: Maine Health Northwell Health One Mind Grant/Research: One Mind National Institute of Health
• Tristan Gorrindo, M.D.  Reports no financial relationships with commercial interests.
• Kate Hardy, ClinPsych.D.  Ms. Hardy discloses the following relationships: Consultant: SME for Click Therapeutics
• Robert K. Heinssen, Ph.D., A.B.P.P. Reports no financial relationships with commercial interests.
• Brian Hepburn, M.D.  Reports no financial relationships with commercial interests.
• Patrick Kaufmann, B.S.  Reports no financial relationships with commercial interests.
• Sherin Khan, L.C.S.W. Reports no financial relationships with commercial interests.
• Steven R. Lopez, Ph.D. Reports no financial relationships with commercial interests.
• Ted Lutterman.  Reports no financial relationships with commercial interests.
• Tushita Mayanil, M.D.  Reports no financial relationships with commercial interests.
• Ryan Melton, Ph.D.  Reports no financial relationships with commercial interests.
• Oladunni Oluwoye , Ph.D.  Reports no financial relationships with commercial interests.
• Abram Rosenblatt, Ph.D.  Reports no financial relationships with commercial interests.
• David L. Shern, Ph.D.  Dr. Shern discloses the following relationships: Grant/Research: Through my employment at NASMHPD, I co-chair the dissemination function of the Early Psychosis Intervention network as part of the national data coordinating center at Westat. Westat was awarded the coordinating center grant by NIMH Other: serve on the Board of Livanta

• Teri Brister, PhD, LPC, National Alliance on Mental Illness. Reports no financial relationships with commercial interests. (Reviewed on 3/14/2024)
• John Torous, MD, MBI, Beth Israel Deaconess Medical Center. Reports no financial relationships with commercial interests. (Reviewed on 3/2/2024
• Amy N. Cohen, Ph.D, American Psychiatric Association. Reports no financial relationships with commercial interests. (Reviewed on 3/8/2024)
• Sherin Khan, LCSW, Thresholds. Reports no financial relationships with commercial interests. (Reviewed on 3/14/2024)

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