Modular Approach

The Modular Approach

Modular Treatment for Youth at CHR (MTY-CHR) is a flexible treatment protocol designed to address the heterogeneous needs of the CHR population. In addition to recommendations from standardized therapy guidelines, the modules are adapted from evidence-based procedures for CBT for psychosis (CBTp) and best practices from the SAMHSA-funded CHR-P clinic led by Jason Schiffman, PhD.

For more information about our modules and how to navigate the MTY-CHR Flowchart, download the Navigating Modules: How-to Guide

The MTY-CHR Flowchart indicates the order in which modules should be followed via the direction of the arrow. In instances where there are arrows in multiple directions indicates where decisions should be re-evaluated once said module is complete.

For example, if “What is primary distress/impairment from?” = “Insomnia,” then the clinician may choose to use internalizing modules (i.e., Sleep). After that module is used to the extent necessary (e.g., a satisfactory improvement in sleep hygiene is reached as indicated by outcome measures), the clinician will reconsider the question, “What is primary distress/impairment from?” It may be the case that once the client has learned skills to improve the indicated internalizing symptom (i.e., Sleep), the main source of distress/impairment might be a different internalizing symptom (e.g., Emotion Regulation) or a different type of symptom altogether (e.g., Attenuated Psychosis Symptoms).

Each module was created so that they may be used independently. Some modules, however, have content that may supplement or support additional modules; this will always be mentioned explicitly.

There are many instances when a clinician should proceed to the next step in the modular flowchart:

When a discrete procedure is completed (e.g., Feedback Module: Once feedback has been provided)
When a client quantitatively reports improvement in symptoms via the modules associated outcome measures (e.g., Reality Testing Module: Improvement in PQ-B scores)
When a client verbally reports improvement in symptoms (e.g., Substance Use Module: Reports less substance use)
When a client reports a disinterest or
The clinician and treatment team determine a more pressing clinical priority (e.g, The client is exhibiting disengagement, and the treatment team decides to stop the Working with NATs module and instead use the Engagement module)

The MTY-CHR manual is intended to be a collection of transdiagnostic and developmentally-informed procedures for CHR treatment that can be tailored and easily implemented in real-world clinical contexts. Nevertheless, there are immeasurable yet critical aspects to successful treatment that cannot be manualized. It is recommended that clinicians employ their clinical skills and feedback from their clinical team to adapt procedures to the client when necessary.