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Development of a Boston Treatment Program for Youth at Clinical High Risk for Psychosis

Center for Early Detection, Assessment, and Response to Risk (CEDAR)

Friedman-Yakoobian, Michelle S., PhD; West, Michelle L., PhD; Woodberry, Kristen A., MSW, PhD; O’Donovan, Keira E., MA; Zimmet, Suzannah V., MD; Gnong-Granato, Andréa, LICSW; Giuliano, Anthony J., PhD; Guyer, Margaret E., PhD; Rodenhiser-Hill, Janine, PhD; Keshavan, Matcheri S., MD; Seidman, Larry J., PhD

doi: 10.1097/HRP.0000000000000181

Over the past two decades, increasing attention has been given to the importance of early intervention for psychosis. This article describes the development of the Center for Early Detection, Assessment and Response to Risk (CEDAR), which focuses on early identification and treatment of youth at clinical high risk for psychosis. There are relatively few models in the United States for such programs, and we present our developmental story, focusing mainly on the CEDAR Clinic, as a case study of how such a program can develop. We describe the rationale, infrastructure, and services provided at the CEDAR Clinic, and present some descriptive data from the CEDAR Clinic through 2016. A case example is provided to illustrate treatment at CEDAR. We hope that the cultural history of our program’s development is informative for clinicians and policy makers as one model of how to build an early intervention service. We believe that this article is timely in view of the growing momentum in the United States for developing programs for intervening as early as possible for youth at clinical high risk for psychosis.

From the Public Psychiatry Division of Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA (Drs. Friedman-Yakoobian, West, Woodberry, Zimmet, Guyer, Rosenhiser-Hill, Keshavan, and Seidman, and Ms. Gnong-Granato); University of Massachusetts Boston (Ms. O’Donovan); Worcester Recovery Center & Hospital, Worcester, MA (Dr. Giuliano); Massachusetts Department of Mental Health (Dr. Guyer).

Supported, in part, by the Sidney R. Baer, Jr. Foundation (Dr. Seidman); an Anonymous Family Foundation; Commonwealth of Massachusetts Department of Mental Health grant no. SCDMH82101008006 (Center of Excellence in Clinical Neuroscience and Psychopharmacological Research; Dr. Seidman); and National Institute of Mental Health grant nos. K23 MH102358 (Dr. Woodberry) and 1R34MH105596 (Dr. Keshavan).

Original manuscript received 12 April 2017, accepted for publication subject to revision 1 August 2017; revised manuscripts received 9 August and 6 September 2017.

Correspondence: Michelle Friedman-Yakoobian, PhD, 75 Fenwood Rd., 5th Floor, Boston, MA, 02115. Email:

This article is dedicated to the memory of Dr. Larry Seidman, whose vision and leadership made this work possible. Larry died on 7 September 2017 while at NIMH, about to give a talk on the history of early intervention in major psychotic disorders. He was just 67 and seemed to be in the prime of his life—enjoying and embracing his work and family (especially his new grandchildren). Larry had a brilliant mind and was an international leader in the effort for early detection, assessment, and intervention in psychotic disorders. He was the driving force behind the development of CEDAR and the work described in this article. His death has been a tremendous loss for our community. The work he began will continue to be carried forward, however, by the hundreds of clinicians and researchers around the world who were lucky to benefit from his mentorship.

© 2018 President and Fellows of Harvard College
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