Implementing Coordinated Specialty Care Programs for Psychosis Across the U.S.: State-Level Administrator and Provider Perspectives.

Over the past decade coordinated specialty care (CSC) programs for psychosis have proliferated across communities throughout the U.S. Although considered the gold standard of care for early psychosis, several states do not have CSC, and among states that do, there is limited availability in underserved communities, and implementation often varies based on geographical locations. We aimed to explore the views of state-level administrators and CSC providers regarding factors that inform the implementation and sustainability of CSC programs in community settings. Between June 2023 and January 2024, 10 state-level administrators/policy makers and 25 mental health providers from early intervention programs for first episode psychosis were purposively recruited across the United States to participate in semi-structured interviews. Transcripts were analyzed using thematic analysis and deductive approaches which classified themes into program planning during pre-implementation and sustaining CSC after the implementation. Qualitative findings revealed four themes: (1) service demand; (2) organizational infrastructure; (3) community partnerships and outreach; and (4) model and service components. Service demand and organization infrastructure primarily influenced state-level decision making as to where CSC programs would be implemented. Community partnerships and outreach and model and service components’ themes highlight cultural and community-level considerations after CSC programs were implemented. The perspectives and experiences revealed from this study may guide the types of organizational, geographical, and cultural considerations necessary to address in future CSC implementation and sustainability efforts.