Adaptation of a Psychosocial Intervention for Canadian Youth at Clinical High Risk for Psychosis: Adaptation d'une intervention psychosociale pour les jeunes à haut risque clinique de psychose au Canada

Abstract

Aim: This paper provides a detailed account of the process and outcomes involved in adapting a psychosocial intervention – the Optimal Health Program (OHP) – for young individuals who are at clinical high risk (CHR) for psychosis. This adaptation process included the active participation of youth with lived experience of psychosis spectrum disorder (CHR and first episode psychosis). Methods: A six-member advisory group consisting of youth with lived experience was established. The group convened weekly to review the OHP workbook in detail. This initiative was supported by a dedicated research assistant. Adherence to established guidelines for engaging with youth was maintained throughout. Following the completion of the adaptation, a review session was conducted to gather feedback. Results: The primary adaptations made to the intervention can be categorized as follows: 1) modification of language; 2) tailoring to the CHR population; 3) incorporation of personal stories; 4) emphasis on personalized recovery; 5) inclusion of ‘guiding and supportive activities’; 6) enhancement of graphic design. Suggestions for a digital application were not integrated due to their scope extending beyond the aims of the current project. An assessment of the engagement process revealed that the involvement of youth was meaningful and impactful. Conclusions: Through sustained and meaningful engagement with youth with lived experience, the present project adapted OHP for CHR individuals. The resulting intervention materials are anticipated to be closely aligned with the distinct needs and priorities of young CHR individuals. Subsequent endeavours in developing appropriate interventions that aim to improve outcomes for this population should involve engaging and collaborating with individuals with lived experience. We are currently in the process of evaluating the feasibility, acceptability, and preliminary efficacy of delivering OHP to individuals with CHR in a clinical trial.

Plain Language Summary Title:

Adapting a Psychosocial Program for Canadian Youth at Clinical High Risk for Psychosis

Plain Language Summary This paper details how the Optimal Health Program (OHP), a psychosocial intervention, was adapted for young people at clinical high risk (CHR) for psychosis. The process involved a six-member advisory group of youth with lived experience of CHR and first episode psychosis, who met weekly to review the OHP workbook. A research assistant supported the effort, ensuring guidelines for working with youth were followed. Key adaptations included modifying language, tailoring content to the CHR population, adding personal stories, focusing on personalized recovery, incorporating supportive activities, and improving graphic design. A digital app suggestion was not pursued due to scope limitations. Feedback from the youth highlighted their meaningful and impactful involvement in the process. The adapted OHP materials are now more aligned with the needs of CHR youth. Future interventions should continue involving youth with lived experience. A clinical trial is underway to assess the feasibility, acceptability, and preliminary effectiveness of the adapted OHP program.

Introduction

The concept of clinical high risk (CHR) for psychosis was introduced to identify individuals at an increased risk for psychosis, provide early intervention and prevent negative outcomes. ¹ CHR is also referred to as the at-risk mental state and the ultra-high risk for psychosis, depending on the methods of assessment used to characterize the pre-psychotic state.^2,3 There are three distinct syndromes that constitute the CHR state: (i) attenuated psychotic symptoms; (ii) brief intermittent psychotic symptoms; or (iii) genetic risk with decline in functioning, ⁴ which are characterized using the structured interview for psychosis risk syndromes (SIPS). ⁵ The cumulative risk of transitioning to a psychotic disorder in CHR individuals is estimated to be approximately 20% by 2 years and 35% by 10 years.^6,7 Those who do not develop psychosis experience mental health comorbidities, functioning difficulties, and an increased risk of suicide. ⁸ Regardless of risk of transition to psychosis, it is important to develop treatment strategies to address psychiatric comorbidity and poor functioning in this population. ⁹ For these reasons, transdiagnostic approaches to meeting mental health needs of CHR youth are needed. ¹⁰

Current CHR treatment guidelines prioritize psychosocial interventions as first-line treatments due to their acceptability, tolerability, and efficacy in improving outcomes as well as delaying transition psychosis.^3,7 There is uncertainty about illness trajectory in the CHR state, which favours individualized, patient-centered, multicomponent treatments that are appropriate to the heterogeneity of this population. ⁷ While there are existing psychosocial programs for CHR youth, many of these have not demonstrated satisfactory efficacy and often face high attrition rates.^11,12 A significant limitation of interventions to date is the primary focus on reduction of risk of transition to psychosis with little emphasis on functional outcomes, which does not align with the treatment priorities of CHR youth. ¹⁰

The Optimal Health Program (OHP) is a comprehensive, evidence-based, psychosocial, and mental health support program. ¹³ OHP focuses on self-management of mental health and wellbeing through a person-centered approach. The intervention is delivered over nine sessions, 1-h weekly for the first 6 weeks and 1-h every 2 weeks for the remaining 6 weeks. OHP has three main components: (i) initial assessment and engagement; (ii) therapy sessions, and (iii) maintenance integration. The therapy sessions in OHP are based on the stress vulnerability model and focus on psychoeducation, coping skills, relapse prevention strategies, and other health promoting behaviours that support mental health maintenance (Table 1). OHP has demonstrated efficacy in reducing psychiatric symptoms and improving quality of life in adults with chronic physical and mental health conditions.^14,15 While OHP has not previously been applied to CHR youth, it has the potential to address mental health symptoms in CHR, potentially preventing the progression to more severe mental health outcomes. Our group was successful in obtaining competitive funding to evaluate the feasibility, acceptability, and preliminary clinical efficacy of delivering OHP to CHR youth in a mixed-methods study. ¹⁶ While OHP shows promise as an early intervention for CHR youth, we would argue that adaptation to the unique needs of CHR individuals is needed prior to evaluation of feasibility, acceptability and preliminary efficacy.

Table 1.

The Structure, Objectives and Content of Optimal Health Program.

Session title	Objectives	Content
1. Introduction to OHP model	Define optimal health and mental health Consider how our behaviour influences our health Complete the health wheel 4. Introduce Health Plans 1–3	Consider six domains of health: physical, emotional, intellectual, social, occupational and spiritual. Provides opportunity to explore and understand current self-management behaviour and satisfaction with day-to-day functioning.
2 & 3. ‘I-Can-Do’ Model	Complete own ‘I-Can-Do’ Model, Identify own strengths, vulnerabilities Understand Health Plan 1 Identify stressors, including those linked to diabetes Explore early warning signs Stress management strategies: Health Plan 2	Sessions 2 and 3 introduce ‘I Can Do’ model, which encompasses health plans exploring the participant's strengths and vulnerabilities, and anticipates effects of stresses on mental health and developing coping strategies to overcome these challenges.
4. Medication and lifestyle	Identify positive and negative aspects of medication, medication monitoring; Understand shared decision-making.	Lifestyle and physical health management, impact of healthy diet and exercise. Effective use/self-management of medication, any side effects. Explore the importance of mental health literacy and collaborative decision-making process in treatment planning.
5. Collaborative partners (CP) and strategies	Understand importance of collaborative partners Identify/plan roles of people/supports as Collaborative partners Make Health Plan 3 and Eco Map	Develop an ‘Eco Map’ detailing key partnerships and supports in the participant's network and community and identify gaps in support/care and make plans to overcome any barriers.
6. Change enhancement	Understand the Wellbeing Timeline Explore ‘Sub-optimal Health’ and episodes of illness Revisit Health Wheel, meaning of change	Change enhancement by tracking mental health fluctuations across time and establishing new proactive avenues for change. Revisit Health Wheel: Visioning and Goal setting. Exploring how problem solving can support self-management.
7. Visioning and goal setting	Identify change and its meaning Explore key steps in problem solving and principles of goal setting	Discusses goal setting via creative problem solving and planning guided by own priorities. Allows reflection of what is useful in any future challenges.
8. Maintaining wellbeing	Understand Health Plans 1–3, Health Journal Introduce/plan booster session	Reviews wellbeing maintenance and sustainability by acknowledging any progress made towards goal, exploring concept of using rewards to improve progress.

OHP=Optimal Health Program.

In accordance with Canada's Strategy for Patient-Oriented Research, and the United Kingdom's Medical Research Council (MRC) framework for developing and evaluating complex interventions, young people with lived experience were engaged in the co-design of the primary study, ¹⁶ OHP adaptations, and knowledge translation. ¹⁷ Consistent with MRC guidance, integrating youth from project outset helped ensure that OHP was both youth-friendly and oriented towards youth priorities. The insights of youth with lived experience can enhance the acceptability of interventions, increase service engagement, and improve health outcomes. Such participatory research is essential for improving engagement with populations that face barriers to accessing healthcare. ¹⁸ Participatory research has the potential to promote a biopsychosocial perspective that expands beyond traditional medical viewpoints. ¹⁹ As the involvement of youth with lived experience in mental health research increases, describing and evaluating examples is essential to identify implementation gaps and inform future endeavours. ²⁰ We set out to document our process of adapting OHP for youth with CHR. We used the conceptual framework ‘The Patient Engagement in Research (PEIR)’, ²¹ adhering to best practices for engaging youth^22,23 including using a reporting checklist called GRIPP2 (Table 2). ²⁴ For the purposes of this article, CHR refers to individuals who are characterized as having a psychosis risk state based on the SIPS. ⁵

Table 2.

Guidance for Reporting Involvement of Patients and the Public (GRIPP2) Reporting Checklist for Lived Experience Engagement in Research.

Section and topic	Description
1: Aim	To adapt a psychosocial intervention, the Optimal Health Program (OHP) for youth at clinical high risk (CHR) for psychosis, led by youth with lived experience.
2: Methods	A youth advisory group consisting of two youth engagement specialists and four young adults with lived experience, supported by a dedicated research analyst and research lead, conducted the adaptation. The youth advisory panel met weekly for nine sessions to review and discuss the OHP workbook. Iterative modifications were then carried out by the adaptation lead from the research team and reviewed with the youth advisors to check whether the modifications successfully addressed the identified issues.
3: Results	Through youth engagement, the intervention was adapted with recovery-based, accessible language tailored to the CHR population, and included an updated colour theme and engaging graphic design. The primary adaptation outcomes achieved through engagement with youth with lived experiences include: 1) Modification of language; 2) Tailoring to the CHR group; 3) Incorporation of personal stories; 4) Emphasis on personalized recovery; 5) Inclusion of ‘guiding and supportive activities’; 6) Enhancement in graphic design. Suggestions for digital application were not incorporated as they extended beyond the current project's scope.
4: Discussion	The adaptation process demonstrated sustained and authentic involvement of youth. The expertise of youth with lived experience was genuinely valued during the adaptation process, and feedback from engagement was incorporated. The iterative feedback process provided reciprocal learning opportunities for both youth and the research team. While recognizing the potential value of accessibility and convenience offered by a digital platform, we unfortunately could not include this adaptation. Alternative methods to enhance accessibility were explored collectively.
5: Reflections	The current project successfully adapted the OHP program to address the needs of CHR youth through sustained and meaningful engagement with youth who have lived experience. However, due to the diversity among CHR youth, the size of the youth advisory group, consisting of only four individuals, may not fully represent the broader CHR community's perspectives. This limitation could impact the generalizability of the intervention. Further adaptation may be warranted at a later stage after receiving participant feedback, highlighting the evolving nature of adaptation work.

OHP=Optimal Health Program; CHR=clinical high risk.

Methods

Developing an Adaptation Team

The OHP-CHR adaptation took place at the Centre for Addiction and Mental Health (CAMH), Canada's largest academic psychiatric hospital. Before initiating recruitment consultation took place with the Youth Engagement Initiative (YEI) at CAMH, which facilitates collaboration between youth with lived experience of mental health challenges and clinical research. Two youth engagement specialists (YES) received training and ongoing support from the YEI to lead the participatory research process described in this paper. The YES provided guidance on the adaptation of OHP. They co-developed a flyer to support recruitment of an additional five young people (between 16 and 35 years of age) with lived experience of psychosis spectrum disorders to participate in the advisory group. The additional young people were recruited from an existing group of ‘youth advisors’ known to the CAMH YEI, with appropriate training and prior experience of engaging in participatory research. These individuals had lived experience of early psychosis without necessarily being characterized as CHR in their trajectory of illness. However, the advisory group was aware that the adaptations to OHP had an at-risk for psychosis population in mind and were not intended to be focused on people who had transitioned to a psychotic illness. Following discussions about the project objectives, activities, and time commitments, four youth advisors were successfully onboarded, forming a six-member youth advisory group (Figure 1). One individual had to withdraw due to other commitments. The youth advisory group was supported by a dedicated research assistant. The PEIR framework was used to guide youth engagement planning and execution, including: ensuring accessibility and flexibility for youth participation, focusing on mutual respect and positive team interactions, promoting an inclusive and open environment, providing sufficient training, skills, and instructional support, acknowledging and adequately compensating youth contributions, highlighting how youth contributions can benefit others, and how they can derive benefits from their engagement.

Figure 1.

Process from recruitment to follow-up of youth engagement adaptation.

Adaptation Process

Prior to forming the lived-experience advisory team, the research group outlined two primary objectives for the adaptation process: 1) aligning the needs and priorities of young people with CHR, and 2) customizing content for individuals with CHR. These goals were presented to the youth advisory group and were agreed upon by all members as a framework to for the adaptation process.

The research team met with the youth advisors to communicate the project's goals, anticipated meeting frequency, and the level of time commitment. The youth advisory group agreed to meet for 90 min weekly over 2 months. A total of nine engagement sessions were conducted from April 2023 to July 2023. These sessions were led by the two YES and supported by the research assistant. Each meeting commenced with an icebreaker activity, followed by a structured review of the OHP workbook modules. The YES reviewed the adaptation plan and its progress, subsequently engaging in an interactive, page-by-page, and module by module evaluation of the workbook with the youth advisory group. The OHP workbook was reviewed cover to cover, and the YES elicited reactions and feedback from the youth advisory group. This feedback was then discussed with the wider research team. This approach facilitated comprehensive input from the advisors and provided valuable perspectives concerning the intervention. Iterative adjustments were implemented by the research adaptation lead and then reviewed with the youth advisors to ensure that the modifications were representative of feedback. Meeting minutes documented all significant feedback and decisions. Weekly debriefs between the YES and the research team were held to discuss adaptation progress.

Following this comprehensive process, the first draft of the OHP-CHR adaptation was completed. The research team subsequently reviewed the adaptation and provided feedback for further refinements. An evaluation session was then conducted with the youth advisory group to review the adapted workbook, and further changes were made based on their input. The youth advisory group was also invited to reflect on their engagement experience on the project. At the final stage, the OHP-CHR adaptation was reviewed by the research team for minor refinements and the materials were finalized. Feedback and suggestions that arose through the youth engagement adaptation process were condensed and organized into distinct themes to allow recognition of common and recurring ideas. This process took place collaboratively with the YES and our youth engagement group.

Results

Adaptation Results

The intervention adaptations were categorized into the following six themes:

Modification of Language

Accessible Language

The adaptation involved using easily comprehensible youth-friendly language. Lengthy paragraphs were condensed into smaller sections, incorporating interactive speech bubbles and utilizing coloured text boxes to emphasize crucial information in a more digestible manner. During the adaptation review, these changes were positively received by the group, who found the content easier to understand.

Language That Brings Hope

Our youth advisors underscored the importance of conveying positive expectations, fostering hope and optimism to instil a sense of value and security among participants. One advisor commented on the importance of language having a more encouraging, reassuring and validating style. Feedback indicated that language on skills building should aim to meet individuals where they are if ready to engage, and working on motivation where individuals may be pre-contemplative. The group indicated that discussion about vulnerabilities could induce feelings of insecurity; they proposed a shift in perspective, viewing vulnerabilities as temporary and opportunities for personal development. We revised language to focus on strengths, offer solutions, and emphasize a recovery-oriented perspective that aimed to meet individuals where they were in their recovery journey. The youth felt the revised language nurtured hope and empowerment.

Language That Builds Confidence

The group recommended integrating language that was more strengths-based, encouraging individuals to reflect on their existing knowledge and accomplishments, with the intention of cultivating confidence. In response, we included the question ‘What are some strategies you are already using?’ in the section discussing effective self-help strategies to reduce distress. Another instance was the introduction of a ‘past success’ activity in the goal-setting section. Additionally, youth suggested rephrasing certain sections to adopt a more positive tone. For example, the original workbook stated, ‘the aim is for you to have some control in the situation that is often very disempowering’, was revised to ‘the purpose is to empower you by providing a sense of control during what can be a difficult time’. The youth expressed that these adjustments enabled them to engage with the content more positively.

Language That Reduces Stigma

An advisor expressed that language and tone are of great importance, citing personal experiences where negatively perceived language and tone acted as barriers to seeking support. The group collectively acknowledged that many individuals struggle with feelings of shame or self-blame when experiencing mental health issues. To foster more compassionate and accepting attitudes, we implemented revisions across the workbook to normalize mental health experiences. Examples of these adjustments include adding paragraphs acknowledging that ‘stress is a natural part of life’, dedicating a page to highlight that ‘all stress responses are typical’, and incorporating sentences explaining that ‘just because you don’t have many friends doesn’t mean you don’t have friends’. Youth advisors reported that these changes created an environment where individuals feel comfortable expressing themselves and able to engage actively with the material.

Tailoring to the CHR Population

The advisory group fed back that the content of session 4 regarding metabolic monitoring was not relevant to CHR youth as this population is rarely exposed to long-term psychotropic medication. The group expressed the viewpoint that information about medication is vital during the CHR phase. One advisor highlighted the importance of providing information about medications to CHR individuals, noting that many may be uninformed or hold biased views towards medication. They suggested that education could potentially influence treatment decisions and help promote medication adherence. Another advisor spoke to the difficulty of processing new information during challenging times, underscoring the importance of prior knowledge. In response to this feedback, content was revised using the medication information booklet that accompanies the OHP workbook. Modifications include information about the primary purposes of various psychiatric medication, a comparison between medication for physical illnesses and those for mental disorders, common categories of psychiatric medication, potential side effects, the collaborative treatment decision-making process, and key considerations when being prescribed medication. The group appreciated the tailored content, noting its relevance in enhancing health literacy and addressing medication misinformation.

Incorporation of Personal Stories

The youth group advocated for the inclusion of personal narratives, noting that hearing about the experiences of others can help people feel understood and less isolated. Several narratives were integrated. For instance, the section discussing ‘what it means to have an episode of illness’, included a story about ‘Sally’, who observed subtle changes in her mood and thoughts, prompting her to seek help. The narratives resonated well with the group, illustrating the progression of a disorder and emphasizing that symptoms often develop insidiously rather than abruptly. The group found these personal stories inspiring, fostering a sense of connection by showing that others have experienced similar challenges and overcome them.

Emphasis on Personalized Recovery

The youth advisors stressed the significance of acknowledging the uniqueness of each individual and their right to discover their own journey towards enhancing their mental health and wellbeing. An additional activity called ‘You at your best, at your lowest and in between’ within the ‘Your optimal health wheel’ section, was added. This activity communicated that clinical self-report scale responses can vary for each person. By encouraging individuals to use their own progress as a benchmark rather than aspiring to predetermined goals set by others, they can establish their own person-specific recovery goals.

Inclusion of Guided and Supportive Activities

The group recognized the need for more supportive and guided activities in the workbook, where individuals receive clearer instructions to complete tasks. One specific suggestion was to incorporate more examples, emphasizing that experiences of others facilitate self-reflection. Examples were integrated throughout the workbook's activities. Additionally, the group stressed that after acquiring a new skill, practice is crucial in achieving mastery. We introduced the imagery of a seed growing into a tree, symbolizing gradual progress, alongside the statement ‘It all starts with little steps’. These additions promoted consistent and gradual progression, building momentum towards goals.

Enhancement in Graphic Design

Colour Theme

In the original workbook, the ‘Health Plans’ were depicted using a warmer colour scheme, with Health Plan 3 represented in red. Feedback from the group indicated that the colour red was associated with crisis and could potentially convey a judgmental tone, be triggering or potentially lead to a stress response in some individuals. The colour themes were modified to green and blue. The group found this change more comforting and visually appealing. Additionally, the blue colour invoked associations with the ocean, which aligned well with the boat analogy used in session 2.

Visual Presentations

The youth advisory group advocated for the inclusion of more images to accompany concepts to simplify ideas and emphasize key points. Graphics were incorporated throughout the workbook to illustrate concepts, such as depicting stress responses in the body, challenging situations, medication side effects, and more. Visualization of content aided comprehension, enhancing accessibility, and memorability.

Adaptation Suggestions Not Incorporated

The youth advisory group suggested that the OHP-CHR workbook be made available as a smartphone application. This would enable users to maintain their personal OHP-CHR journal and document stressors, early warning signs, daily logs, and coping strategies in an easily accessible manner. While acknowledging the potential benefits, we regretfully encountered obstacles that prevented the implementation of this adaptation due to budget restrictions. The research team also acknowledged potential data security and privacy risks that would need to be considered when developing digital health platforms. We discussed the above limitations with the youth advisory team and collectively explored alternative methods to enhance accessibility; the group arrived at a consensus to employ an editable portable document format (pdf) version of the OHP workbook that could be stored locally and accessed for ongoing skills development after engagement in the intervention.

Engagement Evaluation

The OHP workbook was thoroughly reviewed, with the YES facilitating feedback sessions with the youth advisory group throughout the adaptation process. Advisory group feedback was then discussed in detail with the research team, resulting in iterative adjustments to the OHP workbook throughout the engagement process. The revised content was subsequently shared with the youth advisors to ensure their feedback was implemented. We did not encounter any problems establishing consensus. Following the completion of the collaborative adaptation process, the youth advisory group was invited to meet for an evaluation session. Four of the advisory group members participated in the meeting facilitated by the two YES. The adapted OHP workbook had been shared with the advisory group for review beforehand and the main revisions were presented during the evaluation meeting. The feedback was overwhelmingly positive, and the youth advisors reported that they were pleased to see their feedback incorporated in the final version of the adapted OHP workbook. The advisory group also provided feedback on the engagement process, expressing appreciation for the interactive process, stating that the engagement meetings were well-organized, with a welcoming and flexible environment that made them feel comfortable to share their opinions. Overall, they shared that they found the collaborative experience enjoyable and believed they had made a meaningful impact.

Discussion

In this article, we described the process of adaptation of the OHP to the needs and priorities of youth at CHR for psychosis (OHP-CHR) through engagement of youth with lived experience. Our experience is reflective of the critical nature of integrating youth with lived experience in mental health research to ensure that research outputs are in keeping with patient-identified priorities.^25,26 Ultimately, this approach is key to improving patient outcomes in the longer term.

Established guidelines for youth engagement were adhered to during the adaptation process.^22,23 These guidelines encompassed valuing youth expertise, formally recognizing contributions, maintaining transparency and authenticity, defining roles clearly, and creating youth-friendly spaces. We found that youth with lived experience were able to engage meaningfully and contribute to the adaptation. Participants expressed their ability to communicate their viewpoints regarding the intervention content and design. Throughout the adaptation process and in the post-adaptation evaluation, participants conveyed a sense that they had meaningfully contributed, noting their perspectives had been considered and implemented.

Drawing from insights gained during engagement discussions, combined with predefined adaptation goals, various modifications were made to the intervention content and design. Key changes encompassed amending language to enhance comprehension, promote recovery, and reduce stigma. The adjusted language promoted optimism and safety, open dialogue and encouraged youth involvement. The integration of personal stories provided relatable narratives that serve to inspire and connect. Visual elements were modified to further enhance user experience.

A strength of our study is the contribution to the growing field of lived experience engagement in research and the co-development of interventions tailored to the specific mental health needs of service users. The adaptation process involved authentic and sustained involvement of youth with lived experience. The research team maintained transparency with the youth advisory group, clearly communicating goals, expectations, and limitations. This approach involved respectful and non-judgmental communication, as well as a youth-friendly atmosphere and approach. The expertise of youth with lived experience was genuinely valued throughout the adaptation, with engagement feedback being thoughtfully incorporated. The iterative feedback process facilitated reciprocal learning between youth with lived experience and the research team. This collaborative approach not only ensured the intervention adaptations truly reflected the group's priorities, needs and experiences, but also fostered a sense of connection and empowerment.

The youth advisory group that informed the adaptation of OHP was formed of individuals with lived experience of early psychosis without necessarily having been characterized as CHR in their trajectory of illness. Inability to engage non-converting CHR individuals may limit how broadly relatable the adaptations are to CHR youth. Furthermore, the evaluation of the engagement process using quantitative measures would have strengthened the manuscript. ²⁷ We will be able to assess how the adaptations to OHP for CHR youth resonate with the target population through our mixed-methods study evaluating the feasibility, acceptability, and preliminary clinical efficacy of delivering OHP to CHR youth, which is in process. This ongoing work will inform further iterative adaptations. Furthermore, while digital application suggestions were considered, they fell beyond the project's current scope, indicating a potential avenue for design and evaluation in future adaptations. ²⁸

In conclusion, this study serves as a model for the co-design of mental health interventions. It reflects the importance of engaging youth with lived experience in research. The resulting intervention materials from this work are expected to align with the needs and priorities of young people at CHR for psychosis. We recommend collaboration with lived experience individuals to produce relevant and effective resources for the CHR community.