The evolution of specialty care for psychosis

The Foundational NAVIGATE Framework

The RAISE initiative formalized the first-episode psychosis treatment standard through the NAVIGATE model. These four pillars stabilize symptoms and re-engage young adults with their communities through shared decision-making and strength-based support.

The next generation of CSC

Treatment as Usual (TAU): the standard community mental-health response to a first psychotic episode prior to the development of CSC was ineffective on many levels. It was reactive and fragmented: a crisis, an emergency visit, a prescription, and sparse follow-up. Coordinated Specialty Care (CSC) replaced that model with a team-based, recovery-oriented system validated by the NIMH RAISE trials. CSC was the beginning of a new era for psychosis care, but only a beginning. It failed to directly target many features of psychosis like impaired neurocognition or social cognition, among others. Augmented-CSC (aka CSCplus) is the next step in the evolution of care. It adds layers additional evidence-based modules onto the CSC foundation (e.g. cognitive remediation, metabolic monitoring, digital relapse detection, and family-led coaching) to close the gaps the original RAISE cohort still experienced.

The evidence is clear: in the RAISE-ETP trial, CSC outperformed TAU across symptom control, quality of life, and school/work participation, with medication discontinuation rates roughly a quarter of TAU. Augmented-CSC is the next step: the same coordinated backbone, expanded to address the cognitive and physical-health dimensions that still limit long-term recovery. The sections below walk through that backbone first, then the augmentations.