Published in Children’s Voice, Volume 35, Number 1

by Jude Leung and Analla Reid

When a child’s cognitive or emotional state changes in subtle and puzzling ways, families may experience a profound sense of instability. A student who previously enjoyed school may stop submitting assignments, withdraw socially, and develop beliefs that classmates are speaking about them. A previously cautious adolescent may begin to report seeing shadows, hearing whispers, or feeling watched. Such changes are often distressing and confusing for caregivers, and accessing appropriate support can be challenging.

In Contra Costa County, California, the First Hope program assists families by providing coordinated early intervention for children, adolescents, and young adults experiencing early psychosis or identified as clinically high-risk. Receiving the 2026 CWLA Dr. Alexander Gralnick Award for outstanding service to children and adolescents experiencing early-onset schizophrenia and early psychosis affirms the team’s efforts and sends families a powerful message: Recovery is possible.

First Hope and Who it Serves
First Hope is a community mental health program within the Contra Costa County Behavioral Health system that provides early intervention for youth and young adults who are at risk for experiencing psychosis. The program serves individuals aged 12 and older who show clinical signs of being at high risk for psychosis or who have experienced their first psychotic episode within the past 18 months.

Youth presenting for services may be experiencing a range of clinical symptoms and diagnoses, including depression with psychotic features, bipolar disorder with psychosis, schizophrenia-spectrum disorders, or attenuated psychotic symptoms that suggest emerging risk. Psychosis refers to experiences that disrupt an individual’s perception of reality, such as unusual beliefs, heightened suspiciousness, or hallucinations. Although these symptoms may be distressing, effective treatments are available, and early intervention is critical for preserving daily functioning, relationships, and long-term well-being.

Families are referred to First Hope through school staff, mental health and medical providers, child and family services, community organizations, and word of mouth. Additional referrals result from outreach at locations where youth gather, such as LGBTQ+ centers and community recreation programs, where the team provides education on mental health and early psychosis to youth, families, and staff.

Beginnings
When First Hope launched in 2012, early psychosis services for children and adolescents in the county were limited. Families often accessed support only after a crisis, hospitalization, or involvement with law enforcement had taken place. Providers and caregivers frequently reported feelings of isolation and uncertainty, and some perceived that there was “no hope” after the identification of psychosis. First Hope was established to address this gap by integrating early identification, rapid access to care, and intensive family support. The program implements the Portland Identification and Early Referral (PIER) Model, a form of Coordinated Specialty Care (CSC) that delivers team-based services tailored to youth and young adults, with a focus on outreach, family engagement, and stigma reduction related to psychosis.

Meeting Young People Where They Are
The initial phase of participation in First Hope is guided by the principle: “We meet the young person where they are.” For youth recently discharged from psychiatric hospitalization, the team initiates frequent contact, stabilization efforts, and coordination with caregivers and school personnel. For students who remain in school but exhibit emerging symptoms, the team emphasizes careful assessment, psychoeducation, and the development of trust with both the youth and their caregivers. All participants undergo a comprehensive assessment with a therapist, which includes a structured evaluation of psychosis-risk symptoms when appropriate. Youth also meet with a psychiatric provider, regardless of immediate medication needs, to establish a relationship with a prescriber before any potential future crisis. As services progress, youth and caregivers are gradually introduced to additional team members according to collaboratively identified priorities.

Services, Support and Family Partnership
First Hope is structured so that youth and families can access a range of coordinated services in one program. The multidisciplinary team provides individual, family, and group therapy; psychiatric care; supported education and employment services; occupational therapy; peer and family partner support; and services focused on health, wellness, and co-occurring challenges. Family partnership is central to the program. Staff encourage each young person to define their own concept of family, which may include biological relatives, foster or adoptive caregivers, or chosen family members. Multi-family group therapy brings several families together in a structured, problem-solving environment. These groups build communication skills, reduce stress, and support recovery through shared learning and collaboration. Families participate in education sessions about psychosis, stress and vulnerability, recovery, and how daily pressures can affect mental health.

Working with Schools, Child Welfare, and Other Systems
Many children and adolescents served by First Hope are also involved with schools, child welfare agencies, or juvenile justice systems. The team conducts outreach and consultation so that professionals are informed about appropriate referral processes. Within school settings, staff coordinate education plans and return-to-school meetings, emphasizing accommodations and communication strategies that promote learning and safety for youth. For those involved with child welfare or juvenile justice systems, First Hope participates in team meetings and collaborates with probation officers, caregivers, and caseworkers to align mental health objectives with legal and permanency plans. A consistent message to professionals is straightforward: You don’t have to make sense of psychosis alone. If you suspect early psychosis, reach out, consult, and partner with your local early intervention program rather than waiting until a crisis forces action.

Outcomes, Stories, and Impact
Research suggests that many young people who show early warning signs of psychosis eventually develop a full psychotic disorder, such as schizophrenia or bipolar disorder with psychotic features. In contrast, coordinated early intervention can greatly lower that risk. Programs using models similar to First Hope report reduced rates of progression to full psychotic disorders, and First Hope’s internal data indicate that fewer than one in 20 youth identified as clinically high risk later receive a more serious psychosis diagnosis. The team also monitors outcomes that matter in daily life. Many participants enter First Hope while missing school, failing classes, or contemplating dropping out. Upon graduation, most are on track to complete high school, have earned a diploma, or have enrolled in college or vocational programs. Families report enhanced knowledge about psychosis, increased confidence in supporting their children, and a stronger sense of connection to others with similar experiences.

One family who graduated from the program shared that they entered First Hope after seeing multiple relatives living with untreated mental health conditions, including psychosis, and receiving minimal support. The caregiver feared that the young person’s emerging symptoms signaled a recurrence of this pattern. Participation in First Hope provided both the youth and caregiver with education, problem-solving strategies, and ongoing support. The young person subsequently obtained a driver’s license, graduated from high school, and enrolled in college.

Lessons Learned and Key Messages
Through their work with youth experiencing psychosis, the First Hope team has learned that recovery is seldom straightforward and cannot be accelerated. However, recovery becomes more attainable when individuals are provided with adequate time, information, and support. Psychosis may temporarily disrupt a sense of identity, causing youth and caregivers to feel disconnected from themselves. Despite these challenges, children and adolescents consistently exhibit resilience as they gradually reconstruct their lives.

The team deliberately emphasizes strengths, values, and life goals, ensuring that youth are recognized not only by their diagnosis but also by their potential for growth, connection, and meaning. More than 150 participants have graduated from the program.

It is important for parents and caregivers to remember that if their child has been experiencing psychosis, they are not alone—and that it is always appropriate to seek information early. Child- and family- serving professions should identify local early psychosis resources and actively engage in consultation and collaboration so that early recognition, coordinated care, and authentic partnership can foster hope.

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Recognizing Early Psychosis

Early signs to watch for:

  • Difficulty thinking clearly or expressing thoughts; preoccupation with unusual ideas.
  • Unexplained perceptual changes, such as fleeting visions, sounds, or other sensory experiences.
  • Increased fears, mistrust, or suspicion that others intend harm.
  • Noticeable withdrawal from friends and family or reduced motivation.
  • Strong emotional shifts, confusion, or a sudden decline in school or work performance.
Adapted from clinical insights shared by Dr. Jude Leung, First Hope program team.

 

Where to Learn More

  • First Hope: https://www.cchealth.org/get-care/mental-health/first-hope
  • CWLA’s Gralnick Award page: https://www.cwla.org/dr-alexander-gralnick-award/
  • Early Serious Mental Illness Treatment Locator: https://www.samhsa.gov/find-help/locators/esmi
  • Trainings in early psychosis/schizophrenia treatment: http://www.piertraining.com/training-certification/

 

Jude Leung, PhD, is the Program Manager at First Hope, a Contra Costa County Behavioral Health Services Prevention & Early Intervention Program and a PIER (Portland Identification and Early Referral) certified program.

Analla Reid is a Practice Excellence intern at CWLA.