Kate Hardy

All Publications

• Confronting the dialectic between quality and access in early psychosis care in the United States: Finding the synthesis by leveraging psychological expertise. Psychological services Wood, H. J., Eisen, K., Hardy, K. V., Reznik, S. J., Shapiro, D. I., Thompson, E. C., Gaither, M. L., Kopelovich, S. 2023

  Abstract

  Coordinated specialty care (CSC) is the dominant model for early psychosis care in the United States, representing a proactive recovery-oriented approach to serious mental illness in its early stages. CSC involves broad multidisciplinary support for participants, including from psychologists in some CSC teams, encompassing educational and vocational support, medication management, psychotherapy, case management, peer support, and family interventions. CSC programs have proliferated in the last 20 years, leading to a quality-access dialectic, where increasing access to treatment simultaneously prompts concerns about care quality, particularly in the context of staffing shortages and funding limits. Evidence-based psychosocial treatment, including psychotherapy, is an integral part of CSC, yet workforce training deficits, workforce turnover, and CSC financing pose threats to intervention fidelity and thus CSC participants' ability to access high-quality care. We propose an enhanced role for psychologists as a way of resolving the quality-access dialectic in the area of psychosocial treatment, specifically evidence-based therapy. We describe the potential of psychologists' skills in clinical supervision, formulation, evidence-based interventions and measurement-based care, drawing on practice examples. After considering possible limitations, we outline implementation models, for example, drawing on Early Psychosis Intervention Network and Project Extension for Community Healthcare Outcomes. We conclude with four recommendations: Psychologists should be placed in CSC team or network-leadership roles; psychological expertise should be made available to CSC teams for training, consultation, and technical assistance; psychological expertise should be used to address CSC implementation challenges; and research is needed to demonstrate psychologists' value to stakeholders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

  View details for DOI 10.1037/ser0000826

  View details for PubMedID 38127500

• Reductions in synaptic marker SV2A in early-course Schizophrenia. Journal of psychiatric research Yoon, J. H., Zhang, Z., Mormino, E., Davidzon, G., Minzenberg, M. J., Ballon, J., Kalinowski, A., Hardy, K., Naganawa, M., Carson, R. E., Khalighi, M., Park, J. H., Levinson, D. F., Chin, F. T. 2023; 161: 213-217

  Abstract

  Excess synaptic pruning during neurodevelopment has emerged as one of the leading hypotheses on the causal mechanism for schizophrenia. It proposes that excess synaptic elimination occurs during development before the formal onset of illness. Accordingly, synaptic deficits may be observable at all stages of illnesses, including in the early phases. The availability of [11C]UCB-J, the first-in-human in vivo synaptic marker, represents an opportunity for testing this hypothesis with a relatively high level of precision. The first two published [11C]UCB-J schizophrenia studies have documented significant, widespread reductions in binding in chronic patients. The present study tested the hypothesis that reductions are present in early-course patients. 18 subjects completed [11C]UCB-J PET scans, (nine with schizophrenia, average duration of illness of 3.36 years, and nine demographically-matched healthy individuals). We compared binding levels, quantified as non-displaceable specific binding (BPND), in a set of a priori-specified brain regions of interest (ROIs). Eight ROIs (left and right hippocampus, right superior temporal and Heschl's gyrus, left and right putamen, and right caudal and rostral middle frontal gyrus) showed large reductions meeting Bonferroni corrected significant levels, p<0.0036. Exploratory, atlas-wide analyses confirmed widespread reductions in schizophrenia. We also observed significant positive correlations between binding levels and cognitive performance and a negative correlation with the severity of delusions. These results largely replicate findings from chronic patients, indicating that extensive [11C]UCB-J binding deficits are reliable and reproducible. Moreover, these results add to the growing evidence that excess synaptic pruning is a major disease mechanism for schizophrenia.

  View details for DOI 10.1016/j.jpsychires.2023.02.026

  View details for PubMedID 36934603

• I THINK MY PATIENT MAY BE EXPERIENCING PSYCHOSIS - NOW WHAT? HOW PROVIDERS CAN SUPPORT EARLY IDENTIFICATION AND INTERVENTION. Eisen, K., Chari, S., Salaheldin, K., Zepp, C., Ballon, J., Hardy, K. OXFORD UNIV PRESS INC. 2022: S1

  View details for Web of Science ID 000788118600003

• Training inpatient psychiatric nurses and staff to utilize CBTp informed skills in an acute inpatient psychiatric setting PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES Eisen, K., Kharrazi, N., Simonson, A., Lean, M., Hardy, K. 2021

  View details for DOI 10.1080/17522439.2021.1930118

  View details for Web of Science ID 000655336000001

• Psychosis REACH: Effects of a Brief CBT-Informed Training for Family and Caregivers of Individuals With Psychosis. Psychiatric services (Washington, D.C.) Kopelovich, S. L., Stiles, B., Monroe-DeVita, M., Hardy, K., Hallgren, K., Turkington, D. 2021: appips202000740

  Abstract

  OBJECTIVE: Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a training for families of individuals with psychosis that consists of recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training informed by cognitive-behavioral therapy for psychosis (CBTp). The authors assessed the effects of a 1-day and a 4-day training on the natural supports (i.e., family and other caregivers) of individuals with psychotic disorders.METHODS: Attendees of a 1-day (N=168) and a 4-day (N=29) Psychosis REACH training were surveyed at three timepoints: pretraining, posttraining, and 4-month follow-up. Longitudinal changes across the full sample were evaluated by paired-sample t tests or a one-way repeated-measures analysis of variance (ANOVA). Two-way mixed ANOVAs were conducted with training condition, time, and the training condition * time interactions entered into the model.RESULTS: Reductions were noted in self-perceived depression, anxiety, negative aspects of the caregiving experience, and expressed emotion. Trainees also showed more prosocial attitudes toward psychosis immediately and at 4 months after the training.CONCLUSIONS: This evaluation of the launch of Psychosis REACH in the United States suggests that the training can improve the mental health, attitudinal, and relational outcomes of family and caregivers of individuals with psychosis. Given the dearth of CBTp and family interventions for psychosis in mental health services in the United States, short-term, intensive training that supplements clinical services has intuitive appeal as a means of surmounting the barriers that have plagued family interventions.

  View details for DOI 10.1176/appi.ps.202000740

  View details for PubMedID 34015942

• Brief Report Describing the Integration of Two Psychotherapy Evidence-Based Practices Within Coordinated Specialty Care Services for Early Psychosis PSYCHOLOGICAL SERVICES Hardy, K., Meyer-Kalos, P., Adams, C., Elliott-Remes, R., Gingerich, S. 2021; 18 (2): 164-169

  Abstract

  Individual psychotherapy is routinely offered within coordinated specialty care services for early psychosis. In the United States, 2 primary models have been implemented: cognitive-behavioral therapy for psychosis and individualized resiliency training. However, coordinated specialty care services have typically chosen between these approaches, thus limiting access to the unique aspects of each of the models, missing opportunities related to workforce development, and reducing consumer choice. Opportunities exist for integration of these 2 models. This brief report provides an overview of individualized resiliency training and cognitive-behavioral therapy for psychosis. In addition, elements of synergy between the 2 models are identified and opportunities for an integrated approach highlighted. Further study of the core elements of an integrated approach is required, and guidance for clinicians to support clinical decision making is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

  View details for DOI 10.1037/ser0000443

  View details for Web of Science ID 000646667600004

  View details for PubMedID 32658514

• Pilot study of a group worry intervention for recent onset psychosis COGNITIVE BEHAVIOUR THERAPIST Mackintosh, T., Lean, M., Hardy, K. 2021; 14

  View details for DOI 10.1017/S1754470X21000106

  View details for Web of Science ID 000636794500001

• DEVELOPING A LIVED EXPERIENCE ADVISORY COUNCIL IN AN ACADEMIC EARLY INTERVENTION FOR PSYCHOSIS CLINIC. Eisen, K., Lean, M., Ballon, J., Zepp, C., Liliental, J., Hardy, K. OXFORD UNIV PRESS INC. 2021: S140

  View details for Web of Science ID 000648922700284

• Training early psychosis community clinicians in CBT for psychosis: Implementation and feasibility. Early intervention in psychiatry Hardy, K. V., Espil, F. M., Smith, C. L., Furuzawa, A., Lean, M., Zhao, Z., Godzikovskaya, J., Gilbert, A., Loewy, R. L. 2020

  Abstract

  OBJECTIVE: Cognitive behavioural therapy (CBT) has demonstrated efficacy for treating of psychotic symptoms and is recommended as an evidence-based practice (EBP) in early psychosis services. Despite this recommendation, there is limited information about the feasibility of training community clinicians, working in an early psychosis service, to competence in the delivery of this intervention.METHOD: Fifty clinicians working in an early psychosis service across five programs in Northern California were trained in CBT for psychosis (CBTp) between 2010 and 2014. Following the training, clinicians attended weekly group consultation and submitted taped sessions for review. Tapes were rated for competency using the Cognitive Therapy Scale-Revised (CTS-R). Clinicians who achieved competence were engaged in a train-the-trainer model to support ongoing sustainability of the training program.RESULTS: Data from 40 clinicians were reviewed for achievement of competence. Over the training period 18 clinicians achieved competence while 20 clinicians left the service before achieving competence and 12 were still in the process of achieving competence at the point of data analysis. It took on average 54weeks (range 17-130weeks) and an average of six tape reviews (range 3-18) to train clinicians to competency.CONCLUSIONS: Community clinicians working in an early psychosis program can be trained to competence in CBTp following an initial didactic period and ongoing weekly group consultation, although staff turnover hindered implementation. Challenges and opportunities for future implementation in community sites are presented in the context of further expansion of early psychosis services in the United States.

  View details for DOI 10.1111/eip.13010

  View details for PubMedID 32583602

• The impact of COVID-19 on coordinated specialty care (CSC) for people with first episode psychosis (FEP): Preliminary observations, and recommendations, from the United States, Israel and China COUNSELLING PSYCHOLOGY QUARTERLY Meyer-Kalos, P. S., Roe, D., Gingerich, S., Hardy, K., Bello, I., Hrouda, D., Shapiro, D., Hayden-Lewis, K., Cao, L., Hao, X., Liang, Y., Zhong, S., Mueser, K. T. 2020

  View details for DOI 10.1080/09515070.2020.1771282

  View details for Web of Science ID 000547605700001

• Lived experience perspectives on reducing the duration of untreated psychosis: the impact of stigma on accessing treatment PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES Hardy, K. V., Dickens, C. E., Roach, E. L., Harrison, V., Desai, A., Flynn, L., Noordsy, D. L., Dauberman, J., Adelsheim, S. 2020

  View details for DOI 10.1080/17522439.2020.1754890

  View details for Web of Science ID 000531980000001

• CBT for Psychosis: Process-Oriented Therapies and the Third Wave (Book Review) JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Book Review Authored by: Eisen, K., Hardy, K. 2020; 59 (3): 446–48

  View details for DOI 10.1016/j.jaac.2020.01.013

  View details for Web of Science ID 000518536700019

• Growth of Early Intervention in Psychosis in the United States INTERVENING EARLY IN PSYCHOSIS: A TEAM APPROACH Hardy, K. V., Ballon, J. S., Noordsy, D. L., Adelsheim, S., Hardy, K. V., Ballon, J. S., Noordsy, D. L., Adelsheim, S. 2019: 11–22

  View details for Web of Science ID 000549765400003

• Psychotherapeutic Interventions for Early Psychosis INTERVENING EARLY IN PSYCHOSIS: A TEAM APPROACH Hardy, K. V., Landa, Y., Meyer-Kalos, P., Mueser, K. T., Hardy, K. V., Ballon, J. S., Noordsy, D. L., Adelsheim, S. 2019: 211–39

  View details for Web of Science ID 000549765400014

• Special Populations: College and University Students INTERVENING EARLY IN PSYCHOSIS: A TEAM APPROACH Hardy, K. V., Ballon, J. S., Chopra, M., Noordsy, D. L., Hardy, K. V., Ballon, J. S., Noordsy, D. L., Adelsheim, S. 2019: 403–15

  View details for Web of Science ID 000549765400024

• Pilot Study of Group Worry Intervention for First Episode Psychosis Mackintosh, T., Olson, N., Lee, A., Weiler, R., Hardy, K. WILEY. 2018: 135

  View details for Web of Science ID 000444798900376

• Consumer and Family Perspectives on Reducing the Duration of Untreated Psychosis Hardy, K., Dickens, C., Mackintosh, T., Roach, E., Harrison, V., Noordsy, D., Adelsheim, S. WILEY. 2018: 62

  View details for Web of Science ID 000444798900176

• Therapeutic Potential of Physical Exercise in Early Psychosis. The American journal of psychiatry Noordsy, D. L., Burgess, J. D., Hardy, K. V., Yudofsky, L. M., Ballon, J. S. 2018; 175 (3): 209–14

  View details for PubMedID 29490501

• Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis JOURNAL OF MENTAL HEALTH Hardy, K. V., Noordsy, D. L., Ballon, J. S., McGovern, M. P., Salomon, C., Stirman, S. 2018; 27 (3): 257–62

  Abstract

  The average age of onset of psychosis coincides with the age of college enrollment. Little is known about the impact of educational engagement on DUP in a college-aged population.To determine DUP, and the impact of educational engagement, for college-aged participants of the RAISE study (n = 404).We conducted secondary data analyses on the publicly available RAISE dataset. Subsamples were analyzed to determine the impact of age and educational engagement on DUP.DUP was significantly shorter (p < 0.02) for participants who were college-aged (18-22 years, n = 44) and engaged in post-secondary education (median = 12 weeks, mean = 29 weeks) compared with participants who were college-aged and not engaged in higher education (n = 92, median = 29 weeks, mean = 44 weeks).Educational engagement appears to be associated with a shorter DUP. This may be partially explained by the presence of on-site wellness centers in college settings. However, even among young people who engaged in post-secondary education DUP was still at, or beyond, the upper limit of WHO recommendations in this group. Future research exploring how colleges could improve their capacity to detect and refer at risk students for treatment at an earlier stage is recommended.

  View details for PubMedID 29707996

• Editorial: Trauma, Psychosis and Posttraumatic Stress Disorder FRONTIERS IN PSYCHIATRY Hardy, K. V., Mueser, K. T. 2017; 8: 220

  View details for PubMedID 29163239

• Genetic Correlation Profile of Schizophrenia Mirrors Epidemiological Results and Suggests Link Between Polygenic and Rare Variant (22q11.2) Cases of Schizophrenia. Schizophrenia bulletin Duncan, L. E., Shen, H. n., Ballon, J. S., Hardy, K. V., Noordsy, D. L., Levinson, D. F. 2017

  Abstract

  New methods in genetics research, such as linkage disequilibrium score regression (LDSR), quantify overlap in the common genetic variants that influence diverse phenotypes. It is becoming clear that genetic effects often cut across traditional diagnostic boundaries. Here, we introduce genetic correlation analysis (using LDSR) to a nongeneticist audience and report transdisciplinary discoveries about schizophrenia. This analytical study design used publically available genome wide association study (GWAS) data from approximately 1.5 million individuals. Genetic correlations between schizophrenia and 172 medical, psychiatric, personality, and metabolomic phenotypes were calculated using LDSR, as implemented in LDHub in order to identify known and new genetic correlations. Consistent with previous research, the strongest genetic correlation was with bipolar disorder. Positive genetic correlations were also found between schizophrenia and all other psychiatric phenotypes tested, the personality traits of neuroticism and openness to experience, and cigarette smoking. Novel results were found with medical phenotypes: schizophrenia was negatively genetically correlated with serum citrate, positively correlated with inflammatory bowel disease, and negatively correlated with BMI, hip, and waist circumference. The serum citrate finding provides a potential link between rare cases of schizophrenia (strongly influenced by 22q11.2 deletions) and more typical cases of schizophrenia (with polygenic influences). Overall, these genetic correlation findings match epidemiological findings, suggesting that common variant genetic effects are part of the scaffolding underlying phenotypic comorbidity. The "genetic correlation profile" is a succinct report of shared genetic effects, is easily updated with new information (eg, from future GWAS), and should become part of basic disease knowledge about schizophrenia.

  View details for PubMedID 29294133

• Cognitive Interventions Targeting Brain Plasticity in the Prodromal and Early Phases of Schizophrenia ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 9 Fisher, M., Loewy, R., Hardy, K., Schlosser, D., Vinogradov, S. 2013; 9: 435-463

  Abstract

  Several important paradigm shifts have occurred in the field of schizophrenia treatment, including an increased focus on early detection, the development of preemptive interventions, and the view of schizophrenia as a neurodevelopmental disease characterized by decreased efficiency and abnormal connectivity in cortical and subcortical neural networks. In this review, we briefly describe some of the neural impairments that contribute to the development of schizophrenia, with an emphasis on the impact of stress and trauma on cognitively vulnerable neural systems. We then present current data on two behavioral interventions that target these critical risk factors and that aim to preempt the onset of schizophrenia in vulnerable individuals or improve the clinical course in recent-onset schizophrenia: cognitive therapy and computerized cognitive training.

  View details for DOI 10.1146/annurev-clinpsy-032511-143134

  View details for Web of Science ID 000321742100018

  View details for PubMedID 23297786

• Psychosocial interventions for adolescents at clinical high risk for psychosis: cognitive behavioral therapy Adolescent Psychiatry Hardy, K. V., Loewy, R. 2012; 2: 172-181
• Filling the implementation gap: a community-academic partnership approach to early intervention in psychosis EARLY INTERVENTION IN PSYCHIATRY Hardy, K. V., Moore, M., Rose, D., Bennett, R., Jackson-Lane, C., Gause, M., Jackson, A., Loewy, R. 2011; 5 (4): 366-374

  Abstract

  The aim of this study was to describe the development of a sustainable community early psychosis programme created through an academic-community partnership in the United States to other parties interested in implementing early psychosis services founded upon evidence-based practices within community settings.The service was developed around a sustainable core of key components, founded upon evidence-based practice, with additional flexible elements that could be adapted to the needs of the individual commissioning county. This paper describes the ways in which funding was sourced and secured as well as the partnerships developed through this process.Successful development of the Prevention and Recovery from Early Psychosis (PREP) programme in San Francisco County, California. PREP clinicians have received extensive training in the evidence-based approaches that are available through the programme and treated 30 clients and their families in the first year of operation.Development of a sustainable community programme of this type in a non-universal health-care setting, which is historically seen as non-integrated, required extensive partnering with agencies familiar with local resources. Implementation of the community-academic partnership bridged the gap between research and practice with successful integration of fidelity practice at the community level. The community partners were effective in sourcing funding and allocating resources, while the academic side of the partnership provided training in evidence-based models and oversight of clinical implementation of the model. Stringent evaluation of the impact of the service is our next focus.

  View details for DOI 10.1111/j.1751-7893.2011.00310.x

  View details for Web of Science ID 000297018400013

  View details for PubMedID 22032550

• At risk of developing psychosis: the research perspective Experiencing psychosis: personal and professional perspectives Hardy , K. Routledge. 2011
• Re-envisioning psychosis: a new language for clinical practice Current Psychiatry Rose, D., Stuart, B., Hardy, K., Loewy, R. 2010; 9: 23-28
• THE SUBJECTIVE EXPERIENCE OF PEOPLE AT A HIGH RISK OF DEVELOPING PSYCHOSIS JOURNEYING INTO AND THROUGH AN EARLY DETECTION FOR PSYCHOSIS SERVICE 12th International Congress on Schizophrenia Research Hardy, K. V., Dickson, J. M., Morrison, A. P. OXFORD UNIV PRESS. 2009: 309–310

  View details for Web of Science ID 000263964700900