Evaluation of a hybrid asynchronous-synchronous delivery model for family intervention in psychosis: the psychosis REACH program

Introduction: The uptake of Family Interventions for psychosis (FIp) in routine settings has been limited across high-, middle-, and low-income countries due to geographic, systemic, and socioeconomic barriers. Psychosis REACH is a FIp that addresses these barriers by using a direct-to-family model co-facilitated by licensed mental health practitioners with expertise in Cognitive Behavioral Therapy for psychosis and family members with lived experience. While prior delivery relied on in-person training, this approach does not adequately address structural access challenges. The aim of this investigation was to evaluate caregiver outcomes of a hybrid asynchronous-synchronous version of Psychosis REACH consisting of (a) an online course, (b) a live virtual skills workshop, and (c) follow-along skills coaching from a trained family peer (Psychosis REACH Family Ambassador; pRFA). Materials and methods: Psychosis REACH was delivered via a hybrid digital format to 275 caregivers of individuals with psychosis, the majority of whom were parents (61.2%). We evaluated feasibility, acceptability, and participant characteristics, along with outcomes including depression, anxiety, caregiver burden, expressed emotion, attitudes toward psychosis, and self-perceived CBT skillfulness at post-training and 4-month follow-up. Results: Both asynchronous and synchronous components were rated as highly feasible and acceptable. Nearly all participants completed the online course; 85% went on to complete the virtual workshop, of which 66.7% endorsed intention to follow-up with a pRFA. Participants demonstrated significant improvements across multiple domains, including reduced psychiatric symptoms, caregiver burden, stigmatizing attitudes, and expressed emotion, along with increased confidence in CBT-informed skills. Discussion: Findings suggest that this hybrid digital training is both acceptable and feasible, offering a promising approach for disseminating evidence-based family support in psychosis. Clinical and educational outcomes were comparable to in-person delivery, underscoring its potential to reduce access barriers for some caregivers. Future research should prioritize randomized trials and active engagement of diverse and underserved families.