Abstract
BackgroundA key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation.MethodsQualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis.ResultsCase-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics).ConclusionThis study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples’ recovery from first-episode psychosis and increase case-manager job satisfaction.
Highlights
A key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated
The young people discussed were six males and three females, aged 15–24 years. Their overall demographics were consistent with the cohort of young people registered into the Early Intervention Service (EIS) over the recruitment period
Seven young people were single throughout the study, one young person remained in a de facto relationship throughout the study, and one young person experienced a breakdown in his relationship during the study
Summary
A key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation. It is important to note that attrition rates do not capture those who attend appointments but do not participate fully in them, or those who re-engage after a period of disengagement. This has been a significant limitation of previous quantitative studies [5], fully understanding engagement demands a qualitative lens to capture these complexities
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