Engagement with Early Intervention in Psychosis (EIP) services in the critical 2-3 year period following onset improves patients’ symptoms, illness course, employment and suicide rates in the long term. However, at least 25-30% of patients nationally and in the South East disengage from services within the first 12 months with detrimental long term impacts on patient outcome. This evidence and recommendations from the New Horizons document emphasise the need to develop more effective youth-focused models of intervention that improve engagement. This study aims to close this gap in service provision by developing an intervention focused on the specific needs of those patients who disengage from EIP services.

Research question

The research question is threefold:
i)      What are the facilitators and barriers to engagement in EIP services?
ii)     What changes should be made to services, based on knowledge of engagement issues?
iii)    Can youth-focussed service adaptations be effectively implemented to improve engagement?

Aims

To improve engagement by: 
(i)     identifying young people’s and families’ views about facilitators and barriers to engagement. 
(ii)    developing a youth focused model with adaptations including 
          a) the provision and use of information 
          b) approaches to engagement 
          c) the involvement of young people in their services
(iii)   implementing the intervention in EIP services.

Method

Impacts on engagement will be evaluated quantitatively. Stakeholder perceptions of the intervention will be explored qualitatively.

Focus groups with young people, service users and families will find out what helps and hinders engagement. The study team will then consult with
health professionals, managers and commissioners to develop service adaptations, based on the outcome of the focus groups.

PHASE 1
Regional focus groups with young people, EIP service users and carers will provide novel in-depth data to identify what helps or hinders engagement. A multidisciplinary team will use qualitative analyses to produce draft EIP service adaptations.

PHASE 2
A consultation (Delphi) process will be conducted with managers, commissioners and clinicians in the South East to turn the draft into a set of pragmatic, deliverable service adaptations. A booklet and website, consultancy and training, will be designed, with service users, to implement the adaptations.

PHASE 3
The intervention will be implemented as a pilot and the proportion of people who disengage will be compared pre and post intervention. Interviews will explore stakeholders’ perceptions of the adaptations in depth.     

Outcomes and findings

EIP staff will receive booklets, a website, training and consultancy to enable them to implement the adaptations, which will include changes in the
use of information, approaches to engagement and involvement of young people. The proportion of people who disengage from EIP services will be
compared pre and post intervention to determine the impact on engagement. Interviews with service users, carers and staff will explore perceptions of the intervention in more depth. The outcomes and dissemination approaches will enable the development of a larger more definitive study by the research team.

Local routes for dissemination will enable novel and effective engagement approaches to be adopted, leading to more accessible services, better information, and more opportunities for engagement and involvement for young people and their families. The youth-focussed shaping of EIP services aims to increase the number of people who engage and the quality of their engagement experience, thus affecting long term outcomes for service users. Service users and families will benefit from more information and options for engagement to better meet their needs, leading to better outcomes. Clinicians will be better equipped to engage with young people and their families. They will receive user-friendly, pragmatic guidance and tools in the form of training, consultancy, a booklet and a website to help them engage more easily with young people and their families. This will result in more effective and efficient approaches to engagement, fewer failed attempts and more service user and staff satisfaction. The study will pilot the intervention and assess the feasibility of delivery to improve engagement in EIP services. It will report on outcomes and will inform the development of a randomised controlled trial.