Mental Health Service Use Among Young Adults: A Communication Framework for Program Development

Abstract

Research on mental health service engagement has been dominated by attempts to identify determinants of engagement. Such knowledge is important but incomplete. Once identified, program designers need to use evidence-based principles to design programs to bring about changes in the empirically identified determinants. Research is relatively silent on such principles. This article develops a framework to guide program designers' as they address factors that constrain and/or facilitate engagement. The framework is grounded in communication theory and evidence from related behavioral science research. The literature is summarized and used to generate a check-list of questions to consider when structuring engagement programs.

Mental health service use decision‐making among young adults at clinical high risk for developing psychosis

“…One could speculate that the group that was receiving clinical services was more actively engaged in the decision‐making process towards seeking services at the clinic. Some research suggests that young people that are more activated in their cognitive and affective appraisals of a situation (Ben‐David et al, ; Munson & Jaccard, ) have increased agency in actively seeking clinical services. Since these group differences were identified, interventions could further tailor their programs depending on the level of engagement with services at a clinic.…”

Assessing and treating complex mental health needs among homeless youth in a shelter-based clinic

“…In any case, greater priority needs to be taken to directly measure and assess these needs among young adults specifically [53], as opposed to extrapolating findings from the adult and adolescent literatures for this transitional age group. Similarly, as has been identified in previous studies, rather than simply focusing on determinants of program engagement, future iterations of clinical service models for homeless youth need to focus on identifying appropriate ways to communicate with youth [54]], particularly around issues of initiating and sustaining mental health treatment.…”

Engagement intervention versus treatment as usual for young adults with serious mental illness: a randomized pilot trial

“…This approach, discussed in detail below, frames the research design and statistical approach so that the study can answer the following critical questions: (1) does the intervention impact the primary outcome, namely, engagement; (2) does the intervention impact the hypothesized immediate "targets," or mechanisms thought to influence engagement (e.g., beliefs about treatment, stigma, mistrust, and hope) [9,10]; and (3) are the proposed mechanisms thought to be relevant to engagement actually relevant? The study also uses a communication framework for intervention design [11]; that is, our team considered theoretically relevant dimensions of communication when designing the intervention. This included taking into account the source of the communication, the message content, the vehicle of delivery, and the unique characteristics of the targeted audience.…”

“…The field needs additional strategies that strengthen engagement efforts when young adults make contact in the adult system. Further, large numbers of youth do not remain in services past age 18, in part, because they have more autonomy in decision-making [23], and, in part, because of negative past treatment experiences [11]. There is some research on treatment engagement in the children's systems, yet, there is little research on engagement in the adult system [64].…”