The Common Elements of treatment engagement for clinically high‐risk youth and youth with first‐episode psychosis

Abstract

Aim: Without treatment, clinically high-risk (CHR) youth or youth with first-episode psychosis (FEP) have increased risk for significant complications from their illness; yet, treatment engagement among these youth is critically low. The purpose of this study was to examine engagement efforts with CHR/FEP youth to stimulate new ideas that might facilitate participation in services for this population.Methods: A literature review using distillation methods identified engagement practices reported in two bodies of literature. The first body of literature (i.e. 'CHR/FEP engagement') included 13 studies employing qualitative designs to explore consumer perspectives about treatment engagement practices in samples of CHR/FEP youth and their families. The second body of research (i.e. 'CHR/FEP RCTs') included 18 randomized controlled trials (RCTs) testing treatments for CHR/FEP youth and their families. Engagement practice frequencies were compared with the frequency of these practices within effective engagement interventions, as tested in 40 RCTs within the broader child and adolescent mental health literature (i.e. 'CAMH engagement').Results: Treatment attrition and attendance were the most frequent engagement outcomes measured in the CHR/FEP RCTs. There were notable efforts described in the CHR/ FEP RCTs towards engaging youth and families, yet CHR/FEP RCTs reportedly included only a small proportion of engagement practices described in either the CHR/FEP or CAMH engagement literatures. Conclusion:Results suggest there might be practices available to complement current efforts at engaging CHR/FEP youth in treatment, and that increased attention to the measurement of engagement outcomes could provide important information regarding engagement in a population with low treatment engagement rates.

The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review

“…This may be due to factors relating to perceived availability of the mobile interventionist compared with the clinical team [42], as the mobile interventionist is able to reply to questions and problems in real time and communicate with patients daily. This is an important finding given that therapeutic rapport is important for sustained engagement [14,15].…”

“…Clinical engagement is a combination of health-oriented attitudes (ie, beliefs about the cause of illness and intentions of the care team) and behaviors (ie, appointment attendance, adherence to treatment plans, and the level of participation in a clinical relationship) [15,16]. Therefore, disengagement occurs when attitudinal factors cause patients to stop performing treatment behaviors such as taking medications and attending appointments [16].…”

“…Barriers to clinical engagement are rooted in access to treatment including geographic, systemic, and financial obstacles. Psychosocial services are often located in urbanized areas, serving specific catchment areas [21] and limiting access for rural or remote residents [15,[21][22][23]. Moreover, services are often only available in a business model (ie, Monday-Friday, 9 AM-5 PM) [24][25][26], with clinicians often treating double the recommended caseloads, further restricting appointment availability [26] because of funding constraints [24][25][26].…”

“…Moreover, services are often only available in a business model (ie, Monday-Friday, 9 AM-5 PM) [24][25][26], with clinicians often treating double the recommended caseloads, further restricting appointment availability [26] because of funding constraints [24][25][26]. These challenges are often exacerbated by personal factors such as poverty, limited transportation, substance use, trauma history, and beliefs about mental health [15].…”

Development of the Brief Educational Guide for Individuals in Need (BEGIN): A psychoeducation intervention for individuals at risk for psychosis

“…One standalone psychoeducation intervention for PR individuals has been developed (Hauser et al, 2009), though does not involve family members, which appears to be an important component of treatment (Mcfarlane et al, 2012). Although 70% of PR clinics worldwide identified the availability of family psychoeducation in their program (Kotlicka‐Antczak et al, 2020), details about educational content and method of delivery are often absent or varied among programs (Becker et al, 2016). Lack of standardized methods precludes measuring effectiveness of communication about PR and hinders evidence‐based implementation of PR psychoeducation.…”