title: Does engagement with an intensive outreach service predict better treatment outcomes in 'high-risk' youth?
abstract: OBJECTIVE
  Engagement is critical in ensuring that the most 'at risk' clients receive care from psychiatric services, but the relationship between engagement and treatment outcomes remains unclear. This study investigated possible improvements in client engagement and the relationship between engagement and treatment outcomes in a group of difficult-to-engage, 'high-risk' young people seen by the Intensive Mobile Youth Outreach Service (IMYOS) in Western Metropolitan Melbourne, Australia.
  
  
  METHODS
  Data from standardized outcome measures on client engagement, suicidality, hostility, well-being and functioning obtained at referral, after initial assessment and at discharge, were analysed retrospectively.
  
  
  RESULTS
  Improved engagement was achieved after initial assessment and remained steady at discharge. All outcome measures showed significant improvement at discharge. Higher overall engagement following assessment was associated with decreased hostility risk and greater well-being and functioning at discharge. The engagement dimensions 'collaboration', 'perceived usefulness' and 'client-therapist interaction' were most consistently associated with better treatment outcomes.
  
  
  CONCLUSIONS
  Engagement at an early stage of treatment can be a useful predictor for later hostility risk, well-being and functioning. To promote better outcomes for difficult-to-engage youth, service delivery needs to focus on collaborative client involvement, the development of a 'strong' therapeutic alliance and individualization of treatment in regard to client needs.
authors.affiliation: Training & Communications, Orygen Youth Health, Parkville, Australia. carsten.schley@mh.org.au
authors.forename: Carsten
authors.initials: C
authors.lastname: Schley
authors.forename: Kally
authors.initials: K
authors.lastname: Yuen
authors.forename: Karen
authors.initials: K
authors.lastname: Fletcher
authors.forename: Alessandra
authors.initials: A
authors.lastname: Radovini
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D003156:Community Mental Health Services / Q000379:methods* / Q000706:statistics & numerical data; D003159:Community-Institutional Relations; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010549:Personal Satisfaction; D011369:Professional-Patient Relations; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome