title: Factors influencing engagement with case managers: Perspectives of young people with a diagnosis of first episode psychosis.
abstract: Holistic treatment during a first episode psychosis (FEP) can significantly impact the longevity and chronicity of the illness, as well as reduce the risk of premature death by suicide. However, treatment can only be effective if the young person participates. Given that 19-40% of young people disengage from early intervention services for FEP, this qualitative study aimed to understand how young people experienced engagement with case managers at an early intervention service. Semistructured interviews were conducted with seven young people and themes were identified using interpretive phenomenological analysis. Young people detailed how engagement with a service could be viewed as a process, following different stages between initial referral and discharge. Throughout this process, a number of factors influenced young people's decision to engage with, or disengage from, their case manager. This created a push-pull dynamic with periods of good engagement and poor engagement. Discussion of this dynamic adds nuance to established scholarship about engagement, including shifts over time in the importance of client empowerment and valued features of therapeutic relationships. Awareness and understanding of these concepts may guide changes to early intervention services and address the core issue of engagement.
authors.affiliation: Department of Nursing, Orygen Youth Health, Melbourne, Victoria, Australia.
authors.forename: Rachel
authors.identifier: http://orcid.org/0000-0002-0898-4302
authors.initials: R
authors.lastname: Tindall
authors.affiliation: Department of Nursing, Orygen Youth Health, Melbourne, Victoria, Australia.
authors.forename: Shona
authors.initials: S
authors.lastname: Francey
authors.affiliation: Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Bridget
authors.initials: B
authors.lastname: Hamilton
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D019090:Case Management; D000071959:Case Managers; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010358:Patient Participation / Q000523:psychology*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy*; D036301:Qualitative Research; D012008:Recurrence; D055815:Young Adult
keywords: early intervention; first episode psychosis; mental health; qualitative research; therapeutic relationship