IEPA 11

Nev Jones1; 1University of South Florida
               
Purpose: A deeper understanding of the impact of structural disadvantage and/or minority cultural background on treatment engagement is a critically important but under-researched thread within the early intervention (EI) literature. This presentation weaves together both quantitative and qualitative data on disengagement from diverse community-based early psychosis programs in the US in order to deepen and complicate our current understanding of disengagement and raise critical questions for future research. Methods: We report findings from a mixed methods sequential-explanatory research project integrating analysis a large longitudinal quantitative dataset (n = 262) and in-depth interviews with young adults, family members and early intervention providers (n = 40). Findings: 44% of service users within the quantitative sample left EI prematurely (against the treatment team’s advice), with nearly 1/3 of these individuals disengaging within the initial three months of treatment. Both minority race/ethnicity and cumulative structural disadvantage were significantly associated with disengagement.   In-depth multi-stakeholder interviews help elucidate these findings, with key themes including perceived gaps in training and support for trauma-informed work, and client/family distrust stemming from prior child welfare, juvenile justice and children's mental health system involvement. Providers suggested a series of concrete strategies for addressing these concerns. Conclusions: Greater attention to cultural/ethnic/racial diversity and the impact of structural disadvantage in EI appears to be warranted. Implications vis-à-vis program design, assessment, provider training and fidelity will be discussed.