Manuela Ferrari1, Tovah Cowan1, Kevin MacDonald1, Megan Pope1, Céline Villemus1, Ashok Malla1,2, Srividya Iyer1,2; 1Douglas Mental Health University Institute, 2Department of Psychiatry, McGill University
Rationale: Interest in service engagement in the early intervention for psychosis (EIP) literature has largely stemmed from the association between disengagement from services and poor clinical outcomes (e.g., relapse, increased hospital admissions). Research has mainly defined service engagement in terms of attendance to appointments and agreement with/adherence to treatment and/or medication recommendations. However, this definition is at odds with the EIP philosophy and guidelines, which emphasize service user and family engagement in treatment decision-making and service (re)design. There is thus a need to (re)theorize service engagement in EIP by exploring the perspectives of different stakeholders. Our qualitative study aimed to address this need. Method: Forty in-depth, semi-structured interviews were conducted with 24 service users and 16 service providers from a Canadian EIP program. Nineteen service users were currently receiving services and five had discontinued services. Informed by the grounded theory approach, interviews were analyzed comparing and contrasting service users’ and providers’ experiences and understandings of service engagement. Findings: Service users’ and providers’ definitions of service engagement fall on a spectrum ranging from adherence to treatment/services and recovery (symptoms remission), as defined clinically, to engagement and recovery, as defined more personally. Service engagement is shaped by multiple domains (e.g., symptoms/the illness experience; users’ versus providers’ treatment goals). Misalignment of these domains in clinical practice impairs communication and the therapeutic alliance, and, in some cases, leads to disengagement. Conclusions: Our findings offer a new model of service engagement. We propose several recommendations to support the implementation of this model in clinical practice.
