Objective: This study elicited factors that shaped treatment decision-making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement. Methods: This prospective, longitudinal, ethnographic study (using home visits, interviews, and hospital-based fieldwork) asked what mattered to 18 primarily racial/ethnic minority young adults and 19 of their self-identified key supporters (N=37) as they made decisions about treatment during the 12-week "critical period" after an initial hospitalization for psychosis. The analytical approach used inductive coding and constructivist grounded theory methods to analyze interview transcripts and fieldnotes from home visits and generate hypotheses about key factors that seemed to affect treatment decision-making. Factors were ranked in order of frequency across all participants (overall, young adults only, and key supporters only). Results: Among the 37 total participants (young adults and key supporters), over two-thirds were concerned with: getting back to normal, insufficient mental health care on offer, police involvement in their pathway to care, feeling worse, and needing help with repairing strained relationships. More than half were concerned with: affected young adults being able to live independently, paying for mental health care, distrusting mental health diagnoses, how to manage social pressure to use substances, feeling disempowered by hospitalization experiences, and transportation challenges.