Exploring service provider perspectives on service user engagement across service components in coordinated specialty care programs for psychosis.

Abstract

Engagement in services is a core element to successful outcomes for service users and programs. In coordinated specialty care (CSC) programs, designed for individuals experiencing first-episode psychosis, engagement has only been measured programmatically and not by service component. This qualitative study sought to explore provider perspectives on service user engagement in service components of CSC. Semistructured interviews were conducted with 20 service providers from five community-based early intervention programs for psychosis in the United States. Interviews were recorded and transcribed verbatim, and thematic analysis was used to analyze the data collected. Provider participants described barriers and facilitators that contribute to disengagement or engagement in four service components within early intervention programs: individual psychotherapy, family education and support, medication management, and vocational services. Barriers identified included substance use, stigma, trauma, and external pressures. Identified barriers to engagement in CSC were both unique to individual components and cut across them. By better understanding the complexity of barriers and their intersections within and across CSC components, there can be more effective policy and program development to reduce disengagement and hopefully increase positive outcomes for service users. Impact StatementThis article utilizes the perspectives of providers to identify barriers and facilitators to engagement in coordinated specialty care programs for those experiencing first-episode psychosis. The information presented provides value to the field and future policy decisions by identifying how barriers to engagement intersect and differ between coordinated specialty care components and allows for future engagement strategies to be targeted rather than universal to the multitherapeutic model.