The Early Youth Engagement (EYE-2) Intervention in First Episode Psychosis Services: Definition and Implementation of a Therapeutic Motivational-Engagement Model for Early Intervention in Psychosis Key Workers.

BACKGROUND

Psychosis is associated with high disability and societal costs. Early Intervention in Psychosis (EIP) services enhance mental health outcomes, but 15% disengage and more engage intermittently. There is no EIP-specific therapeutic model for how Key Workers should maximize engagement.

AIMS: To identify factors that define the Early Youth Engagement (EYE) therapeutic model for Key Workers in EIP services and affect implementation.

METHODS

The design was a cross-sectional qualitative thematic analysis and the final phase of an iterative mixed-methods model development. Participants were 15 EIP clinicians who took part in the EYE pilot project and were interviewed regarding core therapeutic ingredients and implementation.

RESULTS

The final EYE-2 therapeutic model was defined by 10 sub-themes forming three therapeutic process themes (Psychoeducation; The Motivational-Engagement relationship; An Early Systemic Approach) and an outcome theme (Achieving Meaningful Recovery Outcomes). Fourteen implementation-related subthemes were mapped onto Normalization Process Theory constructs. They revolved largely but not exclusively around the more tangible psychoeducation component.

CONCLUSIONS

The study defines, for the first time, the key components of a Therapeutic Motivational-Engagement Model for Key Workers in EIP services derived from service user and carer perspectives on needs. The clarity regarding core therapeutic processes to better support engagement enables the potential to standardize and reduce complexity in the Key Worker role. This clarity is important because key workers' role confidence impacts on therapeutic relationships and outcomes. The model is well-liked, easy to implement and supported by psychoeducational resources adapted for people from minority ethnic populations. Effectiveness and cost-effectiveness evaluations have revealed positive cost and societal outcomes. The model is highly compatible with the EIP approach but requires organizational support, staff induction and booster training for long-term sustainability.