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improving E ngagement of Y oung People in E arly interventions: the EYE project

improving E ngagement of Y oung People in E arly interventions: the EYE project. Dr Kathryn Greenwood Department of Psychology, University of Sussex Sussex Partnership NHS Foundation Trust. Co-applicants and Collaborators. Institute of Psychiatry.

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improving E ngagement of Y oung People in E arly interventions: the EYE project

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  1. improving Engagement of Young People in Early interventions: the EYE project • Dr Kathryn Greenwood Department of Psychology, University of Sussex Sussex Partnership NHS Foundation Trust

  2. Co-applicants and Collaborators Instituteof Psychiatry Sussex Partnership NHS Foundation Trust University of Sussex, Psychology

  3. Service User Research Forum SURF -Brighton • First episode psychosis service users • Providing consultation on research project design and grant development • Getting rid of jargon, using right language, helping to share information • asking service user led questions and trying to answer these? (Rose 2004; Mosavel et al. 2005)

  4. What’s the problem with engagement? • Psychosis affects 7500 young people per year (375 in South East) (The NHS plan: DoH 2000) • Often devastating consequences • 25 years reduction in life expectancy (Parks et al 2006) • Poor quality of life (Rossler et al. 2005) • One third of premature deaths from suicide (Wiersma et al 1999, Bertelsen et al 2007) • Early Intervention in Psychosis in critical period improves • Symptoms, function, course, outcome and suicide (Nordentoft et al 2004; Garety et al. 2006; Melle et al. Harris et al. 2008; Lester et al. 2009)

  5. EIP improves outcomes in SussexKavanagh, Taylor, Lukats, Greenwood, Whale 2010 Clinical Global Impression Global Assessment of Function DUP≤3months DUP 3-12 months DUP 3-12 months DUP≤3months

  6. What’s the problem with engagement? 25-30% of people disengage within 12 months (Cotton et al. 2009; Polari et al. 2009; Turner ey al. 2009) Even in National Lead EIP service only 70% are well engaged at 12 months (Smith 2009) Disengagement linked to younger age and other associated factors (e.g. substance use/lack of service knowledge) (Cotton et al. 2009; Schimelmann et al 2006; Krstev et al. 2004) need more effective youth-focused service to improve engagement and outcome in this group

  7. But a similar proportion of people drop out in Sussex Non-engagers Engagers

  8. And there’s a desire to develop youth focussed services

  9. Shaping development of research question and designSet up and facilitation of SURF groupShaping methodology around recruitmentsocial-educational sessions, peer researchers to aid access to those who don’t engage (and recently also ethics flyer)Contributing to dissemination (training, leaflets, presentations)Emphasising important outcomes (isolation and suicide). Initial service user contribution – RDS PPI grant

  10. Research Question What are facilitators and barriers to engagement in EIP? What changes should be made to services based on knowledge of engagement? Can youth-focussed service adaptations be effectively implemented to improve engagement and address the specific needs of those who disengage from EIP service?

  11. Phase 1- Focus Groups Surrey, Sussex and Kent 12 x 6-8 people Young People Siblings/Parents Young Service users (Purposive sampling for gender, engagement, status, family, substance use, severity)

  12. Phase 1 - Outcome • Thematic analysis leading to • Set of themes around facilitators and barriers to engagement from each perspective • Set of suggested service adaptations

  13. Phase 2 – Delphi Consultation & Implementation Science(Tansella and Thornicroft 2009) Service managers, clinicians, commissioners

  14. Phase 2 - Outcome Service adaptation Engagement Booklet Training (1 month) Website (Tansella and Thornicroft 2009)

  15. SURF suggested service adaptations • Provision and use of Information • Advertising and social educational sessions • Approaches to engagement • Social networking, sites, texting, broader health and youth sub-culture awareness • Involvement of young people in their services

  16. Phase 3 – Outcome Evaluation Proportion of clients referred during a 6 month period, who drop out of service in the subsequent 12 months pre and post intervention (N=250) Measures of quality of engagement (i.e. DNA rates, medication use, uptake of interventions) Qualitative experience of the service adaptations from service user, carer and clinician perspective (n=18 -24)

  17. Benefits • Improved engagement options in EIP • Training, consultancy and resources • Better skilled staff • More effective and efficient intervention • Fewer DNA’s • Better service user and staff satisfaction • Cost effectiveness • Outcomes to inform larger national Randomised Controlled Trial (RCT)

  18. Phase 3 – Evaluation of outcome -6 months Start of target pre intetvention referral period 0 months End of target referral period Study Start 12 months End of 12 months for follow up period 16 months Training for Intervention Intervention Start 17 months Start of target post intervention referral period 22 months End of target post intervention referral period 34 months End of 12 months for follow up period Study End

  19. Thanks to theResearch for Patient Benefit Programme £207, 000

  20. Thank You www.sussex.ac.uk/spriglab

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