Tindall Rachel, Francey Shona, Hamilton Bridget
Department of Nursing, Orygen Youth Health, Melbourne, Victoria, Australia.
Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia.
Int J Ment Health Nurs. 2015 Aug;24(4):295-303. doi: 10.1111/inm.12133. Epub 2015 May 14.
Holistic treatment during a first episode psychosis (FEP) can significantly impact the longevity and chronicity of the illness, as well as reduce the risk of premature death by suicide. However, treatment can only be effective if the young person participates. Given that 19-40% of young people disengage from early intervention services for FEP, this qualitative study aimed to understand how young people experienced engagement with case managers at an early intervention service. Semistructured interviews were conducted with seven young people and themes were identified using interpretive phenomenological analysis. Young people detailed how engagement with a service could be viewed as a process, following different stages between initial referral and discharge. Throughout this process, a number of factors influenced young people's decision to engage with, or disengage from, their case manager. This created a push-pull dynamic with periods of good engagement and poor engagement. Discussion of this dynamic adds nuance to established scholarship about engagement, including shifts over time in the importance of client empowerment and valued features of therapeutic relationships. Awareness and understanding of these concepts may guide changes to early intervention services and address the core issue of engagement.
首发精神病（FEP）期间的整体治疗可显著影响疾病的病程和慢性化，还能降低自杀过早死亡的风险。然而，只有年轻人参与其中，治疗才会有效。鉴于19%至40%的年轻人会脱离FEP早期干预服务，这项定性研究旨在了解年轻人在早期干预服务中与个案管理员接触的体验。对七名年轻人进行了半结构化访谈，并采用解释现象学分析确定了主题。年轻人详细描述了与服务机构的接触如何可被视为一个过程，在初次转诊和出院之间遵循不同阶段。在这个过程中，一些因素影响了年轻人决定与个案管理员接触或脱离接触。这形成了一种推拉动态，出现了接触良好和接触不佳的时期。对这种动态的讨论为关于接触的既定学术研究增添了细微差别，包括随着时间推移客户赋权的重要性和治疗关系的重要特征的转变。对这些概念的认识和理解可能会指导早期干预服务的变革，并解决接触这一核心问题。
