Session: Treatment Engagement and Disengagement Among Young Adults: Longitudinal Findings from Four Studies at Critical Points of Engagement (Society for Social Work and Research 24th Annual Conference - Reducing Racial and Economic Inequality)

Background and Purpose: The period of transition from late adolescence into young adulthood is the peak period for onset of serious mental illness, yet rates of outpatient mental health treatment are low, particularly in marginalized groups. And, those that have contact with the mental health system often do not remain in treatment over time. Prior work has identified factors that influence treatment engagement, though less is known about the longitudinal and intersectional nature of these factors and specifically how they may vary across treatment settings. This symposium brings together four papers that present longitudinal data from young adults identified in different treatment settings, focused specifically on understanding their engagement or disengagement and how to intervene.

Methods and Results: The symposium papers all used a combination of methods to understand service use behaviors.

The first paper, Aging out of Child Mental Health into Adult Mental Health Services: Missed Opportunities for Engagement, presents results from a longitudinal qualitative study of youth who were interviewed during the key period of transition from child-serving to adult-serving services. Findings highlight the ongoing need for support in the population coupled with the complexity inherent in forming relationships with new mental health providers at this time of developmental change.

The second paper, Unpacking Ghosting among Transition Age Youth Diagnosed with Serious Mental Health Conditions, used semi-structured interview and administrative service data to better understand service disengagement in an outpatient community mental health agency. Findings highlight that over half of young adults that left treatment over a three-year period had unplanned exits. Contributors to exits included developmental life changes and poor communication with providers.

The third paper, Treatment Continuation and Discontinuation in Young Adults Following Psychiatric Hospitalization, used primarily qualitative data to understand engagement in treatment after a crisis hospitalization. Findings highlight that instability in living situations, illness perceptions, and access to treatment are key factors that work together to influence treatment continuation after discharge. The fourth paper, Engagement in Mental Health Services among Young Adults with Serious Mental Illnesses, presents results from the development and testing of an intervention that targets specific mechanisms of change to engage young adults into outpatient treatment. Findings from a trial of 75 young adults enrolled in the intervention found significant increases in engagement and adherence to treatment. This paper provides a model for how to intervene to change engagement behavior.

Conclusion and Implications: Findings across studies highlight the importance of recognizing and explicitly addressing factors such as housing instability and employment transitions which are hallmarks of this developmental stage. The first three studies identify specific strategies that could increase engagement at three critical periods - the point where youth transition from child to adult services, following enrollment in outpatient services, and at discharge from psychiatric hospitalization. The fourth paper provides a model for a successful engagement intervention. Each paper illustrates points across the service continuum where individual providers and the systems in which they work can take steps to specifically respond to the developmental needs of this population.