Stakeholders Perspectives on Engaging Young Adults in Psychiatric Rehabilitation

Background and Purpose: Young adults have high rates of serious mental illness (SMI) and low rates of mental health service use compared to older age groups. Increasing meaningful consumer involvement and collaboration with providers is crucial to improving engagement in treatment and has become an important facet of the recovery movement. This study used qualitative inquiry to explore the implementation and collaborative nature of Just Do You (JDY), which was found to improve treatment engagement among marginalized young adults living with SMI.

Methods: JDY uses culturally and developmentally salient modalities to prepare, ready, inspire, motivate, and empower (PRIME) young adults as they begin treatment. The intervention strategies, including collaborating with providers on decision-making, were designed to reduce barriers (e.g., stigma) and enhance engagement and recovery. In-depth semi-structured interviews were conducted with key stakeholders (N=11) involved with the planning, delivery, and evaluation of JDY. Key stakeholders included providers at the psychiatric rehabilitation program (e.g., supervisors, peers) and researchers. The interview protocol covered domains of implementation and collaboration. Interview transcripts were analyzed using grounded theory coding techniques and constant comparison. Analysts met multiple times to discuss initial codes, grouped codes, memos, and emergent themes.

Results: The sample was 67% female and 67% White identified, 11% South Asian, 11% East Asian, and 11% Biracial-Black. Results revealed an ecology of collaboration at the provider and organizational levels related to the development, facilitation, and implementation of JDY. Two broad themes emerged. The first theme, collaboration between the clinician and person with lived experience, captured the importance of providers collaboration (e.g., “I think if it was just a clinician working, you’re missing something. If it’s just a peer working, you’re missing something. And I think to achieve a goal of success, you have to kind of like address it all together.”). This included subthemes related to the (1) combined strengths of differing expertise within the clinical encounter, (2) preparation for and processing of intervention modules between clinician and peer, and (3) trust as a mechanism to engagement. The second theme, collaborative culture within and between organizations, illustrated a range of attitudes, behaviors, values, and qualities that highlighted facets of collaboration among stakeholders directly and indirectly involved with the planning, delivery, and evaluation of JDY (e.g., “it was such an opportunity for our team to really come together. When I say our team, I mean the communities—our community—to come together to try to figure out how to begin to move the needle on getting young people to consistently come to the PROS Program.”).

Conclusions and Implications: Findings speak to the importance of a ‘culture of collaboration’ across multiple levels of an organization from providers in the clinical encounter all the way up to senior leadership. Data highlight the value of interventions that are facilitated by a clinician and a person with lived experience; in particular, how their collaboration and combined expertise may be the most effective approach to facilitating recovery. Results support policy efforts to increase the number of peer support specialists in community mental health.