Translating Qualitative Data into Dimensions of an Intervention Enhancement to the Supported Employment & Education Model for Young Adults with Psychosis Who Are ‌not in Employment, Education, or Training� (NEET)

Background & Purpose: Young adults receiving treatment for early psychosis are at high risk for extended periods of disability and poverty, due to the time spent recovering from illness that would otherwise be spent in formative education or employment experiences. Approximately 40% of young adults complete Coordinated Specialty Care (CSC) early psychosis programs “not in employment, education, or training” (NEET). Furthermore, the Supported Employment & Education (SEE) and Individual Placement & Support-Young Adults (IPS-Y) models provide limited services to young adults with NEET status as they are directed to assist young adults who have existing work/education goals. Utilizing a participatory research framework, this study aimed to: 1) understand the unmet needs of young adults enrolled in CSC programs who have struggled to overcome NEET status, and identify potential intervention enhancement areas; and 2) identify barriers and facilitators to engaging young adults with NEET status from SEE staff.

Methods: Qualitative data were collected in two phases. First, young adults who met inclusion criteria of: 1) lived experience of psychosis; 2) received treatment from a first-episode psychosis program; and 3) had or still have NEET status were recruited to participate in qualitative interviews. Then, SEE staff were recruited using a national early psychosis board to participate in focus groups. The first phase of the study consisted of semi-structured interviews with young adults until reaching saturation of themes (n=5). Then, two focus groups were held with SEE staff (n=3, n=4) to determine their perceived barriers and facilitators with NEET young adults. Thematic analysis was used for the first round of data analysis. Initial themes were presented to the participatory advisory group, and the lead researcher began an iterative process of comparing qualitative themes with existing literature on engagement, motivation, vocational identity development, and career confidence, resulting in a translation of themes into dimensions of an intervention phase and assessment tool. The second phase of the study involved follow-up interviews with young adults (n=5) to review the findings and present the assessment tool for their feedback. Phase two concluded with a final follow-up focus group with SEE staff (n=5) to review the assessment tool and assess feasibility of this intervention enhancement.

Results suggest that young adults with early psychosis who have NEET status are in need of earlier and lengthier engagement and planning that helps them to build vocational identity and improved confidence after a first-episode of psychosis. SEE staff had mixed understanding of the root causes of NEET status, often viewing young adults as unmotivated. SEE staff also felt that their services and vocational assessment were designed for young people with an existing work history and that their programs lacked resources to effectively engage young adults with NEET status.

Conclusions & Implications: The resulting early engagement and planning phase and assessment tool will enhance the SEE model to be more appropriate for young adults with NEET status. This phase and tool will be pilot tested for preliminary efficacy, including an exploration of mechanisms of action, feasibility and acceptability in real world settings.