Background
Methods
Study context
Sampling
Data collection procedures
Data analysis
Results
Participant overview
Case-Manager Demographics | Young Person Demographics | |
---|---|---|
Case-study 1 | Female, Occupational Therapist 8 years since qualification 2 years in EIS | Unemployed male in a de facto relationship. Aged between 19 and 24 years old. Diagnosis of schizophrenia. Cannabis and amphetamine use. |
Case-study 2 | Female, Occupational Therapist 2 years since qualification 1 year in EIS | Single, male student. Aged between 15 and 18 years old. Diagnosis of possible psychosis, with language deficits and depression. No substance use. |
Case-study 3 | Male, Clinical Psychologist 20 years since qualification 16 years in EIS | Single, male student. Aged between 15 and 18 years old. Diagnosis of hypomania and psychosis. No substance use. |
Case-study 4 | Female, Occupational Therapist 2 years since qualification 1 year in EIS | Single, male student. Aged between 15 and 18 years old. Diagnosis of schizophrenia. Cannabis use. |
Case-study 5 | Female, Clinical Psychologist 5 years since qualification 5 years in EIS | Single, unemployed male. Aged between 19 and 24 years old. Diagnosis of depression, anxiety and psychosis NOS. No substance use. |
Case-study 6 | Female, Social Worker 20 years since qualification 1 year in EIS | Female student in a de facto relationship. Aged between 19 and 24 years old. Diagnosis of Bipolar Affective Disorder with psychotic features. No substance use. |
Case-study 7 | Male, Clinical Psychologist 8 years since qualification 8 years in EIS | Single, male student. Aged between 15 and 18 years old. Diagnosis of schizophreniform psychosis and autism spectrum disorder. Cannabis use. |
Case-study 8 | Female, Occupation Therapist 1 year since qualification < 1 year in EIS | Single, female student. Aged between 19 and 24 years old. Diagnosis of depression and psychosis NOS. No substance use. |
Case-study 9 | Female, Social Worker 8 years since qualification < 1 year in EI | Single, unemployed female. Aged between 19 and 24 years old. Diagnosis of depression and psychosis NOS. No substance use. |
Young person and caregiver influences on engagement
Levels of engagement
“I went last week to go get him [young person] and he wasn't there, and I waited for maybe 15 minutes, knocking on the door, thinking, okay he might be asleep. And after 15 minutes, there was nothing, so I left … So, I think frustration is a big part of it.” (Case-manager 4)
“Sometimes it's hard to not personalize non-attendances or periods of disengagement and feel a bit like, is there something that I'm not bringing, or am I not giving her what she needs or- and that can be sort of a hard thing to navigate as a case manager with any young person.” (Case-manager 9)
Case-manager influences on engagement
Building trust and connection
Without consistency, it was felt that the young person would not have maintained engagement with the service.“It's challenging in terms of engagement and access and being able to have that kind of continuity and so I don't really feel like we've achieved necessarily a whole lot in the time that we have worked together but I suppose the fact he's saying he doesn't want someone new and he does come in when he can … There’s definitely potential to continue working there.” (Case-manager 1)
Relational approaches to engagement
“We talked about [his interests] and I guess I made a bit of a pitch about what we could do for him, in engaging with [EIS] as well. And actually, it's a bit ridiculous but I remember leaving him and thinking, ‘I think this will go alright’ cause he was like, ‘You're a cool dude!’ So, it must have been a reasonably okay first experience for him.” (Case-manager 7)
“I guess for me as a clinician I do focus very strongly on rapport building and taking cues from the young person, so not sort of rushing or pushing anything so hopefully that's created a sense of [young person] feeling quite comfortable and maybe like she's in charge of the pace that we progress.” (Case-manager 9)
“I think we obviously have some goals in mind. I'm always mindful in having done recovery plans and stuff that you have your own stuff which is really about keeping people well … but I think it needs to be driven outside of that. It needs to be driven by the client … Which is not always easy if they don't want to be here or, you know, if they don't actually have any particular goals”. (Case-manager 6)
Strategies to promote engagement
Case-managers also described strategies used during sessions to promote a therapeutic space. These included balancing the involvement of others (caregivers, treating team, other services) and considering the use of language to be fully understood by the young person. When engagement was difficult, case-managers sought advice and support from the broader EIS team through weekly clinical reviews, clinical supervision or informal contacts. However, engagement was predominantly described as individual interactions within the young person – case-manager relationship, and as such, there was a sense of case-managers working in isolation from the broader team.“And also, the fact that when you are sitting in an office, kind of face to face, there's a different interaction between sitting in a car, listening to music. He knows that I have my iPod every time and he knows that I've got a cord and he can plug his phone in, so the music really helps with the engagement as well. And he's shown me some of his favorite rappers, and I've shown him some of mine, that wouldn't happen in an office.” (Case-manager 4)
Individual case-manager qualities
“There’s specific topics that I feel like we kind of, she's talking in one direction and I might be struggling to follow. So especially around like suicide and self-harm. I find these topics really challenging to kind of make her feel safe and elicit the information that I'm trying to find out.” (Case-manager 8).
Case-manager gender or age was noted by two case-managers, but not identified as a significant advantage or deterrent to engagement. Instead, the relational approaches and a commitment to investing time in the young person were identified as more important facilitators of engagement.“He’s a really good client to have, l really enjoy catching up with [young person] and as far as my caseload goes, [young person] is a breath of fresh air. He’s a good therapy client, he engages really well, and I enjoy his company.” (Case-manager 5)
Influences of the EIS system on engagement
The nuances of time
Appreciation of time was echoed by all case-managers, who communicated to the young person and their caregivers that there was someone there for them longer-term.“We’ve got plenty of time to work with him, so that immediately took the pressure off both of us, which I think, paradoxically, actually meant that he was able to be more open, because he didn't feel under any kind of pressure to do that.” (Case-manager 3)
“I do feel like [young person]’s someone, if you know there was a period of disengagement, and I said to her, “Hey, let me meet you at your local cafe and shout you lunch and we'll catch up then”:, that probably would work really well, but there's just not time or money to do that kind of work really, it is quite difficult.” (Case-manager 9)
Young person engagement and associated work satisfaction, which may impact staff turnover and available clinical resources, was therefore both impacted by, and contributed to, service level factors.“There are times when I might have a session and maybe, you know, I think often it's about where I’m at and where my head's at … nothing really kind of comes out of it, or I feel like nothing's really come out of it. I don't know necessarily how she would feel.” (Case-manager 6).