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SRF Webinar: Beyond DUP - Addressing Disengagement in Community-based Early Intervention - Nev Jones
- 1. BEYOND DUP: ADDRESSING DISENGAGMENT IN COMMUNITY- BASED EARLY INTERVENTION Nev Jones PhD* Director, Client Centered Outcomes Research in Public Mental Health, Felton Institute Patient Advocate *nevjonesphd@gmail.com
- 2. DISENGAGEMENT BEYOND DUP • Across studies, disengagement rates in EIP services range from 20-50% • CCOR research suggests that a significant proportion of clients/families disengage very early in treatment (~33% of those who disengage)** • Overall 45% disengage, 45% remain engaged until discharge, 10% discharged due to incarceration or • Strongly linked to sub-optimal outcomes (disengaged clients at 2X risk of discharge w no treatment goals met, unemployed/not in school, not managing symptoms) • Proximal Reasons for Disengagement • 60% of clients who disengaged cited disagreement with diagnosis or clinical interpretation of symptoms and/or disagreement that an EIP service provided what they needed to meet their needs, did not want to take medications, or did not want to engage in therapy • Major Predictors: • Background structural adversity & socioeconomic resources (private versus public insurance, poverty/socioeconomic stressors, family instability) • Criminal justice and substance use intersections • Race/ethnicity • 100% of disengaged families from under-represented ethnic/racial minority groups (African-American, Latino/a, Southeast Asian-American) • Ethnic/racial minority clients 3 times as likely to disengage as white clients **Jones et al., under review; in preparation
- 3. A PATH FORWARD? • Diverse stakeholder involvement and leadership can help re-set research and policy agendas: • Sensitivity/responsiveness to cultural and psychosocial contexts • Use of Cultural Formulation Interview (CFI) in assessment • Working hand-in-hand with youth/peers to develop trainings and intervention components able to bridge gaps between staff and young people who reject standard clinical conceptualizations of their problems • Current gap between youth/peers interested in influencing policy/research and opportunities to do so • Increased attention to the service components that individuals & families value most • Patient- and family-centered program development and research • Explicitly re-centering disadvantaged and ethnic/cultural minority perspectives