Background: Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed. Methods: Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion. Results: The analysis identified four major service-related transitions in a YP’s journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services. Conclusion: Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.
|Status||Udgivet - 13. dec. 2022|
Bibliografisk noteFunding Information:
This research was part of the Early Psychosis Youth Services (EPYS) Evaluation project. This was an independent evaluation of headspace early intervention psychosis services, which commissioned by the Federal Government with partners EY (Pty Ltd), the University of Sydney, and The George Institute for Global Health. The preparation of this manuscript was supported partially by the Australian Government through the Australian Research Council’s Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025).
The authors would like to thank the young people, families and clinicians who supported this project from headspace, Sydney Local Health District, Western Sydney Local Health District, the Nepean Blue Mountains Local Health District, and the evaluation partners. Thank you to Christiane Klinner, Margaret Yeung and Anthony Chan for their support on the research. AM (BSc, PGDip Psych, MAppSc Health Psych, PhD): is a psychologist and research fellow with Australian and international experience working with EIPS and adult mental health services. TP (BSc, MBBS, M Psychiatry) is a psychiatry registrar (trainee) with experience working in child, youth (EIPS) and adult mental health services. KC (BSc, Bed) is a teacher and lived experience researcher with a lived experience of using EIPS. RE (BScN, MN, PhD) is a nurse and qualitative researcher specializing in critical social theory. NB (BN, MScN, PhD) is a mental health nurse and professor in qualitative research and qualitative research methodology, with a focus on critical health research, ethnographic theories and methods. NG (MA, MBBS, MSc, MRCPsych, FRANZCP, PhD) is an academic and consultant psychiatrist specialising in epidemiology, trials and health services research.
© 2022, The Author(s).