Falling through the Cracks: Perspectives from local leaders on substance use and psychosis treatment for youth

Christina Freibott MPH (1), Thisara Jayasinghe (2), Ellen Reagan B.S. (1), Daisy Perez MPH (1), Anne Berrigan LICSW (1), Emily Kline PhD (1,2) Hannah Brown, M.D. (1,2) Amy Yule, M.D. (1,2)

1. Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian and Avedisian School of Medicine

Abstract

Background: Substance Induced Psychosis (SIP) requires early intervention in youth to improve prognosis. The Assertive Community Treatment (ACT) model has been used to treat severe mental illness in adults who have struggled to engage in typical treatment. However, this model has not been adapted to treat youth in an urban setting who struggle to engage in typical office based treatment. The objective of this study was explore local leaders experiences and perspectives with substance use and psychosis treatment (“leaders”) when adapting and implementing the ACT model to treat and engage urban youth with SIP.
Methods: Purposeful sampling was used to recruit leaders who interact with youth with SIP for semi-structured interviews to understand barriers and facilitators in adapting the ACT model to treat urban youth with SIP. Interviews were recorded, transcribed, and de-identified. Using the software NVivo, de-identified interviews were deductively coded using the Consolidated Frameworks for Implementation Research (CFIR). Themes emerged from deductive coding that were identified and agreed upon by a three person coding team.
Results: Eleven interviews were completed with 14 leaders. The four themes included: 1). A patchwork of systems attempts to catch youth early on, but often does not, 2). The inability to simultaneously address mental health and substance use concerns complicates how youth and their families engage in care, 3). An ideal program would be flexible in all the ways the current system is inflexible, centering treatment around youth and families, and 4). Factors important in tailoring a community-based program to serve under-resourced and historically marginalized urban youth.
Conclusion: Urban youth with SIP are a unique and vulnerable population. When designing a community based program to support their engagement in treatment it is imperative to take a patient centered approach that accounts for their symptoms, setting, and individually tailored how care is presented.