Program-level Factors Associated with Patient Retention and Family Engagement in First-Episode Psychosis Coordinated Specialty Care Programs in Massachusetts
Cheryl Y. S. Foo (1,2,3), Catherine Leonard (1), Kelsey A. Johnson (3,4), Dost Ongur (2,3,5), Corinne Cather (1,2*), Kim T. Mueser (1,6*)
1. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
2. Department of Psychiatry, Harvard Medical School
3. Laboratory for Early Psychosis (LEAP) Center
4. Massachusetts PsychosisNetwork for Early Treatment (MAPNET), Beth Israel Deaconess Medical Center
5. Schizophrenia and Bipolar Disorder Research Program, McLean Hospital
6. Center for Psychiatric Rehabilitation, Boston University
*Co-senior authors
Background: Poor treatment engagement of individuals with first-episode psychosis (FEP) and their families adversely impacts the effectiveness of early intervention services and increases patients’ risk of relapse. This study examined modifiable program-level determinants of patient retention and family engagement rates across FEP coordinated specialty care (CSC) programs in Massachusetts.
Method: Out of the total number of active patients in their program from October 2022 to September 2023, program leaders reported the number of patients who prematurely discontinued services (for reasons other than successful completion, attainment of recovery/treatment goals, or no longer meeting program eligibility) and number of families who participated in at least one session of any type of family intervention (e.g., family psychoeducation, multifamily group, family peer support). Program characteristics (EPINET Program-Level Battery) and MAPNET Fidelity Scale (adapted FEP Services Fidelity Scale 2.0) ratings on level/type of family involvement and outreach and engagement practices (e.g., proactive outreach, flexible hours and location, shared decision making documentation) were explored as predictors of patient retention and family engagement using independent t-tests or univariate linear regressions.
Results: Across the nine participating sites, mean patient retention rate was 86% (SD: 13) and family engagement rate was 40% (SD: 27). Higher overall fidelity in providing evidence-based family interventions had a significant, large, positive effect on patient retention (B (SE)=11.5 (2.7); AR2=.68, p=.004). Fidelity to family interventions was not associated with family engagement rates. Higher overall fidelity to recommended outreach and engagement practices had marginally significant positive effects on family engagement rates (B (SE)=19.8 (10.5); AR2=.24; p=.10), but not on patient retention rates. Programs that offered home/in-community visits for family interventions (B (SE)=29.4 (15.6); g [95% CI]=1.12 [-0.21, 2.40]) and family partner/peer support services (B (SE)=30.9 (16.5); g [95% CI]=1.17 [-0.23, 2.51]) had higher family engagement rates (p=.10).
Conclusion: Among Massachusetts FEP CSC programs, those that offer high-fidelity family services delivered by clinicians trained in evidence-based family interventions for psychosis had better patient retention than those who did not. While flexible and varied approaches of engaging families were helpful, patient factors (e.g., age, living at home, consent) may be more important determinants of the family engagement rates in FEP CSC services. Our findings are consistent with studies showing effects of family psychoeducation on treatment adherence in early psychosis.