Case managers' experiences of engagement with service users in UK early intervention services

Henderson, Paul and Sellwood, Bill and Hodge, Suzanne (2023) Case managers' experiences of engagement with service users in UK early intervention services. PhD thesis, Lancaster University.

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Abstract

Background: Early intervention services (EIS) were set up during the 1990s worldwide to provide support and treatment for individuals experiencing first-episode psychosis (FEP) to reduce delay of treatment. Staff engagement with individuals with FEP in EIS settings is important to reduce the longer-term impact of this condition and promote recovery. Further qualitative understanding is required due to a paucity of evidence exploring engagement from the perspectives of staff in these settings. Aim: To explore and understand case managers’ experiences of engagement with service users in early intervention settings. Methods: A systematic review of qualitative literature was undertaken and followed by a primary qualitative study. Seven case managers from mental health nursing backgrounds and working in EI services were purposively sampled and interviewed from a single NHS Foundation Trust. Semi-structured interviews were used. Interpretive phenomenological analysis (IPA) of transcripts was undertaken following six stages. Results: The reviewed literature identified three key themes influencing engagement: 1) Being authentic based on real dialogue and collaboration 2) Pushing against barriers- engaging against all odds 3) The chameleon effect- the skill of being adaptable. Five master themes were identified from the primary qualitative study as key to engagement: (1) Being on the same page; (2) Engagement as an interpersonal relationship; (3) Managing self and emotions; (4) The practicalities of engagement (5) The impact of organisational factors upon engagement. Discussion: Engagement was experienced as multi-faceted, complex, and changeable. Collaboration, trust, and shared understanding were identified as important elements to effectively engage. Conclusions: Engagement in the context of EIS can be defined as a mutually beneficial connection that takes place between service users and staff which allows for implementation of treatment. Engagement strategies found helpful were trust, therapeutic dialogue, shared understanding, collaboration, and practical approaches. Further exploratory research should be conducted across multiple UK settings, to further build on and understand engagement within the wider EIS context.