Qualitative Analysis of Telephone Logs: Client Engagement and Barriers to Completing an Initial Early Psychosis Assessment.

Abstract

Objective: Time between the onset of psychosis and the start of treatment significantly influences outcomes. Rapid access to care is essential, yet barriers such as stigma, difficulties with navigating the mental health system, and financial constraints prolong this process. This mixed-methods study aimed to assess how these barriers affect participation in early psychosis services.

Methods: A directed content analysis of telephone log data was conducted from intake assessments at an early psychosis clinic. Stepwise logistic regression and analyses of variance were used to evaluate the impact of barriers on assessment completion and time from referral to assessment.

Results: Of 1,048 individuals screened for early psychosis services, 201 completed a telephone assessment. Individuals who dropped out had a higher proportion of barriers overall than did those who completed the assessment (p<0.01). Greater than 50% of interactions included at least one barrier, with logistical issues being the most common. Increased barriers were correlated with longer assessments and lower completion rates. Adults and Hispanic participants reported more barriers, compared with adolescents and non-Hispanic individuals, respectively. Significant contributors to nonengagement included unknown gender, public insurance, and various barriers.

Conclusions: Identifiable barriers to intake assessment were frequently reported by clients and were associated with higher intake noncompletion and a longer assessment process. Efforts to address logistical barriers may represent an essential step in improving the linkage process and reducing the duration of untreated psychosis.