Implementation of Community Participation Practices in Coordinated Specialty Care: Insights from a Qualitative Study

Community participation is critical for health, particularly during young adulthood. Coordinated Specialty Care (CSC) programs for young adults with early psychosis aim to promote community participation; however, research on practices beyond those focused on employment, education, and family relationships is limited. This qualitative study explored CSC programs' community participation practices across a broad range of areas and the factors influencing their implementation. Following a national survey, individual semi-structured interviews were conducted with 11 CSC program leaders to examine ten specific practices. Recorded responses were transcribed and qualitatively analyzed using an integrated thematic analysis approach. Findings revealed that programs implemented a range of practices, including outreach to mainstream organizations, fostering mutual support among clients, facilitating independent community participation, and providing targeted support in spirituality/religion, intimate relationships, and civic engagement activities. Effective leadership, organizational culture, and staff factors (e.g., knowledge, skills, supportive attitudes and behaviors) emerged as key facilitators, while primary barriers included limited resources, staff challenges (e.g., lack of training), and environmental challenges (e.g., stigma, rural settings). Client-level factors, such as motivation and interference from symptoms, and the perceived effectiveness and acceptability of various practices, also impacted implementation. Recommendations include enhancing leadership buy-in, staff training, and creative resource use to overcome barriers and sustain community participation efforts. This study highlights variability across CSC programs and provides actionable strategies to strengthen community participation practices for young adults with early psychosis.