Client Engagement With an Early Psychosis Program and Post-Program Health Service Use: A Retrospective Cohort Study

Poor engagement with Early Intervention Services (EIS) for first-episode psychosis threatens program effectiveness, yet research often reduces engagement to a binary measure (engaged/disengaged), limiting understanding of those who disengage and re-engage. This study examined demographics, clinical characteristics, and health service utilisation patterns among engaged, intermittently engaged, and disengaged patients of the Nova Scotia Early Psychosis Program (NSEPP).

A retrospective cohort comprised of 331 individuals enrolled in NSEPP between July 22, 2005, and October 9, 2015, was constructed by linking clinical and administrative datasets. Engagement types (engaged, intermittently engaged, disengaged) were characterised in terms of baseline demographics and clinical factors, along with patterns of health service utilisation before, during, and after program enrollment. Crude and adjusted associations between program engagement and post-program health service utilisation (emergency department (ED) use and mental health-related hospital admissions) were assessed using negative binomial regression models.

During program enrollment, the intermittently engaged group had the greatest illness severity (35% spent 30+ days in hospital), and the highest proportion of individuals with at least one ED visit (85%) and one hospital admission (55%). These during-program health service use factors were the strongest predictors of post-program health service use outcomes.

The three engagement types show distinct health service utilisation patterns, which may reflect differences in need, access, or program effectiveness. These results provide evidence that dichotomisation of engagement may mask important heterogeneity. Further characterisation of the engagement continuum to include intermittent engagement may provide insights to reducing barriers and improving access to and uptake of EIS.