Manuela Ferrari ^1,2* Kevin MacDonald ¹ Judith Sabetti ¹ Tovah Cowan ^1,2 SRIVIDYA N. IYER ^1,2

• ¹ Douglas Mental Health University Institute, Montreal, Quebec, Canada
• ² McGill University, Montreal, Canada

Background: Early intervention services (EIS) for psychosis have proven highly effective in treating first episode psychosis. Yet, retention or “engagement” in EIS remains highly variable. Dis/engagement as a contested concept and fluid process involving relationships between service providers and service users remains poorly understood. This study aimed to critically evaluate and explain the dynamic interplay of service provider-user relationships in effecting dis/engagement from an early intervention program for psychosis. Methods: Forty study participants, 16 service providers and 24 service users (19 current and 5 disengaged) from a Canadian EIS program, were administered semi-structured interviews. Qualitative analysis was conducted using grounded theory methods, with findings captured and reconceptualized in a novel explanatory model. Findings: A model of engagement with eight major domains of engagement in EIS positioned along a control-autonomy spectrum was developed from the findings, with Clinical engagement (attendance) and Life engagement (life activities) at opposite ends of the spectrum, interspersed by six intermediate domains: Medication/treatment, Symptoms/illness, Mental health, Physical health/wellness, Communication, and Relationships, each domain bearing uniquely on engagement. Conclusions: An examination of service user and service provider perspectives on the various domains identified in the spectrum model, and their dynamic interplay, reveals the complexity of choices faced by service users in engaging and not engaging with services