Outcomes of a Metaintervention to Improve Treatment Engagement Among Young Adults With Serious Mental Illnesses: Application of a Pilot Randomized Explanatory Design

Purpose: The objective of this study was to conduct a preliminary evaluation of a new young adult–centered metaintervention to improve treatment engagement among those with serious mental illness. Methods: Young adults, clinic staff, and policy makers provided feedback on the intervention, which is a two-module engagement program provided by a clinician and person with lived experience (peer) during intake. A two-group pilot randomized explanatory trial design was conducted, comparing treatment as usual with treatment as usual plus the engagement program, Just Do You. The primary outcomes were treatment engagement and presumed mediators of program effects measured at 3 months after baseline. Results: The randomized explanatory trial indicated that young adults in Just Do You were more engaged in treatment than treatment as usual and that changes in several mediators of engagement occurred. Mechanisms that demonstrated between-group differences were stigma, perceived expertise of providers, trust in providers, and beliefs about the benefits of treatment. Results also provide diagnostic information on mediators that the program failed to change, such as hope, self-efficacy, and emotional reactions to treatment. These results inform next steps in the development of this promising intervention. Conclusions: Just Do You illustrated feasibility, acceptability and preliminary impact. It represents an innovative metaintervention that has promise for improving treatment engagement in mental health services among young adults who have a history of poor engagement.