LAUSR

Abstract Background Clinical disengagement of youth in early psychosis clinics continues to be a significant barrier to recovery as evidenced by high rates of treatment non-adherence (up to 60%) and clinic drop-out (30%). Disengagement from services results in longer durations of untreated/partially-treated illness, which in turn leads to higher rates of symptom burden, re-hospitalization, and poorer functional outcomes. Approaches aimed at improving engagement have typically hinged on efforts to increase access to clinicians either via telephone or in person, however financial and human resource limitations often undermine these efforts. This has caused a shift toward the use of SMS due to its low cost and popularity as 95% of youth in North America send and receive SMS messages daily. The current randomized controlled trial sought to evaluate the efficacy of a weekly SMS intervention delivered over nine months to improve engagement in early psychosis services. Methods 60 participants between the ages of 16 and 29 presenting with a first episode psychosis to an early psychosis clinic in an academic health centre were recruited for this study. Participants were randomized to either an active or sham SMS intervention arm, delivered weekly for nine months. Participants were blind to treatment allocation. The active SMS intervention consisted of weekly SMS messages with adaptive questions regarding general wellbeing, clinic attendance and medication adherence, while the sham SMS arm consisted of a weekly generic text message with no clinically relevant subject matter. Results All participants have been enrolled, with the final study visits to be completed in December 2019. Results presented will include analyses of efficacy of the active versus sham SMS intervention for improving service engagement, our primary outcome, consisting of self-reported medication adherence, clinician and client rated engagement, and attendance rates extracted from electronic medical charts. In addition, symptom and functional outcomes were assessed over the course of the nine month intervention across the active and sham intervention groups, which will also be presented. Feasibility data collected to date indicates a high degree of interest and acceptance by participants for the use of SMS as a means of engagement. Further, there have been no tolerability difficulties reported by participants to date. Discussion The high rates of disengagement from clinical services seen among youth and emerging adults with early psychosis indicate a need for effective interventions to promote engagement in treatment and support symptomatic and functional recovery for affected individuals. The results of this trial stand to offer insights into the potential efficacy of a simple weekly SMS intervention to promote engagement in clinical services for this population. The acceptability of this intervention by participants, coupled with its low cost and the popularity of SMS, suggest that this treatment approach, if effective, could be readily implemented within early psychosis services to support positive outcomes from an initial psychosis episode.