The Early Youth Engagement in first episode psychosis (EYE-2) study: pragmatic cluster randomised controlled trial of implementation, effectiveness & cost effectiveness of a team-based motivational engagement intervention to improve engagement
Recipient organisationSussex Partnership NHS Foundation Trust
Funding£1.7M
PeriodJun 2018 — Jan 2022
In plain English
AI plain-English summary
One in four young people with first-episode psychosis disengages from mental health services within their first year of treatment, often with severe consequences for their recovery. This trial tests a team-based motivational intervention—called Early Youth Engagement (EYE)—designed to keep them in care. The problem is stark: 25% of young people drop out of Early Intervention in Psychosis (EIP) services within 12 months, despite those services being proven to improve long-term health outcomes. Disengagement harms their mental and physical health, strains families, and increases costs to the NHS and society. The EYE intervention, developed with input from service users, carers, and clinicians, aims to address the specific barriers that cause young people to leave treatment. The study will run across 20 EIP services in England, involving 950 young people aged 14–35. It compares standard EIP care plus the EYE intervention against standard care alone, measuring time to disengagement as the primary outcome, alongside mental and physical health, social function, and cost-effectiveness over 24 months. If successful, the intervention could keep at least an extra 10% of young people engaged in care, improving their health outcomes and reducing long-term costs to the NHS and society. The project will also produce a publicly available toolkit—including training, manuals, and a commissioning guide—to support national rollout.
View original technical description
Background: Early Intervention in Psychosis (EIP) services improve health outcomes for young people with severe mental illness in the medium-long term, but 25% of young people disengage in the first 12 months at significant cost to their mental health, their families, society & the NHS. Our own feasibility-pilot work clarified the issues that affect engagement. This study will now refine and test the team-based motivational Early Youth Engagement (EYE) intervention to improve engagement and outcomes for young people. A process evaluation will explore implementation across setting. Objectives: to refine a toolkit, resources and training for the EYE intervention, to evaluate its effectiveness, implementation, and cost-effectiveness and to disseminate widely. Study design: A cluster randomised controlled trial with economic evaluation will compare the EYE intervention + standardised EIP service to standardised EIP service alone, with randomisation at service level. A qualitative study with ethnic minority service users will ensure acceptability specifically for the diverse EIP population. An implementation study, drawing on normalisation process theory (NPT), will shape the implementation toolkit and evaluate the delivery of the intervention qualitatively and quantitatively across context. Setting: 20 EIP services in Manchester, London, Norfolk-Cambridge & South of England. Sussex services will be involved in the implementation study. Populations: 950 young people (14-35 years) with first episode psychosis (F20-29, 31; ICD-10) including ethnic minority service users; and EIP staff. Intervention: The team-based motivational engagement (EYE) intervention, derived in consultation with service users, carers & clinicians in the original EYE study, will be delivered by EIP clinicians alongside standardised EIP services, supported by website, training, booklet series, schools pack, friends & family, & social group protocol. Comparator: Standardised EIP service, provided by EIP clinicians, including NICE guidelines approved interventions. Outcomes: Primary outcome is time to disengagement (time in days from date of allocation to care coordinator to date of last contact following refusal to engage with EIP service, or lack of response to EIP contact for a consecutive 3-month period). Secondary outcomes include mental & physical health, social & occupational function, recovery, satisfaction & service use at 6, 12, 18 & 24 months. Economic evaluation: 12M within-trial economic evaluation of cost-effectiveness of the EYE intervention from a societal perspective, accounting for cost impacts within and beyond the mental health sector, with a secondary analysis taking a narrower NHS perspective to inform a commissioning guide. Duration 44 months: 11.5 months set-up & training, 14 months recruitment plus a further 12 months follow-up, 6.5 months data analysis & dissemination. Benefits and Impact: If effective, integration of the intervention into standardised care will ensure that at least an extra 10% of young people & families with severe mental illness will maintain engagement, resulting in better physical & mental health and economic outcomes. Clinicians, managers & commissioners will benefit from a toolkit including manuals, commissioning guide, training & resources, adapted to meet the needs of the diverse EIP population, and based on an in-depth process evaluation to enable national roll out
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