“It’s a dent, not a break”: an exploration of how care co-ordinators understand and navigate boundaries in early intervention in psychosis services

BACKGROUND Early Intervention in Psychosis Services (EIP) offer a unique service model for people experiencing a first episode of psychosis. They are intensive case-management services which adopt an assertive outreach approach, employing flexible boundaries to meet clients in the community, and support them towards recovery and holistic goals. Current boundary theory is therefore not easily applied to this clinical context.

This study aimed to explore how care-co-ordinators in EIP develop their understanding and practise around navigating boundaries.

METHODS Participants were 13 EIP care co-ordinators. Semi-structured interviews with participants were conducted and analysed using grounded theory.

RESULTS A concentric model emerged, defining different layers of influence impacting care co-ordinators’ navigation of boundaries. This included higher governing levels (e.g. professional codes of conduct), factors and challenges specific to EIP culture, client characteristics and individual care co-ordinator decision-making processes. A flexible, case-by-case approach was adopted in response to challenges.

DISCUSSION Findings suggest clinical implications for how care co-ordinators can jointly construct appropriate boundaries with clients and families, and discuss dilemmas using the team resource. This model can be used as a tool in clinical practice to aid clinicians’ thinking and reflection around boundaries within EIP.