Community Mental Health Journal

, Volume 38, Issue 3, pp 213–221

Therapist and Case Manager Perceptions of Client Barriers to Treatment Participation and Use of Engagement Strategies


  • Jerry Jo Manfred-Gilham
    • Department of Social WorkFranciscan University of Steubenville
  • Esther Sales
    • University of Pittsburgh
  • Gary Koeske
    • University of Pittsburgh

DOI: 10.1023/A:1015263606948

Cite this article as:
Manfred-Gilham, J.J., Sales, E. & Koeske, G. Community Ment Health J (2002) 38: 213. doi:10.1023/A:1015263606948


This study of 33 mental health therapists and 30 case managers examined the relationship between practitioners' assessments of the importance of potential treatment barriers and their use of engagement strategies to overcome those barriers and improve treatment participation. Results confirmed the hypothesis that workers who viewed treatment barriers as more important were significantly more active in their reported efforts to engage clients (r = .28, p < .05). Although no significant differences between the two groups were found in overall use of engagement strategies, we found a significant interaction effect between position and types of strategies used, with therapists employing more discussion strategies while case managers were more likely to employ practical engagement strategies (F = 35.79, p < .001). Findings suggest the desirability of enhancing mental health workers' sensitivity to the range of barriers that clients may experience, and expanding the repertoire of engagement strategies they use to encourage client retention.

treatment participation barriersengagement strategiesclient attrition

Copyright information

© Human Sciences Press, Inc. 2002