Advertisement

Journal of Abnormal Child Psychology

, Volume 47, Issue 9, pp 1437–1454 | Cite as

The Influence of Treatment Engagement on Positive Outcomes in the Context of a School-Based Intervention for Students with Externalizing Behavior Problems

  • Michael A. LindseyEmail author
  • Meghan Romanelli
  • Mesha L. Ellis
  • Edward D. Barker
  • Caroline L. Boxmeyer
  • John E. Lochman
Article

Abstract

We examined the stability of and cross-influences between externalizing behaviors and intervention engagement among children participating in a randomized clinical trial of an intervention for disruptive behavioral youth. Analyses also accounted for the influence of caregiver depression, family relationship quality, and sociodemographic factors (race, income) on the relationship between behaviors and intervention engagement. Analyses were based on 118 children participating in the Coping Power intervention. Composite variables were created to represent externalizing behaviors and intervention engagement constructs. Associations between these composite variables were examined over 24 treatment sessions. Findings indicated a regressive relationship among externalizing behaviors, i.e., baseline externalizing behaviors were positively associated with immediate follow-up behaviors. There were also dynamic relationships observed among engagement constructs. Notably, engagement with in-session activities during sessions 1–8 was positively associated with out-of-session activity engagement during the same treatment time period. Engagement with out-of-session activities during sessions 1–8 was positively associated with in-session activity engagement during sessions 9–16, indicating a complete mediation between early and middle in-session engagement through the mechanism of early out-of-session engagement. A crosslag relationship was observed: middle in-session engagement was negatively associated with externalizing behaviors at immediate follow-up. Finally, an interaction of race by income on immediate follow-up externalizing behaviors was observed, such that Black children’s externalizing behaviors remain static regardless of income level while White children’s behaviors decreased with higher income. Our findings support the contention that focusing on intervention engagement may be especially important in prevention interventions.

Keywords

Prevention intervention Engagement Child behavior problems Caregiver depression Family income 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

All participants provided informed consent under an approved IRB study protocol; IRB Project #: 07-OR-257-R12.

References

  1. Alegría, M., Green, J. G., McLaughlin, K. A., & Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the US. New York: William T. Grant Foundation.Google Scholar
  2. Barlow, M., Wildman, B. G., & Stancin, T. (2005). Mothers' help-seeking for pediatric psychosocial problems. Clinical Pediatrics, 44(2), 161–167.Google Scholar
  3. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II manual San Antonio. TX: Psychological Corporation.Google Scholar
  4. Becker, K. D., Lee, B. R., Daleiden, E. L., Lindsey, M., Brandt, N. E., & Chorpita, B. F. (2015). The common elements of engagement in children's mental health services: Which elements for which outcomes? Journal of Clinical Child & Adolescent Psychology, 44(1), 30–43.Google Scholar
  5. Breland-Noble, A.M., & AAKOMA Project Adult Advisory Board. (2012). Community and treatment engagement for depressed African American youth: The AAKOMA FLOA pilot. Journal of Clinical Psychology in Medical Settings, 19, 41–48.Google Scholar
  6. Burnett-Zeigler, I., & Lyons, J. S. (2010). Caregiver factors predicting service utilization among youth participating in a school-based mental health intervention. Journal of Child and Family Studies, 19(5), 572–578.Google Scholar
  7. Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960–970.Google Scholar
  8. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2(1), 40.Google Scholar
  9. Ceballo, R., McLoyd, V. C., & Toyokawa, T. (2004). The influence of neighborhood quality on adolescents’ educational values and school effort. Journal of Adolescent Research, 19(6), 716–739.Google Scholar
  10. Chacko, A., Wymbs, B. T., Wymbs, F. A., Pelham, W. E., Swanger Gagne, M. S., Girio, E., et al. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child and Adolescent Psychology, 38(2), 206–218.Google Scholar
  11. Chu, B. C., & Kendall, P. C. (2004). Positive association of child involvement and treatment outcome within a manual-based cognitive-behavioral treatment for children with anxiety. Journal of Consulting and Clinical Psychology, 72(5), 821–829.Google Scholar
  12. Conklin, L. R., & Strunk, D. R. (2015). A session-to-session examination of homework engagement in cognitive therapy for depression: Do patients experience immediate benefits? Behaviour Research and Therapy, 72, 56–62.Google Scholar
  13. Cribbie, R. A. (2007). Multiplicity control in structural equation modeling. Structural Equation Modeling, 14(1), 98–112.Google Scholar
  14. Cronin, T. J., Lawrence, K. A., Taylor, K., Norton, P. J., & Kazantzis, N. (2015). Integrating between-session interventions (homework) in therapy: The importance of the therapeutic relationship and cognitive case conceptualization. Journal of Clinical Psychology, 71(5), 439–450.Google Scholar
  15. Dowell, K. A., & Ogles, B. M. (2010). The effects of parent participation on child psychotherapy outcome: A meta-analytic review. Journal of Clinical Child and Adolescent Psychology, 39(2), 151–162.Google Scholar
  16. Eamon, M. K. (2005). Social-demographic, school, neighborhood, and parenting influences on the academic achievement of Latino young adolescents. Journal of Youth and Adolescence, 34(2), 163–174.Google Scholar
  17. Ellis, M. L., Lindsey, M. A., Barker, E. D., Boxmeyer, C. L., & Lochman, J. E. (2013). Predictors of engagement in a school-based family preventive intervention for youth experiencing behavioral difficulties. Prevention Science, 14(5), 457–467.Google Scholar
  18. Farmer, M. M., & Ferraro, K. F. (2005). Are racial disparities in health conditional on socioeconomic status? Social Science & Medicine, 60(1), 191–204.Google Scholar
  19. Gaskin, D. J., Kouzis, A., & Richard, P. (2008). Children's and adolescents' use of mental health care is a family matter. Medical Care Research and Review, 65(6), 748–762.Google Scholar
  20. Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 41(3), 296–306.Google Scholar
  21. Gleason, M. M., Goldson, E., Yogman, M. W., & Council on Early Childhood, Committee on Psychosocial Aspects of Child and Family Health, & Section on Developmental and Behavioral Pediatrics. (2016). Addressing early childhood emotional and behavioral problems. Pediatrics, e20163025.Google Scholar
  22. Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., & McKay, M. (2010). Engaging families into child mental health treatment: Updates and special considerations. Journal of the Canadian Academy of Child & Adolescent Psychiatry, 19, 182–196.Google Scholar
  23. Groenman, A. P., Janssen, T. W., & Oosterlaan, J. (2017). Childhood psychiatric disorders as risk factor for subsequent substance abuse: A meta-analysis. Journal of the American Academy of Chlid & Adolescent Psychiatry, 56(7), 556–569.Google Scholar
  24. Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18(2), 133–150.Google Scholar
  25. Hammen, C., & Brennan, P. A. (2003). Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample. Archives of General Psychiatry, 60(3), 253–258.Google Scholar
  26. Harrison, M. E., McKay, M. M., & Bannon, W. M. (2004). Inner-city child mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40(2), 119–131.Google Scholar
  27. Hawley, K. M., & Weisz, J. R. (2005). Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction and treatment outcome. Journal of Clinical Child and Adolescent Psychology, 34, 117–128.Google Scholar
  28. Henning-Smith, C., & Alang, S. (2016). Access to care for children with emotional/behavioral difficulties. Journal of Child Health Care, 20(2), 185–194.Google Scholar
  29. Hoagwood, K. E. (2005). Family-based services in children's mental health: A research review and synthesis. Journal of Child Psychology and Psychiatry, 46(7), 690–713.Google Scholar
  30. Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., & Liddle, H. A. (2006). Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 74(1), 121–129.Google Scholar
  31. Howard, K. I., Lueger, R. J., Maling, M. S., & Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology, 61(4), 678–685.Google Scholar
  32. Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child and Family Studies, 19(5), 629–645.Google Scholar
  33. Jaccard, J., & Wan. (1996). LISREL analyses of interaction effects in multiple regression. Newbury Park: Sage.Google Scholar
  34. Jungbluth, N. J., & Shirk, S. R. (2009). Therapist strategies for building involvement in cognitive–behavioral therapy for adolescent depression. Journal of Consulting and Clinical Psychology, 77(6), 1179–1184.Google Scholar
  35. Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2005). A theoretical model of common process factors in youth and family therapy. Mental Health Services Research, 7(1), 35–51.Google Scholar
  36. Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26(1), 50–65.Google Scholar
  37. Kazantzis, N., & Lampropoulos, G. K. (2002). The use of homework in psychotherapy: An introduction. Journal of Clinical Psychology, 58(5), 487–488.Google Scholar
  38. Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7(2), 189–202.Google Scholar
  39. Kazantzis, N., Deane, F. P., & Ronan, K. R. (2004). Assessing compliance with homework assignments: Review and recommendations for clinical practice. Journal of Clinical Psychology, 60, 627–641.Google Scholar
  40. Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144–156.Google Scholar
  41. Kazdin, A. E. (1996). Dropping out of child psychotherapy: Issues for research and implications for practice. Clinical Child Psychology and Psychiatry, 1(1), 133–156.Google Scholar
  42. Kazdin, A. E., & Whitley, M. K. (2006). Pretreatment social relations, therapeutic alliance, and improvements in parenting practices in parent management training. Journal of Consulting and Clinical Psychology, 74(2), 346–355.Google Scholar
  43. Kim, I. J., Ge, X., Brody, G. H., Conger, R. D., Gibbons, F. X., & Simons, R. L. (2003). Parenting behaviors and the occurrence and co-occurrence of depressive symptoms and conduct problems among African American children. Journal of Family Psychology, 17(4), 571–583.Google Scholar
  44. King, G., Currie, M., & Petersen, P. (2014). Child and parent engagement in the mental health intervention process: A motivational framework. Child and Adolescent Mental Health, 19(1), 2–8.Google Scholar
  45. Lewinsohn, P. M., Olino, T. M., & Klein, D. N. (2005). Psychosocial impairment in offspring of depressed parents. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 35(10), 1493–1503.Google Scholar
  46. Lindhiem, O., & Kolko, D. J. (2010). Trajectories of symptom reduction and engagement during treatment for childhood behavior disorders: Differences across settings. Journal of Abnormal Child Psychology, 38(7), 995–1005.Google Scholar
  47. Lindsey, M. A., Korr, W. S., Broitman, M., Bone, L., Green, A., & Leaf, P. J. (2006). Help-seeking behaviors and depression among African American adolescent boys. Social Work, 51(1), 49–58.Google Scholar
  48. Lindsey, M. A., Joe, S., & Nebbitt, V. (2010). Family matters: The role of mental health stigma and social support on depressive symptoms and subsequent help seeking among African American boys. Journal of Black Psychology, 36(4), 458–482.Google Scholar
  49. Lindsey, M. A., Gilreath, T. D., Thompson, R., Graham, J. C., Hawley, K. M., Weisbart, C., Browne, D., & Kotch, J. B. (2012). Influence of caregiver network support and caregiver psychopathology on child mental health need and service use in the LONGSCAN study. Children and Youth Services Review, 34(5), 924–932.Google Scholar
  50. Lindsey, M. A., Brandt, N. E., Becker, K. D., Lee, B. R., Barth, R. P., Daleiden, E. L., & Chorpita, B. F. (2014). Identifying the common elements of treatment engagement interventions in children’s mental health services. Clinical Child and Family Psychology Review, 17(3), 283–298.Google Scholar
  51. Lochman, J. E., & Wells, K. C. (2002). Contextual social-cognitive mediators and child outcome: A test of the theoretical model in the coping power program. Development and Psychopathology, 14(4), 945–967.Google Scholar
  52. Lochman, J. E., & Wells, K. C. (2003). Effectiveness of the coping power program and of classroom intervention with aggressive children: Outcomes of a 1-year follow-up. Behavior Therapy, 34(4), 493–515.Google Scholar
  53. Lochman, J. E., Boxmeyer, C., Powell, N., Roth, D. L., & Windle, M. (2006). Masked intervention effects: Analytic methods for addressing low dosage of intervention. New Directions for Evaluation, 2006, 19–32.Google Scholar
  54. Lochman, J. E., Wells, K., & Lenhart, L. A. (2008). Coping power: Child group Facilitator's guide. USA: Oxford University Press.Google Scholar
  55. Lochman, J. E., Boxmeyer, C. L., Powell, N. P., Barry, T. D., & Pardini, D. A. (2010). Anger control training for aggressive youths. In J. Weisz & A. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 227–242). New York, NY: Guilford Press.Google Scholar
  56. Lochman, J. E., Boxmeyer, C. L., Powell, N. P., Qu, L., Wells, K., & Windle, M. (2012). Coping power dissemination study: Intervention and special education effects on academic outcomes. Behavioral Disorders, 37, 192–205.Google Scholar
  57. Lochman, J. E., Wells, K. C., Qu, L., & Chen, L. (2013). Three year follow-up of coping power intervention effects: Evidence of neighborhood moderation? Prevention Science, 14, 364–376.Google Scholar
  58. Lochman, J. E., Baden, R. E., Boxmeyer, C. L., Powell, N. P., Qu, L., Salekin, K. L., & Windle, M. (2014). Does a booster intervention augment the preventive effects of an abbreviated version of the coping power program for aggressive children? Journal of Abnormal Child Psychology, 42, 367–381.Google Scholar
  59. Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 35(5), 429–438.Google Scholar
  60. McKay, M. M., Hibbert, R., Hoagwood, K., Rodriguez, J., Murray, L., Legerski, J., & Fernandez, D. (2004). Integrating evidence-based engagement interventions into "real world" child mental health settings. Brief Treatment and Crisis Intervention, 4(2), 177–186.Google Scholar
  61. Miller, G. E., & Prinz, R. J. (2003). Engagement of families in treatment for childhood conduct problems. Behavior Therapy, 34(4), 517–534.Google Scholar
  62. Molock, S. D., Barksdale, C., Matlin, S., Puri, R., Cammack, N., & Spann, M. (2007). Qualitative study of suicidality and help-seeking behaviors in African American adolescents. American Journal of Community Psychology, 40(1–2), 52–63.Google Scholar
  63. Moses, T. (2009). Stigma and self-concept among adolescents receiving mental health treatment. American Journal of Orthopsychiatry, 79, 261–274.Google Scholar
  64. Muratori, P., Milone, A., Manfredi, A., Polidori, L., Ruglioni, L., Lambruschi, F., Masi, G., & Lochman, J. E. (2017). Evaluation of improvement in externalizing behaviors and callous-unemotional traits in children with disruptive behavior disorder: A 1-year follow up clinic-based study. Administration and Policy in MH and MH Services, 44, 452–462.Google Scholar
  65. Mushtaq, A., Lochman, J. E., Tariq, P. N., & Sabih, F. (2017). Preliminary effectiveness study of coping power program for aggressive children in Pakistan. Prevention Science, 18, 762–771.Google Scholar
  66. Muthén, L., & Muthén, B. (2017). Mplus (Version 8)[computer software]. (1998-2017). Los Angeles, CA: Muthén & Muthén.Google Scholar
  67. Myers, H. F. (2009). Ethnicity-and socio-economic status-related stresses in context: An integrative review and conceptual model. Journal of Behavioral Medicine, 32(1), 9–19.Google Scholar
  68. Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73(5), 872–879.Google Scholar
  69. Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., et al. (2002). Barriers to children's mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 41(6), 731–738.Google Scholar
  70. Prinz, R. J., & Miller, G. E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62(3), 645–650.Google Scholar
  71. Proctor, B.D., & Dalaker, J. (2002). U.S. Census Bureau, Current Population Reports, P60–222, Poverty in the United States. U.S. Government Printing Office, Washington, DC.Google Scholar
  72. Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24–31.Google Scholar
  73. Robinson, L. R., Bitsko, R. H., Thompson, R. A., Dworkin, P. H., McCabe, M. A., Peacock, G., & Thorpe, P. G. (2017). CDC grand rounds: Addressing health disparities in early childhood. Morbidity and Mortality Weekly Report, 66(29), 769–772.Google Scholar
  74. Santisteban, D. A., Szapocznik, J., Perez-Vidal, A., Kurtines, W. M., Murray, E. J., & La Perriere, A. (1996). Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology, 10(1), 35–44.Google Scholar
  75. Shirk, S. R., Gudmundsen, G., Kaplinski, H. C., & McMakin, D. L. (2008). Alliance and outcome in cognitive-behavioral therapy for adolescent depression. Journal for Clinical Child Psychology, 37(3), 631–639.Google Scholar
  76. Singh, G. K., & Ghandour, R. M. (2012). Impact of neighborhood social conditions and household socioeconomic status on behavioral problems among US children. Maternal and Child Health Journal, 16(1), 158–169.Google Scholar
  77. Smith, C. E., & Cribbie, R. A. (2013). Multiplicity control in structural equation modeling: Incorporating parameter dependencies. Structural Equation Modeling: A Multidisciplinary Journal, 20(1), 79–85.Google Scholar
  78. Snell-Johns, J., Mendez, J. L., & Smith, B. H. (2004). Evidence-based solutions for overcoming access barriers, decreasing attrition, and promoting change with underserved families. Journal of Family Psychology, 18(1), 19–35.Google Scholar
  79. Staudt, M. (2007). Treatment engagement with caregivers of at-risk children: Gaps in research and conceptualization. Journal of Child and Family Studies, 16(2), 183–196.Google Scholar
  80. Stormshak, E. A., Connell, A., & Dishion, T. J. (2009). An adaptive approach to family-centered intervention in schools: Linking intervention engagement to academic outcomes in middle and high school. Prevention Science, 10(3), 221–235.Google Scholar
  81. Thompson, R., Lindsey, M. A., English, D. J., Hauley, K. M., Lambert, S., & Browne, D. C. (2007). The influence of family environment on mental health need and service use among vulnerable children. Child Welfare, 86(5), 57–74.Google Scholar
  82. Tolan, P. H., Gorman-Smith, D., Huesmann, L. R., & Zelli, A. (1997). Assessment of family relationship characteristics: A measure to explain risk for antisocial behavior and depression among urban youth. Psychological Assessment, 9(3), 212–223.Google Scholar
  83. Tsujikawa, N., Tsuchida, S., & Shiotani, T. (2016). Changes in the factors influencing public acceptance of nuclear power generation in Japan since the 2011 Fukushima Daiichi nuclear disaster. Risk Analysis, 36(1), 98–113.Google Scholar
  84. Vanderbleek, L. M. (2004). Engaging families in school-based mental health treatment. Journal of Mental Health Counseling, 26(3), 211–224.Google Scholar
  85. Visser, J. H., van der Ende, J., Koot, H. M., & Verhulst, F. C. (2003). Predicting change in psychopathology in youth referred to mental health services in childhood or adolescence. Journal of Child Psychology and Psychiatry, 44(4), 509–519.Google Scholar
  86. Watsford, C., & Rickwood, D. (2015). Young people's expectations, preferences and actual experience of youth mental health care. International Journal of Adolescence and Youth, 20(3), 284–294.Google Scholar
  87. Williams, D. R. (1999). Race, socioeconomic status, and health the added effects of racism and discrimination. Annals of the New York Academy of Sciences, 896(1), 173–188.Google Scholar
  88. Winters, K. C., Stinchfield, R. D., Latimer, W. W., & Stone, A. (2008). Internalizing and externalizing behaviors and their association with the treatment of adolescents with substance use disorder. Journal of Substance Abuse Treatment, 35, 269–278.Google Scholar
  89. Woody, S. R., & Adessky, R. S. (2002). Therapeutic alliance, group cohesion, and homework compliance during cognitive-behavioral group treatment of social phobia. Behavior Therapy, 33(1), 5–27.Google Scholar
  90. Zonnevylle-Bender, M. J. S., Matthijs, W., Van de Wiel, N. M. H., & Lochman, J. E. (2007). Preventive effects of treatment of disruptive behavior disorder in middle childhood on substance use and delinquent behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 33–39.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Michael A. Lindsey
    • 1
    Email author
  • Meghan Romanelli
    • 1
  • Mesha L. Ellis
    • 2
  • Edward D. Barker
    • 3
  • Caroline L. Boxmeyer
    • 4
  • John E. Lochman
    • 5
  1. 1.McSilver Institute for Poverty Policy and Research, Silver School of Social WorkNew York UniversityNew YorkUSA
  2. 2.Ellis Evaluation & Consulting ServicesAtlantaUSA
  3. 3.Institute of Psychiatry, Psychology and NeuroscienceKing′s CollegeLondonUK
  4. 4.Department of Psychiatry and Behavioral MedicineThe University of AlabamaTuscaloosaUSA
  5. 5.Department of PsychologyThe University of AlabamaTuscaloosaUSA

Personalised recommendations