Journal of Child and Family Studies

, Volume 16, Issue 2, pp 183–196 | Cite as

Treatment Engagement with Caregivers of At-risk Children: Gaps in Research and Conceptualization

Original Paper


The high rates of dropping out and other engagement problems are significant concerns in the delivery of mental health and adjunct services to the families of at-risk children. Consequently, researchers have examined the correlates of attrition and have developed interventions to increase engagement and retention. However, the lack of a clear definition of engagement and gaps in theory about the relationship of engagement to other treatment processes hinder knowledge development. In this paper the behavioral and attitudinal aspects of engagement are disentangled. Current knowledge about treatment barriers and interventions to increase appointment keeping is summarized. A preliminary conceptualization of the engagement process is presented and research needs and practice implications are discussed.


Engagement Retention Service use Treatment process At-risk children 


  1. Armbruster, P., & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic. American Journal of Orthopsychiatry, 64, 577–585.PubMedCrossRefGoogle Scholar
  2. Azar, S. T. (2000). Preventing burnout in professionals and paraprofessionals who work with child abuse and neglect cases: A cognitive behavioral approach to supervision. Journal of Clinical Psychology, 56, 643–663.PubMedCrossRefGoogle Scholar
  3. Baydar, N., Reid, J., & Webster-Stratton, C. (2003). The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for Head Start mothers. Child Development, 74, 1433–1453.PubMedCrossRefGoogle Scholar
  4. Bonner, B. L., & Everett, F. L. (1986). Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy. Professional Psychology: Research and Practice, 17, 223–229.CrossRefGoogle Scholar
  5. Braswell, L., Kendall, P. C., Braith, J., Carey, M. P., & Vye, C. S. (1985). “Involvement” in cognitive-behavioral therapy with children: Process and its relationship to outcome. Cognitive Therapy and Research, 9, 611–630.CrossRefGoogle Scholar
  6. Coleman, D. J., & Kaplan, M. S. (1990). Effects of pretherapy videotape preparation on child therapy outcomes. Professional Psychology: Research and Practice, 21, 199–203.CrossRefGoogle Scholar
  7. Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40, 313–332.PubMedCrossRefGoogle Scholar
  8. Costello, E. J., Pescosolido, B. A., Angold, A., & Burns, B. J. (1998). A family network-based model of access to child mental health services. Research in Community and Mental Health, 9, 165–190.Google Scholar
  9. Cunningham, P. B., & Henggeler, S. W. (1999). Engaging multiproblem families in treatment: Lessons learned throughout the development of multisystemic therapy. Family Process, 38, 265–286.PubMedCrossRefGoogle Scholar
  10. Dadds, M. R., & McHugh, T. A. (1992). Social support and treatment outcome in behavioral family therapy for child conduct problems. Journal of Consulting and Clinical Psychology, 60, 252–259.PubMedCrossRefGoogle Scholar
  11. Day, L., & Reznikoff, M. (1980). Preparation of children and parents for treatment at a children's psychiatric clinic through videotaped modeling. Journal of Consulting and Clinical Psychology, 48, 303–304.PubMedCrossRefGoogle Scholar
  12. Dearing, R. L., Barrick, C., Dermen, K. H., & Walitzer, K. S. (2005). Indicators of client engagement: Influences on alcohol treatment satisfaction and outcomes. Psychology of Addictive Behaviors, 19, 71–78.PubMedCrossRefGoogle Scholar
  13. DiClemente, C. C., & Hughes, S. O. (1990). Stages of change profiles in outpatient alcoholism treatment. Journal of Substance Abuse, 2, 217–235.PubMedCrossRefGoogle Scholar
  14. Donohue, B., & Van Hasselt, V. B. (1999). Development and description of an empirically based ecobehavioral treatment program for child maltreatment. Behavioral Interventions, 14, 55–82.CrossRefGoogle Scholar
  15. Dumas, J. E., & Wahler, R. G. (1983). Predictors of treatment outcome in parent training: Mother insularity and socioeconomic disadvantage. Behavioral Assessment, 5, 301–313.Google Scholar
  16. Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: patterns of care for children's mental health across one year. Community Mental Health Journal, 35, 31–46.PubMedCrossRefGoogle Scholar
  17. Firestone, P., & Witt, J. E. (1982). Characteristics of families completing and prematurely discontinuing a behavioral parent-training program. Journal of Pediatric Psychology, 7, 209–221.PubMedCrossRefGoogle Scholar
  18. Flisher, A. J., Kramer, R. A., Grosser, R. C., Alegria, M., Bird, H. R., Bourdon, K. H., et al. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27, 1145–1154.PubMedCrossRefGoogle Scholar
  19. Frankel, F., & Simmons, J. Q. (1992). Parent behavioral training: why and when some parents drop out. Journal of Clinical Child Psychology, 21, 322–330.CrossRefGoogle Scholar
  20. Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70, 439–443.PubMedCrossRefGoogle Scholar
  21. Gorin, S. S. (1993). The prediction of child psychotherapy outcome: Factors specific to treatment. Psychotherapy, 30, 152–158.Google Scholar
  22. Guterman, N. B. (2001). Stopping maltreatment before it starts: Emerging horizons in early home visitation services. Thousand Oaks: Sage.Google Scholar
  23. Hansen, D. J., & Warner, J. E. (1994). Treatment adherence of maltreating families: A survey of professionals regarding prevalence and enhancement strategies. Journal of Family Violence, 9, 1–19.CrossRefGoogle Scholar
  24. 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, 119–131.PubMedCrossRefGoogle Scholar
  25. Haskett, M. E., Nowlan, N. P., Hutceson, J. S., & Whitworth, J. M. (1991). Factors associated with successful entry into therapy in child sexual abuse cases. Child Abuse and Neglect, 15, 467–476.PubMedCrossRefGoogle Scholar
  26. Henggeler, S. W., Pickrel, S. G., Brondino, M. J., & Crouch, J. L. (1996). Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy. American Journal of Psychiatry, 153, 427–428.PubMedGoogle Scholar
  27. Holmes, D. S., & Urie, R. G. (1975). Effects of preparing children for psychotherapy. Journal of Consulting and Clinical Psychology, 43, 311–318.PubMedCrossRefGoogle Scholar
  28. Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that wok: Therapist contributions and responsiveness to patients (pp. 37–69). New York: Oxford University Press.Google Scholar
  29. 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, 35–51.PubMedCrossRefGoogle Scholar
  30. Kazdin, A. E. (2000). Perceived barriers to treatment participation and treatment acceptability among antisocial children and their families. Journal of Child and Family Studies, 9, 157–174.CrossRefGoogle Scholar
  31. Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65, 453–463.PubMedCrossRefGoogle Scholar
  32. Kazdin, A. E., & Mazurick, J. L. (1994). Dropping out of child psychotherapy: Distinguishing early and late dropouts over the course of treatment. Journal of Consulting and Clinical Psychology, 62, 1069–1074.PubMedCrossRefGoogle Scholar
  33. Kazdin, A. E., Mazurick, J. L., & Bass, D. (1993). Risk for attrition in treatment of antisocial children and families. Journal of Clinical Child Psychology, 22, 2–16.CrossRefGoogle Scholar
  34. Kazdin, A. E., & Wassell, G. (2000). Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research, 2, 27–40.PubMedCrossRefGoogle Scholar
  35. Kazdin, A. E., & Whitley, M. K. (2003). Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior. Journal of Consulting and Clinical Psychology, 71, 504–515.PubMedCrossRefGoogle Scholar
  36. Kroll, L., & Green, J. (1997). The therapeutic alliance in child inpatient treatment: Development and initial validation of a family engagement questionnaire. Clinical Child Psychology and Psychiatry, 2, 431–447.CrossRefGoogle Scholar
  37. Kruzich, J. M., Jivanjee, P., Robinson, A., & Friesen, B. J. (2003). Family caregivers’ perceptions of barriers to and supports of participation in their children's out-of-home care. Psychiatric Services, 54, 1513–1518.PubMedCrossRefGoogle Scholar
  38. Lau, A. S., & Weisz, J. R. (2003). Reported maltreatment among clinic-referred children: Implications for presenting problems, treatment attrition, and long-term outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1327–1334.PubMedCrossRefGoogle Scholar
  39. Liddle, H. A. (1995). Conceptual and clinical dimensions of a multidimensional, multisystems engagement strategy in family-based adolescent treatment. Psychotherapy, 32, 39–58.Google Scholar
  40. Littell, J. H., Alexander, L. B., & Reynolds, W. W. (2001). Client participation: Central and underinvestigated elements of intervention. Social Service Review, 75, 1–28.CrossRefGoogle Scholar
  41. Lutzker, J. R., Bigelow, K. M., Doctor, R. M., & Kessler, M. L. (1998). Safety, health care, and bonding within an ecobehavioral approach to treating and preventing child abuse and neglect. Journal of Family Violence, 13, 163–185.CrossRefGoogle Scholar
  42. Macgowan, M. J. (1997). A measure of engagement for social group work: The Groupwork Engagement Measure (GEM). Journal of Social Service Research, 23, 17–37.CrossRefGoogle Scholar
  43. Macgowan, M. J. (2000). Evaluation of a measure of engagement for group work. Research on Social Work Practice, 10, 348–361.Google Scholar
  44. MacNaughton, K. L., & Rodrigue, J. R. (2001). Predicting adherence to recommendations by parents of clinic-referred children. Journal of Consulting and Clinical Psychology, 69, 262–270.PubMedCrossRefGoogle Scholar
  45. McCammon, S. L., Cook, J. R., & Kilmer, R. P. (2002). Integrating systems-of-care values into university-based training. In D. T. Marsh & M. A. Fristad (Eds.), Handbook of serious emotional disturbance in children and adolescents (pp. 56–76). New York, NY: John Wiley and Sons.Google Scholar
  46. McGinty, K. L., Diamond, J. M., Brown, M. B., & McCammon, S. L. (2003). Training child and adolescent psychiatrists and child mental health professionals for systems of care. In A. J. Pumariega & N. C. Winters (Eds.), The handbook of child and adolescent systems of care: The new community psychiatry (pp. 487–507). San Francisco, CA: Jossey-Bass.Google Scholar
  47. McKay, M. M., Bennet, E., Stone, S., & Gonzales, J. (1995). A comprehensive training model for inner-city social workers. Arete, 20, 56–64.Google Scholar
  48. McKay, M. M., Nudelman, R., McCadam, K., & Gonzales, J. (1996). Evaluating a social work engagement approach to involving inner-city children and their families in mental health care. Research on Social Work Practice, 6, 462–472.CrossRefGoogle Scholar
  49. McKay, M. M., Stoewe, J., McCadam, K., & Gonzales, J. (1998). Increasing access to child mental health services for urban children and their caregivers. Health and Social Work, 23, 9–15.PubMedGoogle Scholar
  50. McKay, M. M., Pennington, J., Lynn, C. J., & McCadam, K. (2001). Understanding urban child mental health service use: Two studies of child, family, and environmental correlates. Journal of Behavioral Health Services and Research, 28, 475–483.PubMedCrossRefGoogle Scholar
  51. Meezan, W., & O’Keefe, M. (1998). Evaluating the effectiveness of multifamily group therapy in child abuse and neglect. Research on Social Work Practice, 8, 330–353.CrossRefGoogle Scholar
  52. Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance, and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70, 1051–1055.PubMedCrossRefGoogle Scholar
  53. Miller, G. E., & Prinz, R. J. (1990). Enhancement of social learning family interventions for childhood conduct disorder. Psychological Bulletin, 108, 291–307.PubMedCrossRefGoogle Scholar
  54. Morrissey-Kane, E., & Prinz, R. J. (1999). Engagement in child and adolescent treatment: The role of parental cognitions and attributions. Clinical Child and Family Psychology Review, 2, 183–198.PubMedCrossRefGoogle Scholar
  55. Nye, C. L., Zucker, R. A., & Fitzgerald, H. E. (1999). Early family-based intervention to alcohol problems: Rationale and relationship between treatment process characteristics and child and parenting outcomes. Journal of Studies on Alcohol, Supplement No. 13, 10–21.Google Scholar
  56. 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 Psychiatry, 41, 731–738.CrossRefGoogle Scholar
  57. Prinz, R. J., & Miller, G. E. (1991). Issues in understanding and treating childhood conduct problems in disadvantaged populations. Journal of Clinical Child Psychology, 20, 379–385.CrossRefGoogle Scholar
  58. 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, 645–650.PubMedCrossRefGoogle Scholar
  59. Reis, B. F., & Brown, L. G. (1999). Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy, 36, 123–136.Google Scholar
  60. Ringeisen, H., & Hoagwood, K. (2002). Clinical and research directions for the treatment and delivery of children's mental health services. In D. T. Marsh & M. A. Fristad (Eds.), Handbook of serious emotional disturbance in children and adolescents (pp. 33–55). New York, NY: John Wiley and Sons.Google Scholar
  61. Santisteban, D. A., & Szapocznik, J. (1994). Bridging theory, research and practice to more successfully engage substance abusing youth and their families into therapy. Journal of Child and Adolescent Substance Abuse, 3, 9–24.CrossRefGoogle Scholar
  62. Santisteban, D. A., Szapocznik, J., Perez-Vidal, A., Kurtines, W. M., Murray, E. J., & LaPerriere, 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, 35–44.CrossRefGoogle Scholar
  63. Smith, B. D., & Donovan, S. E. F. (2003). Child welfare practice in organizational and institutional context. Social Service Review, 77, 541–563.CrossRefGoogle Scholar
  64. Staudt, M. M. (2003). Helping children access and use services: A review. Journal of Child and Family Studies, 12, 49–60.CrossRefGoogle Scholar
  65. Staudt, M., Scheuler-Whitaker, L., & Hinterlong, J. (2001). The role of family preservation therapists in facilitating use of aftercare services. Child Abuse and Neglect:The International Journal, 25, 803–817.CrossRefGoogle Scholar
  66. Szapocznik, J., Perez-Vidal, A., Brickman, A. L., Foote, F. H., Santisteban, D., Hervis, O., et al. (1988). Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology, 56, 552–557.PubMedCrossRefGoogle Scholar
  67. Tryon, G. S., & Winograd, G. (2002). Goal consensus and collaboration. In J. C. Norcross (Ed.), Psychotherapy relationships that wok: Therapist contributions and responsiveness to patients (pp. 109–125). New York: Oxford University Press.Google Scholar
  68. Viale-Val, G., Rosenthal, R. H., Curtiss, G., & Marohn, R. C. (1984). Dropout form adolescent psychotherapy: A preliminary study. Journal of the American Academy of Child Psychiatry, 23, 562–568.PubMedCrossRefGoogle Scholar
  69. Wahler, R. G. (1980). The insular mother: Her problems in parent-child treatment. Journal of Applied Behavior Analysis, 13, 207–219.PubMedCrossRefGoogle Scholar
  70. Webster-Stratton, C. (1985). Predictors of treatment outcome in parent training for conduct-disordered children. Behavior Therapy, 16, 223–243.CrossRefGoogle Scholar
  71. Webster-Stratton, C. (1998). Parent training with low-income families: Promoting parental engagement through a collaborative approach. In J. R. Lutzker (Ed.), Handbook of child abuse research and treatment (pp. 183–210). New York: Plenum Press.Google Scholar
  72. Wenning, K., & King, S. (1995). Parent orientation meetings to improve attendance and access at a child psychiatric clinic. Psychiatric Services, 46, 831–833.PubMedGoogle Scholar
  73. Yatchmenoff, D. K. (2005). Measuring client engagement from the client's perspective in nonvoluntary child protective services. Research on Social Work Practice, 15, 84–96.CrossRefGoogle Scholar
  74. Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research, 5, 65–77.PubMedCrossRefGoogle Scholar
  75. Yoo, J. (2002). The relationship between organizational variables and client outcomes: A case study in child welfare. Administration in Social Work, 26, 39–61.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.College of Social WorkUniversity of TennesseeKnoxvilleUSA

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