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
  • Esther Sales
  • Gary Koeske


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 barriers engagement strategies client attrition 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Acosta, F. X. (1980). Self-described reasons for premature termination of psychotherapy by Mexican American, black American, and Anglo-American patients. Psychological Reports, 47, 435–443.Google Scholar
  2. 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(4), 577–585.Google Scholar
  3. Bachrach, L. L. (1989). Case management: Toward a shared definition. Hospital and Community Psychiatry, 40(9), 883–884.Google Scholar
  4. Bachrach, L. L. (1992). Case Management Revisited. Hospital and Community Psychiatry, 43(3), 209–210.Google Scholar
  5. Baekeland, F. & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82(5), 738–783.Google Scholar
  6. Carpenter, P. J., Morrow, G. R., DelGaudio, A. C., & Ritzler, B. A. (1981). Who keeps the first outpatient appointment? American Journal of Psychiatry, 138(1), 102–105.Google Scholar
  7. Eiduson, B. I. (1968). Retreat from help. American Journal of Orthopsychiatry, 38, 910–921.Google Scholar
  8. Farley, O.W., Peterson, K.D., & Spanos, G. (1975). Self-termination from a child guidance center. Community Mental Health Journal, 11(3), 325–334.Google Scholar
  9. Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to treatment participation scale: Evaluation and validation in the context of child outpatient treatment. Journal of Child Psychology and Psychiatry, 38(8), 1051–1062.Google Scholar
  10. Kazdin, A. E., Mazurick, J. L. & Siegel, T. C. (1993). Treatment outcome among children with externalizing disorder who terminate prematurely versus those who complete psychotherapy. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 549–557.Google Scholar
  11. Kournay, R.F.C., Garber, J., & Tornusciolo, G. (1990) Improving first appointment attendance rates in child psychiatry outpatient clinics. Journal of the American Academy of Child and Adolescent Psychiatry, (4), 657–660.Google Scholar
  12. McKay, M.M., Bennett, E., Stone, S., & Gonzales, J. (1995). A comprehensive training model for inner-city social workers. Arete, 20(1), 56–64.Google Scholar
  13. McKay, M. M., McCadam, K., & Gonzales, J. J. (1996). Addressing the barriers to mental health services for inner city children and their caretakers. Community Mental Health Journal, 32(4), 353–361.Google Scholar
  14. 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(4), 462–472.Google Scholar
  15. McKay, M.M., Stoewe, J., Mc Cadam, K., & Gonzales, J. (1998). Increasing access to child mental health services for urban children and their caregivers. Health and Social Work, 23(1), 9–15.Google Scholar
  16. Noonan, J. R. (1973). A follow-up of pre-therapy dropouts. Journal of Community Psychology, 1, 43–44.Google Scholar
  17. Rogawski, A. S. & Edmundson, B. (1971). Factors affecting the outcome of psychiatric interagency referral. American Journal of Orthopsychiatry, 127, 925–934.Google Scholar
  18. Russell, M. N., Lang, M., & Brett, B. (1987). Reducing dropout rates through improved intake procedures. Social Casework, 421–425.Google Scholar
  19. Shivack, I. M. and Sullivan, C. W. (1989). Use of telephone prompts at an inner-city outpatient clinic. Hospital and Community Psychiatry, 40(8), 851–853.Google Scholar
  20. Singh, H., Janes, C.L., & Schechtman, J.M. (1982). Problem children's treatment attrition and parents' perception of the diagnostic evaluation. Journal of Psychiatric Treatment Evaluation, 4, 257–263.Google Scholar
  21. Solomon, P. (1998). The conceptual and empirical base of case management for adults with severe mental illness. In J. B. W. Williams & K. Ell, Advances in Mental Health Research: Implications for practice (pp. 482–497). Washington, D.C.: NASW Press.Google Scholar
  22. Szapocznik, J., Perez-Vidal, A., Brickman, A. L., Foote, F. H., Santisteban, D., Hervis, O., & Kurtines, W. M. (1988). Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology, 56(4), 552–557.Google Scholar
  23. Wierzbicki, M. & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology Research and Practice, 24(2), 190–195.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2002

Authors and Affiliations

  • Jerry Jo Manfred-Gilham
    • 1
  • Esther Sales
    • 2
  • Gary Koeske
    • 2
  1. 1.Department of Social WorkFranciscan University of SteubenvilleSteubenville
  2. 2.University of PittsburghUSA

Personalised recommendations