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

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Abstract

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.

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References

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Coleman, D. J., & Kaplan, M. S. (1990). Effects of pretherapy videotape preparation on child therapy outcomes. Professional Psychology: Research and Practice, 21, 199–203.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • DiClemente, C. C., & Hughes, S. O. (1990). Stages of change profiles in outpatient alcoholism treatment. Journal of Substance Abuse, 2, 217–235.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Frankel, F., & Simmons, J. Q. (1992). Parent behavioral training: why and when some parents drop out. Journal of Clinical Child Psychology, 21, 322–330.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Gorin, S. S. (1993). The prediction of child psychotherapy outcome: Factors specific to treatment. Psychotherapy, 30, 152–158.

    Google Scholar 

  • Guterman, N. B. (2001). Stopping maltreatment before it starts: Emerging horizons in early home visitation services. Thousand Oaks: Sage.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Holmes, D. S., & Urie, R. G. (1975). Effects of preparing children for psychotherapy. Journal of Consulting and Clinical Psychology, 43, 311–318.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Littell, J. H., Alexander, L. B., & Reynolds, W. W. (2001). Client participation: Central and underinvestigated elements of intervention. Social Service Review, 75, 1–28.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Macgowan, M. J. (2000). Evaluation of a measure of engagement for group work. Research on Social Work Practice, 10, 348–361.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Miller, G. E., & Prinz, R. J. (1990). Enhancement of social learning family interventions for childhood conduct disorder. Psychological Bulletin, 108, 291–307.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Reis, B. F., & Brown, L. G. (1999). Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy, 36, 123–136.

    Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Smith, B. D., & Donovan, S. E. F. (2003). Child welfare practice in organizational and institutional context. Social Service Review, 77, 541–563.

    Article  Google Scholar 

  • Staudt, M. M. (2003). Helping children access and use services: A review. Journal of Child and Family Studies, 12, 49–60.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • Wahler, R. G. (1980). The insular mother: Her problems in parent-child treatment. Journal of Applied Behavior Analysis, 13, 207–219.

    Article  PubMed  Google Scholar 

  • Webster-Stratton, C. (1985). Predictors of treatment outcome in parent training for conduct-disordered children. Behavior Therapy, 16, 223–243.

    Article  Google Scholar 

  • 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 

  • Wenning, K., & King, S. (1995). Parent orientation meetings to improve attendance and access at a child psychiatric clinic. Psychiatric Services, 46, 831–833.

    PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Yoo, J. (2002). The relationship between organizational variables and client outcomes: A case study in child welfare. Administration in Social Work, 26, 39–61.

    Article  Google Scholar 

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Acknowledgments

Preparation of this article was supported by Grant 5K01MH068473 from the National Institute of Mental Health. The author extends appreciation to David Patterson, Christy Hickman, and Jill Shoffner for their contributions to the article, and to Jennifer Kuczmarski for help in manuscript preparation.

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  1. College of Social Work, University of Tennessee, Knoxville, TN, 37996-3333, USA

    Marlys Staudt

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Staudt, M. Treatment Engagement with Caregivers of At-risk Children: Gaps in Research and Conceptualization. J Child Fam Stud 16, 183–196 (2007). https://doi.org/10.1007/s10826-006-9077-2

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