Identifying the Common Elements of Treatment Engagement Interventions in Children’s Mental Health Services

Abstract

Difficulty engaging families in mental health treatment is seen as an underlying reason for the disparity between child mental health need and service use. Interpretation of the literature on how best to engage families is complicated by a diversity of operational definitions of engagement outcomes and related interventions. Thus, we sought to review studies of engagement interventions using a structured methodology allowing for an aggregate summary of the most common practices associated with effective engagement interventions. We identified 344 articles through a combination of database search methods and recommendations from engagement research experts; 38 articles describing 40 studies met our inclusion criteria. Following coding methods described by Chorpita and Daleiden (J Consul Clin Psychol 77(3):566-579, 2009, doi: 10.1037/a0014565 ), we identified 22 engagement practice elements from 89 study groups that examined or implemented family engagement strategies. Most frequently identified engagement practice elements included assessment, accessibility promotion, psychoeducation about services, homework assignment, and appointment reminders. Assessment and accessibility promotion were two practice elements present in at least 50 % of treatment groups that outperformed a control group in a randomized controlled trial. With the exception of appointment reminders, these frequently identified engagement practice elements had a high likelihood of being associated with winning treatments when they were used. This approach offers a novel way of summarizing the engagement literature and provides the foundation for enhancing clinical decision-making around treatment engagement.

The Impact of Latino Caregiver Acculturation on Treatment Engagement in Children’s Community Mental Health Services

“…As a whole, treatment engagement outcomes can be considered in terms of a cognitive or attitudinal domain, as well as a behavioral domain (Lindsey et al 2014). The cognitive or attitudinal domain, defined by Staudt (2007) refers to a client's ''emotional investment in and commitment to treatment that follow from believing that it is worthwhile and beneficial (p.…”

The Common Elements of Engagement in Children's Mental Health Services: Which Elements for Which Outcomes?

“…Empirical studies of engagement most often measure attendance as their sole or primary outcome of interest (Lindsey et al, 2013). Attendance involves the presence of the agreed-upon participants during a therapeutic contact (Nock & Ferriter, 2005) and is an easy-to-measure outcome with demonstrated associations with treatment outcome (e.g., Baydar, Reid, & Webster-Stratton, 2003).…”

“…In particular, adherence might be a potentially important engagement outcome, although it is included less frequently than attendance as an outcome of interest (Lindsey et al, 2013). Adherence is defined as an individual's active demonstration in a course of collaboratively determined behaviors (e.g., session participation, out-of-session practice, contact with referrals) thought to enhance the likelihood of a positive therapeutic outcome (Nock & Ferriter, 2005).…”

“…Notably, cognitive constructs are less often measured in intervention studies on engagement than are constructs such as attendance and adherence (Lindsey et al, 2013), yet in theories of engagement and behavior change (e.g., Ajzen, 1991;Staudt, 2007), cognitions shape behavior. It has been COMMON ELEMENTS OF ENGAGEMENT demonstrated in the literature that positive cognitions are associated with attendance (McKay, Pennington, Lynn, & McCadam, 2001;Thornton & Calam, 2011), whereas the experience of practical or psychological barriers (e.g., concerns about treatment relevance) is associated with poor attendance (Kazdin & Wassell, 1999, 2000Spirito, Boergers, Donaldson, Bishop, & Lewander, 2002).…”

“…Over time, reviews of the empirical literature reflect an expanding conceptualization of engagement as encompassing the cognitive and behavioral constructs described in theoretical models and are useful to showcase innovations in the field. However, terminology within engagement literature as a whole lacks precision, thereby creating some challenges for synthesizing the literature to identify effective engagement practices (Lindsey et al, 2013).…”