Engaging families in child mental health services

Departments of Psychiatry and Community Medicine, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA.
Child and Adolescent Psychiatric Clinics of North America (Impact Factor: 2.6). 11/2004; 13(4):905-21, vii. DOI: 10.1016/j.chc.2004.04.001
Source: PubMed


To increase the involvement of urban youth and families who need mental health services, child mental health agencies and providers might consider the following: (1) examining intake procedures and developing interventions to target specific barriers to service use; (2) providing training and supervision to providers to increase a focus on engagement in the first face-to-face meetings with youth and families; (3) providing service delivery options with input from consumers regarding types of services offered. Involvement of youth and their families is a primary goal that must receive as much attention as any other part of the service delivery process. One might argue that without youth and family participation, effective services never will be provided to youth and families in need.

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    • "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). Multiple scholars have published qualitative reviews of engagement intervention studies presenting strategies for increasing initial attendance and ongoing retention in services, such as appointment reminders, discussion and resolution of barriers to treatment, incentives, and motivational interviewing (e.g., Ingoldsby, 2010; McKay & Bannon, 2004). Yet the overreliance on attendance as the primary outcome of interest has important implications for our conceptualization of evidence-based engagement interventions . "
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    ABSTRACT: Using the distillation component of the Distillation and Matching Model framework (Chorpita, Daleiden, & Weisz, 2005), we examined which engagement practices were associated with three domains of treatment engagement: attendance, adherence, and cognitive preparation (e.g., understanding of, readiness for treatment). Eighty-nine engagement interventions from 40 randomized controlled trials in children' s mental health services were coded according to their engagement practices and outcomes. Analyses examined whether the practices used in successful interventions differed according to engagement domain. Practice patterns differed somewhat depending on whether attendance, adherence, or cognitive preparation was the outcome of interest. For example, assessment of barriers to treatment frequently occurred in successful interventions targeting attendance, whereas homework assignment frequently occurred in successful interventions when adherence was the target outcome. Modeling and expectation setting were frequently used in successful interventions targeting cognitive preparation for treatment. Distillation provides a method for examining the practice patterns associated with different engagement outcomes. An example of the application of these findings to clinical practice includes using certain practices (e.g., assessment, psychoeducation about services, and accessibility promotion) with all youth and families to promote attendance, adherence, and cognitive preparation. Then, other practices (e.g., modeling, homework assignment) can be added on an as-needed basis to boost engagement or to address interference in a particular engagement domain. The use of a distillation framework promotes a common language around engagement and highlights practices that lend themselves well to training, thereby promoting the dissemination of engagement interventions.
    Journal of Clinical Child & Adolescent Psychology 01/2015; 44(1):30-43. DOI:10.1080/15374416.2013.814543 · 1.92 Impact Factor
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    • "Engagement is critical for implementing EBTs with high-stress families [74]. Counselors felt engagement required substantial attention as this type of “talk therapy” was mostly new to Zambia. "
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    ABSTRACT: The need to address the treatment gap in mental health services in low- and middle-income countries (LMIC) is well recognized and particularly neglected among children and adolescents. Recent literature with adult populations suggests that evidence-based mental health treatments are effective, feasible, and cross-culturally modifiable for use in LMIC. This paper addresses a gap in the literature documenting pre-trial processes. We describe the process of selecting an intervention to meet the needs of a particular population and the process of cross-cultural adaptation. Community-based participatory research principles were implemented for intervention selection, including joint meetings with stakeholders, review of qualitative research, and review of the literature. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) was chosen as the evidence-based practice for modification and feasibility testing. The TF-CBT adaptation process, rooted within an apprenticeship model of training and supervision, is presented. Clinical case notes were reviewed to document modifications. Choosing an intervention can work as a collaborative process with community involvement. Results also show that modifications were focused primarily on implementation techniques rather than changes in TF-CBT core elements. Studies documenting implementation processes are critical to understanding why intervention choices are made and how the adaptations are generated in global mental health. More articles are needed on how to implement evidence-based treatments in LMIC.
    International Journal of Mental Health Systems 10/2013; 7(1):24. DOI:10.1186/1752-4458-7-24 · 1.06 Impact Factor
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    • "In addition, mean duration of treatment length varies substantially between research and practice. Youths in OMHCs attend an average of three sessions (Hansen et al. 2002; McKay and Bannon 2004). By contrast, among youth anxiety psychotherapies that meet criteria for “probably efficacious treatment” (see Silverman et al. 2008), the shortest intervention (Barrett et al. 1996) was 12 sessions of CBT. "
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    ABSTRACT: Predictors of treatment attrition were examined in a sample of 197 youths (ages 5-18) with clinically-significant symptoms of anxiety seeking psychotherapy services at a community-based outpatient mental health clinic (OMHC). Two related definitions of attrition were considered: (a) clinician-rated dropout (CR), and (b) CR dropout qualified by phase of treatment (pre, early, or late phases) (PT). Across both definitions, rates of attrition in the OMHC sample were higher than those for anxious youths treated in randomized controlled trials, and comorbid depression symptoms predicted dropout, with a higher rate of depressed youths dropping out later in treatment (after 6 sessions). Using the PT definition, minority status also predicted attrition, with more African-American youths lost pre-treatment. Other demographic (age, gender, single parent status) and clinical (externalizing symptoms, anxiety severity) characteristics were not significantly associated with attrition using either definition. Implications for services for anxious youths in public service settings are discussed. Results highlight the important role of comorbid depression in the treatment of anxious youth and the potential value of targeted retention efforts for ethnic minority families early in the treatment process.
    Administration and Policy in Mental Health and Mental Health Services Research 10/2010; 38(5):356-67. DOI:10.1007/s10488-010-0323-y · 3.44 Impact Factor
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