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Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings

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Abstract

Background

The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families.

Objective

The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists’ self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children’s mental health services.

Method

One hundred and three therapists reported on two types of engagement challenges—Limited Client Engagement and Expressed Client Concerns—in 702 sessions with 274 clients.

Results

Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists’ report of their ability to carry out intended activities in the same session.

Conclusions

Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.

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References

  • Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice attitude scale (EBPAS). Mental Health Services Research, 6(2), 61–74.

    Article  PubMed  PubMed Central  Google Scholar 

  • Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.

    Article  PubMed  Google Scholar 

  • Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., & Palinkas, L. A. (2009). Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis. American Journal of Public Health, 99(11), 2087–2095.

    Article  PubMed  PubMed Central  Google Scholar 

  • Addis, M. E., Wade, W. A., & Hatgis, C. (1999). Barriers to dissemination of evidence-based practices: Addressing practitioners’ concerns about manual-based psychotherapies. Clinical Psychology: Science and Practice, 6(4), 430–441.

    Google Scholar 

  • Aisenberg, E. (2008). Evidence-based practice in mental health care to ethnic minority communities: Has its practice fallen short of its evidence? Social Work, 53(4), 297–306.

    Article  PubMed  Google Scholar 

  • Ballon, B., Kirst, M., & Smith, P. (2004). Youth help-seeking expectancies and their relation to help-seeking behaviours for substance use problems. Addiction Research and Theory, 12(3), 241–260.

    Article  Google Scholar 

  • Becker, K. D., Boustani, M., Gellatly, R., & Chorpita, B. F. (2017). Forty years of engagement research in children’s mental health services: Multidimensional measurement and practice elements. Journal of Clinical Child and Adolescent Psychology, 47, 1–23.

    Article  PubMed  Google Scholar 

  • Becker, K. D., & Chorpita, B. (2016). Enhancing the design of engagement interventions to enhance the public health impact of mental health treatments for youth. In K. Becker (Chair), Extending the reach and impact of science on clinical care for youth and families: Looking for new models for the old challenges. Symposium conducted at the NIMH Conference on Mental Health Services Research. Harnessing Science to Strengthen the Public Health Impact, Bethesda, MD.

  • Becker, K. D., Lee, B. R., Daleiden, E. L., Lindsey, M., Brandt, N. E., & Chorpita, B. F. (2015). The common elements of engagement in children’s mental health services: Which elements for which outcomes? Journal of Clinical Child and Adolescent Psychology, 44(1), 30–43.

    Article  PubMed  Google Scholar 

  • Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17(1), 1–30.

    Google Scholar 

  • Berger, L. K., Zane, N., & Hwang, W. C. (2014). Therapist ethnicity and treatment orientation differences in multicultural counseling competencies. Asian American Journal of Psychology, 5(1), 53.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brookman-Frazee, L. I., Drahota, A., & Stadnick, N. (2012). Training community mental health therapists to deliver a package of evidence-based practice strategies for school-age children with autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 42(8), 1651–1661.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., et al. (1995). Children’s mental health service use across service sectors. Health Affairs, 14(3), 147–159.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., & Southam-Gerow, M. A. (2006). Fears and anxieties. Treatment of Childhood Disorders, 3, 271–335.

    Google Scholar 

  • Cook, J. M., Thompson, R., & Schnurr, P. P. (2015). Perceived characteristics of intervention scale: Development and psychometric properties. Assessment, 22(6), 704–714.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Copeland, W., & Angold, A. (2011). Trends in psychopathology across the adolescent years: What changes when children become adolescents, and when adolescents become adults? Journal of Child Psychology and Psychiatry, 52(10), 1015–1025.

    Article  PubMed  Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.

    Article  PubMed  PubMed Central  Google Scholar 

  • Danko, C. M., Garbacz, L. L., & Budd, K. S. (2016). Outcomes of parent–child interaction therapy in an urban community clinic: A comparison of treatment completers and dropouts. Children and Youth Services Review, 60, 42–51.

    Article  Google Scholar 

  • Dickson, K. S., Zeedyk, S. M., Martinez, J., & Haine-Schlagel, R. (2017). Examining ethnic disparities in provider and parent in-session participation engagement. Journal of Children’s Services, 12(1), 47–58.

    Article  PubMed  PubMed Central  Google Scholar 

  • DiMeo, M. A., Moore, G. K., & Lichtenstein, C. (2012). Relationship of evidence-based practice and treatments: A survey of community mental health providers. Journal of Community Psychology, 40(3), 341–357.

    Article  Google Scholar 

  • Drake, R. E., Goldman, H. H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179–182.

    Article  PubMed  Google Scholar 

  • Edmunds, J. M., Read, K. L., Ringle, V. A., Brodman, D. M., Kendall, P. C., & Beidas, R. S. (2014). Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety. Implementation Science, 9(1), 1–12.

    Article  Google Scholar 

  • Frankel, F., & Simmons, J. Q., III. (1992). Parent behavioral training: Why and when some parents drop out. Journal of Clinical Child Psychology, 21(4), 322–330.

    Article  Google Scholar 

  • Godley, S. H., Hedges, K., & Hunter, B. (2011). Gender and racial differences in treatment process and outcome among participants in the adolescent community reinforcement approach. Psychology of Addictive Behaviors, 25(1), 143.

    Article  PubMed  Google Scholar 

  • Greenhalgh, T., Glenn, R., Bate, P., Macfarlane, F., & Kyriakidou, O. (2005). Diffusion of innovations in health service organizations: A systematic literature review. Oxford: Blackwell.

    Book  Google Scholar 

  • Guan, K., Lau, A. S., Zhang, A., Chlebowski, C., Haine-Schlagel, R., & Brookman-Frazee, L. (2018). In-session caregiver behaviors during evidence-based intervention delivery for children with ASD in community settings (under review).

  • Haen, C. (Ed.). (2011). Engaging boys in treatment: Creative approaches to the therapy process. London: Taylor and Francis.

    Google Scholar 

  • Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18(2), 133–150.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hawley, K. M., & Weisz, J. R. (2003). Child, parent and therapist (dis) agreement on target problems in outpatient therapy: The therapist’s dilemma and its implications. Journal of Consulting and Clinical Psychology, 71(1), 62.

    Article  PubMed  Google Scholar 

  • Henggeler, S. W., & Schaeffer, C. M. (2016). Multisystemic therapy®: Clinical overview, outcomes, and implementation research. Family Process, 55(3), 514–528.

    Article  PubMed  Google Scholar 

  • Hinkin, T. R. (1995). A review of scale development practices in the study of organizations. Journal of Management, 21, 967–988.

    Article  Google Scholar 

  • Hinkin, T. R. (1998). A brief tutorial on the development of measures for use in survey questionnaires. Organizational Research Methods, 1, 104–112.

    Article  Google Scholar 

  • Hoagwood, K. E., Olin, S. S., Horwitz, S., McKay, M., Cleek, A., Gleacher, A., et al. (2014). Scaling up evidence-based practices for children and families in New York State: Toward evidence-based policies on implementation for state mental health systems. Journal of Clinical Child and Adolescent Psychology, 43(2), 145–157.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jungbluth, N. J., & Shirk, S. R. (2009). Therapist strategies for building involvement in cognitive–behavioral therapy for adolescent depression. Journal of Consulting and Clinical Psychology, 77(6), 1179.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28(2), 160–172.

    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(3), 504.

    Article  PubMed  Google Scholar 

  • Kim, J. J., Brookman-Frazee, L., Gellatly, R., Stadnick, N., Barnett, M. L., & Lau, A. S. (2018). Predictors of burnout among community therapists in the sustainment phase of a system-driven implementation of multiple evidence-based practices in children’s mental health. Professional Psychology: Research and Practice, 49(2), 132.

    Article  Google Scholar 

  • King, G., Currie, M., & Petersen, P. (2014). Child and parent engagement in the mental health intervention process: A motivational framework. Child and Adolescent Mental Health, 19(1), 2–8.

    Article  PubMed  Google Scholar 

  • Kiselica, M., & Englar-Carlson, M. (2008). Establishing rapport with boys in individual counseling and psychotherapy: A male-friendly perspective. In M. S. Kiselica, M. Englar-Carlson, & A. M. Horne (Eds.), Counseling trouble boys: A guidebook for practitioners (pp. 49–65). London: Routledge.

    Google Scholar 

  • Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lau, A. S., & Brookman-Frazee, L. (2016). The 4KEEPS study: Identifying predictors of sustainment of multiple practices fiscally mandated in children’s mental health services. Implementation Science, 11(1), 1.

    Google Scholar 

  • Lau, A. S., Fung, J. J., Ho, L. Y., Liu, L. L., & Gudiño, O. G. (2011). Parent training with high-risk immigrant Chinese families: A pilot group randomized trial yielding practice-based evidence. Behavior Therapy, 42(3), 413–426.

    Article  PubMed  Google Scholar 

  • Lau, A. S., Gonzalez, J. C., Barnett, M. L., Kim, J. J., Saifan, D., & Brookman-Frazee, L. (2018). Community therapist reports of client engagement challenges during the implementation of multiple EBPs in children’s mental health. Evidence-Based Practice in Child and Adolescent Mental Health, 3, 197–212.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee, M. T., Garnick, D. W., O’Brien, P. L., Panas, L., Ritter, G. A., Acevedo, A., et al. (2012). Adolescent treatment initiation and engagement in an evidence-based practice initiative. Journal of Substance Abuse Treatment, 42(4), 346–355.

    Article  PubMed  Google Scholar 

  • Lim, A., Nakamura, B. J., Higa-McMillan, C. K., Shimabukuro, S., & Slavin, L. (2012). Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers. Behaviour Research and Therapy, 50, 397–406.

    Article  PubMed  Google Scholar 

  • Lindsey, M. A., Chambers, K., Pohle, C., Beall, P., & Lucksted, A. (2013). Understanding the behavioral determinants of mental health service use by urban, under-resourced Black youth: Adolescent and caregiver perspectives. Journal of Child and Family Studies, 22(1), 107–121.

    Article  PubMed  Google Scholar 

  • Lochman, J. E., Dishion, T. J., Boxmeyer, C. L., Powell, N. P., & Qu, L. (2017). Variation in response to evidence-based group preventive intervention for disruptive behavior problems: A view from 938 coping power sessions. Journal of Abnormal Child Psychology, 45(7), 1271–1284.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lynn Mensinger, J., Diamond, G. S., Kaminer, Y., & Wintersteen, M. B. (2006). Adolescent and therapist perception of barriers to outpatient substance abuse treatment. The American Journal on Addictions, 15, 16–25.

    Article  Google Scholar 

  • Mak, W. W., Law, R. W., Alvidrez, J., & Pérez-Stable, E. J. (2007). Gender and ethnic diversity in NIMH-funded clinical trials: Review of a decade of published research. Administration and Policy in Mental Health and Mental Health Services Research, 34(6), 497–503.

    Article  PubMed  Google Scholar 

  • McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence based psychological treatments: A review of current efforts. American Psychologist, 65(2), 73–84.

    Article  PubMed  Google Scholar 

  • McKay, M. M., & Bannon, W. M., Jr. (2004). Engaging families in child mental health services. Child and Adolescent Psychiatric Clinics, 13(4), 905–921.

    Article  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(3), 183–198.

    Article  PubMed  Google Scholar 

  • Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341–352.

    Article  PubMed  Google Scholar 

  • Muthén, B. (1994). Multilevel covariance structure analysis. In J. Hox & I. Kreft (Eds.), Multilevel modeling, a special issue of Sociological Methods and Research, 22, 376–398.

  • Muthén, L. K., & Muthén, B. O. (2012). Mplus Version 7 user’s guide. Los Angeles, CA: Muthén and Muthén.

    Google Scholar 

  • Nakamura, B. J., Higa-McMillan, C. K., Okamura, K. H., & Shimabukuro, S. (2011). Knowledge of and attitudes towards evidence-based practices in community child mental health practitioners. Administration and Policy in Mental Health and Mental Health Services Research, 38(4), 287–300.

    Article  PubMed  Google Scholar 

  • Nelson, M. M., Shanley, J. R., & Bard, E. (2012). Therapists’ attitudes toward evidence-based practices and implementation of parent–child interaction therapy. Child Maltreatment, 17(1), 47–55.

    Article  PubMed  Google Scholar 

  • Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., et al. (2016). Parent management training and collaborative and proactive solutions: A randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology, 45(5), 591–604.

    Article  PubMed  Google Scholar 

  • Orrell-Valente, J. K., Pinderhughes, E. E., Valente, E., Laird, R. D., Bierman, K. L., Coie, J. D., et al. (1999). If it’s offered, will they come? Influences on parents’ participation in a community-based conduct problems prevention program. American Journal of Community Psychology, 27(6), 753–783.

    Article  PubMed  PubMed Central  Google Scholar 

  • Panichelli-Mindel, S. M., Flannery-Schroeder, E., Callahan, S., & Kendall, P. C. (1995). Disclosure and nondisclosure among anxiety-disordered youth: Participant characteristics and treatment outcome differences. In Poster presented at the convention for the Association for the Advancement of Behavior Therapy, Washington, DC.

  • Patterson, G. R., & Chamberlain, P. (1994). A functional analysis of resistance during parent training therapy. Clinical Psychology: Science and Practice, 1(1), 53–70.

    Google Scholar 

  • Pemberton, J. R., Conners-Burrow, N. A., Sigel, B. A., Sievers, C. M., Stokes, L. D., & Kramer, T. L. (2015). Factors associated with clinician participation in TF-CBT post-workshop training components. Administration and Policy in Mental Health and Mental Health Services Research, 44(4), 524–533.

    Article  Google Scholar 

  • Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879.

    Article  PubMed  Google Scholar 

  • Rapp, C. A., Bond, G. R., Becker, D. R., Carpinello, S. E., Nikkel, R. E., & Gintoli, G. (2005). The role of state mental health authorities in promoting improved client outcomes through evidence-based practice. Community Mental Health Journal, 41(3), 347–363.

    Article  PubMed  Google Scholar 

  • Reding, M. E., Chorpita, B. F., Lau, A. S., & Innes-Gomberg, D. (2014). Providers’ attitudes toward evidence-based practices: Is it just about providers, or do practices matter, too? Administration and Policy in Mental Health and Mental Health Services Research, 41(6), 767–776.

    Article  PubMed  Google Scholar 

  • Reid, M. J., Webster-Stratton, C., & Beauchaine, T. P. (2001). Parent training in head start: A comparison of program response among African American, Asian American, Caucasian, and Hispanic mothers. Prevention Science, 2(4), 209–227.

    Article  PubMed  Google Scholar 

  • Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., et al. (2015). Barriers to and facilitators in the implementation of cognitive-behavioral therapy for youth anxiety in the community. Psychiatric Services, 66(9), 938–945.

    Article  PubMed  Google Scholar 

  • Rogers, E. M. (1962). Diffusion of innovations. New York, NY: Free Press.

    Google Scholar 

  • Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.

    Google Scholar 

  • Schoenwald, S. K., Chapman, J. E., Kelleher, K., Hoagwood, K. E., Landsverk, J., Stevens, J., et al. (2008). A survey of the infrastructure for children’s mental health services: Implications for the implementation of empirically supported treatments (ESTs). Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 84–97.

    Article  PubMed  Google Scholar 

  • Southam-Gerow, M. A., Chorpita, B. F., Miller, L. M., & Gleacher, A. A. (2008). Are children with anxiety disorders privately referred to a university clinic like those referred from the public mental health system? Administration and Policy in Mental Health and Mental Health Services Research, 35(3), 168–180.

    Article  PubMed  Google Scholar 

  • Southam-Gerow, M. A., Rodríguez, A., Chorpita, B. F., & Daleiden, E. L. (2012). Dissemination and implementation of evidence based treatments for youth: Challenges and recommendations. Professional Psychology: Research and Practice, 43(5), 527.

    Article  Google Scholar 

  • Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod, B. D., Gordis, E. B., & Connor-Smith, J. K. (2010). Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 1043–1052.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stadnick, N. A., Haine-Schlagel, R., & Martinez, J. I. (2016). Using observational assessment to help identify factors associated with parent participation engagement in community-based child mental health services. Child and Youth Care Forum, 45(5), 745–758.

    Article  PubMed  Google Scholar 

  • Sussman, S., Skara, S., & Ames, S. L. (2008). Substance abuse among adolescents. Substance Use and Misuse, 43(12–13), 1802–1828.

    Article  PubMed  Google Scholar 

  • Webster, S., & Harrison, L. (2008). Constructing a research based pre-care model to improve mental health interventions for young people. The Australian Journal of Advanced Nursing, 25(4), 31–39.

    Google Scholar 

  • Weisz, J. R., & Kazdin, A. E. (Eds.). (2010). Evidence-based psychotherapies for children and adolescents. New York, NY: Guilford Press.

    Google Scholar 

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Funding

This study was funded by NIMH (R01MH100134).

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Resham Gellatly, M.A., Anna Lau, Ph.D., and Lauren Brookman-Frazee, Ph.D. take responsibility for the integrity of the data and the accuracy of the data analysis.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gellatly, R., Brookman-Frazee, L., Barnett, M. et al. Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings. Child Youth Care Forum 48, 55–75 (2019). https://doi.org/10.1007/s10566-018-9472-z

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