Review of Interventions to Improve Family Engagement and Retention in Parent and Child Mental Health Programs

Engaging and retaining families in mental health prevention and intervention programs is critically important to insure maximum public health impact. We evaluated randomized-controlled trials testing methods to improve family engagement and retention in child mental health programs published since 1980 (N = 17). Brief, intensive engagement interventions in which providers explicitly addressed families’ practical (e.g. schedules, transportation) and psychological (e.g. family members’ resistance, beliefs about the treatment process) barriers as they entered treatment were effective in improving engagement in early sessions. The few interventions found to produce long-term impact on engagement and retention integrated motivational interviewing, family systems, and enhanced family stress and coping support strategies at multiple points throughout treatment. Few interventions have been tested in the context of prevention programs. There are promising approaches to increasing engagement and retention; they should be replicated and used as a foundation for future research in this area.     

Family Influences on Treatment Refusal in School-linked Mental Health Services

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their families participated. Results indicated that (1) family environment factors explained a significant amount of variance in treatment refusal after controlling for demographic factors, (2) families of children with predominantly internalizing symptoms were at greater risk for refusing treatment than families of children with predominantly externalizing symptoms, and (3) lower level of family cohesion was an individual risk factor for refusing treatment. Incorporating an evaluation of family environment within SLMHS assessments may aid in the identification of areas wherein intervention may be beneficial in preventing treatment refusal.     

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

This mixed method study examined factors associated with parents not attending their child’s mental health treatment after initially seeking help for their 2–5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71?% African American or multi-racial; 97.6?% low-income), 36 (29.3?%) never attended their child’s first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child’s first treatment session were more likely to live with more than four adults and children (p?=?.007) and have more depressive symptoms (p?=?.003). Median length of treatment delay was 80 days (IQR?=?55) for those who attended and 85 days (IQR?=?67.5) for those who did not attend their child’s first treatment session (p?=?.142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.     

Identifying Youth at Risk for Treatment Failure in Outpatient Community Mental Health Services

We developed predicted change trajectories and a warning system designed to identify psychotherapy cases at risk for treatment failure as observed in archival Youth Outcome Questionnaire data (parent/guardian-report) from 363 children and adolescents (ages 4–17) served in an outpatient community mental health system. We used multilevel modeling procedures to develop models of predicted change based on demographic information. Controlling for the effects of age on intercept, no other variables were significant in the model. The warning system we created from half of the sample (n = 181) correctly identified 71% of treatment failures in the other half of the sample (n = 182), defined as cases whose symptoms were significantly higher at the end of treatment compared to symptoms at intake. As over half of youth cases in this usual care setting did not demonstrate reliable improvement in symptoms, these results further emphasize the value of patient-focused research in monitoring patient progress and prompting changes in the treatment approach if suitable progress is not observed.     

Exploring the Influence of Attitude and Stigma on Participation of African American and Latino Populations in Mental Health Services

Various factors, including mistrust and disparities, prevent people of color from taking advantage of mental health services. Previous research has focused on mistrust, disparities, and stigma. However, little is understood about how one's attitude affects participation in mental health. The authors surveyed 129 African American and Latino community participants to examine the relationships among attitudes, stigma, and help‐seeking behavior. Linear regression analyses revealed that attitude is a unique predictor in one's decision to seek counseling and is influenced by the presence of stigma. Varios factores, entre los que se incluyen la falta de confianza y las disparidades, impiden que las personas de color aprovechen los servicios de salud mental. Las investigaciones hasta ahora se han centrado en la falta de confianza, las disparidades y los estigmas. Sin embargo, falta mucho para comprender cómo la actitud de una persona afecta a su participación en la salud mental. Los autores entrevistaron a 129 participantes de comunidades afroamericanas y latinas para examinar las relaciones entre actitudes, estigmas y la búsqueda de ayuda. Los análisis de regresión lineal revelaron que la actitud es un indicador único en la decisión de un individuo de buscar servicios de consejería, y está influida por la presencia de estigmas.     

Acculturation and Latino Adolescent Mental Health: Integration of Individual,Environmental, and Family Influences

In order to address the mental health disparities that exist for Latino adolescents in the United States, psychologists must understand specific factors that contribute to the high risk of mental health problems in Latino youth. Given the significant percentage of Latino youth who are immigrants or the children of immigrants, acculturation is a key factor in understanding mental health among this population. However, limitations in the conceptualization and measurement of acculturation have led to conflicting findings in the literature. Thus, the goal of the current review is to examine and critique research linking acculturation and mental health outcomes for Latino youth, as well as to integrate individual, environmental, and family influences of this relationship. An integrated theoretical model is presented and implications for clinical practice and future directions are discussed.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

Implementation of Primary Care-Mental Health Integration Services in the Veterans Health Administration: Program Activity and Associations with Engagement in Specialty Mental Health Services

This paper describes the status of the Veterans Health Administration (VHA) Primary Care-Mental Health Integration (PC-MHI) services implementation and presents an assessment of associations between receipt of PC-MHI services and likelihood of receiving a second specialty mental health (SMH) appointment following an initial SMH encounter. The total PC-MHI service recipients and encounters/month rose substantially between October 2007 and April 2011. Adjusting for important covariates, the likelihood of receiving a second SMH encounter within 3 months of an index SMH appointment was 1.37 times greater among individuals who had received a PC-MHI encounter within 3 months of the initial SMH appointment. Implementation of VHA PC-MHI services has substantially increased VHA capacity to deliver mental health services in primary care and findings indicate that PC-MHI services are associated with greater engagement in SMH treatment. Implementation of VHA PC-MHI services is progressing with new technical assistance strategies being deployed.     

Linking Foster Family Characteristics and Mental Health Symptoms of Youth in Care

Youth in foster care are disproportionately at risk for developing internalizing and externalizing problems (Lawrence et al., 2006); however, a history of maltreatment prior to foster care placement does not automatically result in poor mental health outcomes. Among non-foster care youth, the quality of family interactions has been related to adjustment outcomes, such that low family cohesion and high family conflict is associated with poor mental health symptoms (Caples & Barrera, 2006). While little is known about these constructs in foster care placements, they may help explain the variance in internalizing and externalizing problems for youth in foster care. The present study aimed to examine whether characteristics of the foster care environment (i.e., conflict, cohesion) across various placement types (i.e., traditional foster homes, group-care settings) could help explain the link between previous maltreatment exposure and mental health problems. The sample included 178 youth in foster care (M_age?=?15.18, SD?=?1.76) and their foster caregivers living in the Midwest. Youth participants completed self-report measures about prior maltreatment history, current family environment characteristics, and youth internalizing symptoms. Foster caregivers completed measures on current family environment and youth externalizing symptoms. Results indicated that caregiver report, but not youth report, of family cohesion was negatively associated with youth report of internalizing problems. When examining the indirect effects, youth report of family conflict partially accounted for the link between youth self-report of maltreatment and internalizing symptoms (B?=?0.106, 95% CI?=?0.026–0.186). Caregiver report of family conflict fully accounted for the association between youth self-report of maltreatment and caregiver report of youths’ externalizing symptoms (B?=?0.108, 95% CI?=?0.005–0.211). Findings highlight the importance of utilizing multiple informants when measuring foster family environment and suggest that family conflict is particularly salient for the mental health of youth in foster care.

     

Miscarriage,Religious Participation,and Mental Health

Approximately 15–20 percent of pregnancies result in miscarriage, yet pregnancy loss remains a socially taboo topic and one that has received limited attention in the literature. Utilizing nationally representative longitudinal data from the NLSY97, this study examines the influence of miscarriage on mental health and whether this relationship is moderated by religious participation. Results from this study suggest that miscarriage is associated with lower mental health among women who also experience a live birth. Results also suggest that religious participation moderates the relationship between miscarriage and mental health; religion is more likely to lead to increases in mental health among women who experience a miscarriage than among women who do not experience a miscarriage. Overall, evidence suggests that religion may be an important coping mechanism for women who deal with pregnancy loss.     

Mental Health Disparities,Treatment Engagement,and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review

Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.     

Mental Health Values and Response to Alcoholism Treatment

Mental health values consist of the subset of values that refer to what constitutes good mental health. Torrey (1972) suggested that agreement between patient and therapist about such values may influence psychotherapy outcome. The authors found mixed support for this hypothesis using a sample of 100 chemical dependency inpatients. Positive treatment effects were associated with pretreatment agreement between counselor and patient about some mental health values, but with pretreatment disagreement about others. Because outcome measures assess general personality functioning, the authors suggest that attitudes about what constitutes good mental health may predict general psychotherapy effects as well as response to alcoholism treatment.     

Examining Latino Family Participation in Treatment for Childhood ADHD: The Role of Parental Cultural Factors and Perceptions

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health disorder in childhood. Unfortunately, Latino youth and their families are at increased risk of demonstrating poor treatment outcomes. The current study examined the impact of parental cultural factors and perceptions on Latino family participation in a psychosocial intervention for childhood ADHD. Sixty-one Latino youth and at least one of their primary parents and teachers participated in the current study. Results indicated that parental acculturation, attitudes regarding treatment, and baseline severity of child symptomatology and functional impairment were related to treatment participation outcomes. Implications and future directions are discussed.     

Mental Health Services - 2001:

No abstract available for this article.     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.