(PS5-C71) Low Caregiver Engagement in Youth Treatment Predicts Community Therapists’ Use of Techniques to Address Barriers in EBP Sessions

Background:

Caregiver engagement in mental health services is associated with improved child mental health outcomes (Schlagel and Walsh, 2015). However, community therapists report in-session client engagement challenges while delivering evidence-based practices (EBPs) (Gellatly et al., 2019). Evidence-based techniques for client engagement challenges include strategies such as problem-solving about practical barriers to attendance, or improving the feasibility of homework assignments (Staudt, 2006). It is unclear whether these techniques are used in response to engagement challenges in community practice. This study will examine: (1) whether reported caregiver engagement in child treatment is associated with subsequent therapist delivery of techniques for Addressing Barriers in sessions and, (2) whether baseline caregiver engagement and therapists’ use of Addressing Barriers techniques have independent effects on child trajectories.

Methods:

Data were obtained from the ECCA study of EBP strategy delivery within the Los Angeles County Department of Mental Health (LACDMH). The sample included 70 community therapists (78.6% female, 60% Hispanic/Latinx) and 179 caregivers (92.7% female, 73.7% Hispanic/Latina).  Caregivers completed the Parent Participation Engagement Measure (PPEM) at baseline and 4-month follow-up. Therapists completed the EBP Concordant Care Assessment (ECCA; Brookman-Frazee et al., 2021) for up to 8 sessions to measure their use of the EBP technique strategy, Addressing Barriers. A multi-level regression analysis was conducted to examine associations between caregiver engagement at baseline and therapist use of Addressing Barriers (maximum observed extensiveness across sessions) using a three-level nested structure with child (level 1) nested within therapists (level 2) nested within programs (level 3).

Preliminary

Results:

We found a significant negative association between caregiver engagement at baseline and therapist use of Addressing Barriers (r =-.43, p </span>< .05). However, there was no association between therapists’ use of Addressing Barriers in sessions and caregiver engagement at 4 month- follow-up (r= .12, p > .05).

Conclusion

Findings thus far show that low caregiver engagement at baseline predicted the extent to which therapists used techniques to address barriers to treatment in session. Further analysis will test how child treatment outcome trajectories are associated with baseline levels of caregiver engagement and therapist use of addressing barriers techniques in sessions.