1 - (SYM 139) Empirical Foundations and Design of the Reaching Families Engagement System

Despite the significance of low treatment engagement in youth mental health services, the field offers almost no guidance to mental health providers about: (1) how to assess engagement; thus, providers tend to rely on their own observations of engagement (namely, attendance) (Becker, Wu et al., 2021) and (2) what clinical procedures to use when they encounter engagement challenges in clinical practice; thus, providers frequently use procedures that are not well-suited to the specific engagement problem at hand (Becker, Dickerson et al., 2021).

We present three studies that informed a solution to these challenges. In Study 1, we examined whether evidence-based treatments (EBTs) provide sufficient guidance about engagement practices. Ninety-three providers (M_age = 43.6; 93.5% female) completed a survey about their EBT training history and a 14-item knowledge test (KT) about engagement practices from the evidence base. The average KT score was 6.37 (45.5%) and KT scores were not significantly correlated with number of EBT trainings (r = .11, p = .29). Results suggested that EBT trainings are not wholly sufficient to produce provider knowledge about how to engage clients in treatment.

In Study 2, we examined engagement problems; namely, the structural validity of the REACH dimensions in clinical practice. We developed and administered an engagement questionnaire to 1,807 primarily Hispanic American (56.0%) and African American/Black (26.3%) youth (Mage = 12.7; 46.8% female) and/or their caregivers receiving mental health services. Results supported the hypothesized five-factor model of engagement relative to a one-factor model (Chorpita & Becker, 2022). Confirmation of the multidimensional structure for treatment engagement set the stage for advances in measurement in clinical care.

In Study 3, we reviewed 50 RCTs testing engagement interventions (Becker et al., 2018) to examine the associations between problems and practices. We identified empirical associations between discrete engagement procedures in these interventions and the REACH dimensions (e.g., cultural acknowledgement - Relationship; motivational enhancement - Expectancies). Thus, we had a framework for matching specific engagement procedures to the engagement dimensions they were well-suited to address.

In closing, we describe the features of the CKS, a knowledge-centric solution with multiple resources to address the complexities related to detecting low engagement and choosing engagement practices that are well-suited to the identified engagement problem.