1 - (SYM 76) Collaborating to Build a Modular Treatment Engagement System: Helping Mental Health Providers Use More Evidence and Use Evidence for More

Low treatment engagement is a ubiquitous challenge in youth mental health services. The evidence base of engagement interventions is sizable, yet not widely disseminated. Moreover, although clients can experience different types of engagement challenges, the evidence base is generally fragmented by engagement dimension (e.g., those who develop an intervention to improve attendance do not also target alliance). In its current form, engagement science is not well-suited to inform engagement practice. To help providers use more evidence and use evidence for more applications, we created a modular engagement system from the evidence base of engagement procedures tested by independent scholars.

First, we conducted a review of 50 RCTs testing engagement interventions (Becker et al., 2018). We applied a standard vocabulary to classify engagement procedures (e.g., appointment reminders, psychoeducation) across effective engagement interventions. We then identified empirical associations between engagement procedures and five engagement dimensions (e.g., cultural acknowledgement - relationship; motivational enhancement - expectancies). Thus, we extracted a model for matching engagement procedures with the dimensions they might be well-suited to address.

Second, we designed an engagement system that includes content modules describing how to use the engagement procedures, as synthesized across independent studies. Given that this system leverages the entire evidence base, it includes engagement procedures to address not just one, but five different engagement dimensions. A visual representation of the empirical associations between engagement practices and the five engagement dimensions guides decisions about what engagement procedures to use for what dimension. 

Third, we tested our engagement system with youth mental health providers in a multisite cluster RCT. Analyses revealed that those providers who used the modular engagement system interacted with the evidence base more extensively and more broadly than providers in a comparison condition that did not summarize the evidence base.

In sum, we capitalized on the contributions of independent scholars to design a modular engagement system that makes the evidence base more accessible to providers. The findings that mental health providers used more evidence and used evidence for more applications have implications for treatment design and are related to the current study of the efficiency, implementation, and effectiveness of this engagement system.