There is a significant unmet need for care along with identification of significant barriers to access. Empirical findings can serve as the basis for modifying urban child mental health service delivery systems.

The authors present the results of two studies designed to improve treatment engagement among urban youths with conduct and oppositional behavioral difficulties. In the first study, information on attitudes about mental health treatment was obtained from 159 adult caregivers of children who were referred to an urban child mental health clinic because of disruptive behavioral difficulties. The caregivers listed insufficient time, lack of transportation, the child's not wanting to attend treatment, and the caregiver's concern that treatment might not help as barriers to service use. The data from study 1 were used to design a multiple-family group intervention to be tested in study 2. The families who participated in these groups attended an average of seven sessions during the 16-week study, compared with four sessions for families who participated in family therapy and three for families who participated in individual psychotherapy.

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Mental health clinicians and program administrators must implement effective strategies for engaging and retaining clients in care. At a recent series of forums open to providers from clinics in New York City that was sponsored by the city and state public mental health authorities, high-performing providers described their client engagement strategies. In this column the effective strategies reported are summarized in four areas: the first session, staff training and expertise, productivity measures, and engaging families and support persons. The approaches should be of use to administrators to improve programs' ability to engage and retain clients in community-based clinic care.