Community Therapist Reports of Client Engagement Challenges During the Implementation of Multiple EBPs in Children’s Mental Health

Abstract

This study investigated therapist reports of client engagement challenges in delivering evidence-based practices (EBPs), within the context of a large-scale implementation of multiple practices in children’s mental health services. Data were drawn from an online survey of 668 therapists (88% female, 35.0% Non-Hispanic White). The majority of therapists (75.4%) endorsed at least one client engagement challenge during their implementation of an EBP with an identified client over the previous two months. Two types of EBP client engagement challenges with distinct correlates but similar overall frequencies could be readily differentiated – Expressed Client Concerns and Limited Client Engagement in therapy activities. Limited Client Engagement were more commonly reported for clients with externalizing problems and by therapists with higher emotional exhaustion and negative perceptions of the specific EBP being delivered, whereas Hispanic/Latino therapists were less likely to report Limited Client Engagement. In contrast, Expressed Client Concerns were more commonly reported by therapists with positive general attitudes towards EBPs, and among therapists delivering a parent training EBP. Limited Client Engagement but not Expressed Concerns were linked with therapists’ self-reported ability to carry out the EBP with the target client. Findings suggest that client engagement challenges are frequent during the delivery of EBPs, but may impact implementation differently based on whether they relate to challenges in engaging clients in therapy activities versus addressing concerns raised by clients

How community therapists describe adapting evidence‐based practices in sessions for youth: Augmenting to improve fit and reach

“…However, defining how therapists could have adapted a session may have altered reported frequencies of adaptations overall or for specific adaptation types. Yet, previous studies using survey methods in the current study context overall suggested similar patterns of more frequent Augmenting than Reducing adaptations and also allowed for the study of an additional category of Generalizing adaptations (Lau et al, 2018). Additional studies are needed to replicate findings on relative rates and contextual factors associated with adaptation types.…”

“…Within the session survey, therapists completed a checklist indicating whether client‐related engagement challenges were encountered. Items assessing engagement challenges were adapted from the 2‐month retrospective report measure of client engagement challenges for an index case described in a previous study (Lau et al, 2018). In the current study, therapists reported on four items to indicate whether each engagement challenge had occurred.…”

Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings

“…Given that the majority (69.6%) of the clients participating in the study were Hispanic/ Latino, this finding may suggest that therapist ethnicity might have a bearing on client engagement and implementation outcomes, such that clients are more engaged in treatment when it is delivered by a therapist who they feel understands their culture (Berger et al 2014). In addition, therapist reports of Limited Client Engagement in Therapy Activities, but not Expressed Client Concerns, were related to a lower self-assessed ability to deliver the EBP (Lau et al 2018). These findings suggest that whereas limited client participation might portend barriers to EBP implementation, clients being comfortable or even invited to share their concerns about an intervention may not be associated with a therapist's compromised ability to deliver care as intended.…”

“…A recent study examined therapist perceptions of engagement challenges in the context of mandated EBP implementation (Lau et al 2018). Therapists reported on two types of engagement challenges encountered during the implementation of an EBP with a child client in the previous 2 months: Expressed Client Concerns and Limited Client Engagement in Therapy Activities.…”

“…The Limited Client Engagement in Therapy Activities subscale included three items related to poor engagement: (e) apathetic or disinterested behavior, (f) avoiding participation in therapy activities, and (g) consistently veering off topic. Support for the subscales was derived through a conceptually driven, confirmatory factor analysis (CFA) revealing that the two-factor solution had good model fit, with standardized factor loadings ranging from .46 to .75 (Lau et al 2018).…”