Engagement in Mental Health Treatment Among Adolescents and Young Adults: A Systematic Review

Kim, Hyun Soo; Munson, Michelle R.; McKay, Mary M.

doi:10.1007/s10560-012-0256-2

Cited by 120 publications

(107 citation statements)

References 47 publications

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“…212 Research indicates that this type of preparatory work may enhance rates of uptake and engagement in child mental health and child welfare interventions, [283][284][285][286] and it would be worth considering how these techniques can be extended to this field of work, especially as this already seems to be a feature of one widely implemented UK intervention. We note that an ongoing trial is examining the impact of a 6-week preparatory programme for parents as an adjunct to trauma-focused CBT, 62 which aims to increase parents' insightfulness and orient them to their children's needs before they take part in the full therapeutic programme.…”

Section: Ongoing Abusementioning

confidence: 99%

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly < 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.

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Section: Ongoing Abusementioning

confidence: 99%

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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“…More comprehensive definitions incorporate multiple elements such as behavioral (e.g., attendance) and attitudinal (e.g., emotional investment in treatment) components (Staudt, 2007), as well as considering the facilitating role of the therapeutic relationship (see King et al, 2014, below). However, definitions lack consensus (Kim, Munson, & McKay, 2012), and are not specific to the older adolescence. Help-seeking definitions also incorporate elements of engagement, such as seeking professional help (e.g., Rickwood, Deane, Wilson, & Ciarrochi, 2005), meaning the overlap between the two is apparent but undefined.…”

mentioning

confidence: 99%

Experiences of Engaging With Mental Health Services in 16- to 18-Year-Olds: An Interpretative Phenomenological Analysis

2017

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Petersen, 2014), such as the therapeutic relationship (Shirk & Karver, 2003), may be linked to treatment outcome. For older adolescents, service engagement could be a challenge (Royal College of Psychiatrists, 2012). Alongside experiencing mental distress, they may also be faced with societal (e.g., stigma; Eisenberg, Downs, Golberstein, & Zivin, 2009), familial (YoungMinds, 2006), and developmental (Erikson, 1968) pressures. In addition, 16 to 18 years is a potential time of transition between CAMHS and adult mental health services (AMHS), which may impose its own challenges (

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“…Estimates indicate that 44 % of youth terminate their treatment prematurely (Dierker, Nargiso, Wiseman, & Hoff, 2001), with the average length of treatment as low as only four sessions (Kim, Munson, & McKay, 2012). Furthermore, 48-62 % do not attend their initial appointment after being accepted for treatment (Harrison, McKay, & Bannon, 2004).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Engagement of Adolescents with Emotional and Behavioral Disorders

DiCroce

Preyde

Flaherty³

et al. 2015

Child Adolesc Soc Work J

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Youth engagement is increasingly recognized as a preferred approach and often necessary step in the treatment of emotional and behavioral disorders. The purpose of this study was to explore the degree and quality of youth engagement in the therapeutic process, compare engagement scores between youth accessing residential and day treatment, and explore the association between engagement and interpersonal difficulties in a sample of youth with an emotional and/or behavior disorder in residential and day treatment programs based in Southern Ontario. Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their Prime Workers. Relevant constructs included client engagement (as rated by youth and Prime Workers), and youth-rated behavioral screen, interpersonal problems and family functioning. Both Prime Workers and youth rated youth as moderately high in their level of engagement in therapy. Furthermore, Prime Worker and youth ratings did not significantly differ statistically, suggesting that youth may have actually engaged at a moderate level. Interpersonal problems were shown to be negatively associated with youth engagement, and family functioning approached significance for only youth in residential treatment. Assessing youth engagement during the treatment process as an intervention technique may highlight areas where greater clinical efforts are needed. Future considerations include testing methods of sharing and discussing results of an engagement measure within the context of a one-on-one clinical encounter with youth.

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Engagement in Mental Health Treatment Among Adolescents and Young Adults: A Systematic Review

Cited by 120 publications

References 47 publications

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

Experiences of Engaging With Mental Health Services in 16- to 18-Year-Olds: An Interpretative Phenomenological Analysis

Therapeutic Engagement of Adolescents with Emotional and Behavioral Disorders

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