Psychoeducation as a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior

Abstract

Parent engagement in treatment for child disruptive behavior has been associated with improved child outcomes in care. However, many families who enter care do not receive an adequate dose of treatment, and parents are often not involved. We examined therapists' use of psychoeducation, a therapeutic practice used to present factual information about target problems and treatments, and its association with parent engagement in child psychotherapy. Participants were drawn from the Child System and Treatment Enhancement Projects' multisite trial contrasting standard evidence-based treatments, modular treatment, or usual care. We included an ethnically diverse sample of 46 youth (ages 7-13) who received treatment for disruptive behavior in modular treatment or usual care. A reliable observational coding system was developed to assess therapists' in-session use of psychoeducation strategies (e.g., discussing causes of misbehavior, describing and providing rationale for treatment, etc.), as well as other engagement strategies (e.g., collaborative goal setting, managing expectations, etc.), in the early phase of treatment. Findings revealed that modular treatment therapists provided more psychoeducation and other engagement strategies compared with usual care therapists. Furthermore, psychoeducation strategies employed by therapists early on uniquely predicted subsequent parent involvement in treatment, over and above the use of other engagement strategies. Finally, therapists' use of the psychoeducation strategy of discussing causes of child's misbehavior mediated the effect of treatment condition on parent involvement in their child's therapy. These findings suggest that the implementation of psychoeducation strategies upon entry into care promotes parent involvement in child psychotherapy for disruptive behavior.

Observational Assessment of Engagement Strategies to Promote Parent Homework Planning in Community-Based Child Mental Health Treatment: A Pilot Study

“…A previous study found that of all therapist endorsed strategies for enhancing therapy homework completion, praising families to empower them to complete homework was the highest endorsed strategy (Houlding et al 2010). The finding that therapist use of Psychoeducation strategies in the initial phase of treatment predicted subsequent parents ’ sharing perspective on homework planning aligns with studies of predictors of overall parent engagement in child psychotherapy (Martinez et al 2015), and studies that have included psychoeducation strategies as a core component in successful parent engagement interventions (Becker et al 2015). Preparing and orienting parents on the rationale of therapy homework completion using psychoeducation strategies can help address parent misconceptions and unrealistic expectations about therapy homework, thereby increasing the likelihood of active participation in therapy homework planning and completion (Chacko et al 2013; Dozois 2010; Houlding et al 2010).…”

“…However, most families only attend three to four treatment sessions before dropping out prematurely (Armbruster and Fallon 1994; Harpaz-Rotem et al 2004; Kazdin 1996; Pellerin et al 2010), and parents are often not actively involved in community-based MH service settings (Baker-Ericzén et al 2013; Garland et al 2010; Martinez et al 2015). Community-based MH settings are locations in which MH services, which may or may not be evidence-based, are delivered to children, families, and adults within a “usual care” context, versus settings such as university training clinics or for efficacy research that do not provide care as it is typically provided (Garland et al 2013).…”

“…A recent study that examined parent participation in community-based MH services found significant program-level intra-class correlations (ICCs; Haine-Schlagel et al 2016), while another study found very small program-level ICCs for parent attendance (Israel et al 2007), suggesting variability in program-level effects on parent engagement. To address these challenges to parent engagement in community-based care, attention to parent engagement processes has increased in recent years (Becker et al 2015; Gopalan et al 2010; Haine-Schlagel and Walsh 2015; Ingoldsby 2010; Martinez et al 2015). …”

Using Research-Informed Pedagogical Practices to Maximize Learning in Youth Cognitive Behavioral Therapy

“…Further, misconceptions are common when being introduced to new material (for a review, see Taylor & Kowalski, 2014) and should be clarified during psychoeducation (Martinez et al, 2015). Patients may have created their own language or mental representations, some of which may be analogous to CBT terminology but may prevent psychoeducation from resonating.…”

Psychoeducation Effectiveness on Expectations About Counseling for a Mental Illness Among the Youth: A Case Study of Teacher-Trainees in Kenya

“…This result is in line with findings of Gonzalez, et al [14] among college students. Psychoeducation among parents who have children that display symptoms of disruptive behavior have indicated an improved treatment outcome, [15].…”