Engagement of Young Children and Caregivers in Outpatient Mental Health Services: Facilitators and Barriers.

Overview: Abstract/

Overview:
Young children are increasingly experiencing mental health disorders and rely on their family/caregiving system to facilitate participation in mental health care. This study aims to develop better understanding of barriers and facilitators to engagement and retention of young children and their families to improve service delivery and treatment outcomes.Proposal text: Background/Rationale

Early intervention with children experiencing mental health disorders is crucial to help prevent long-term negative impacts on lifelong well-being and success (Cho & Shin, 2013). Current research indicates that although children are increasingly accessing mental health services there continue to be barriers to access, as well as barriers to engagement and retention after entering services (Drent et al., 2020; Lindsey et al., 2014; Pellerin et al., 2010; Reardon et al., 2017; Svirydzenka et al., 2017). Young children are dependent on their parents/caregivers to engage in consistent and meaningful mental health treatment (Drent et al, 2020), so it is essential for clinicians to have information about the emotional and logistical barriers and facilitators experienced by parents/caregivers in order to intervene to increase the chances of a successful treatment episode (Drent et al, 2020; Kazdin et al, 2006). To fill this current gap in knowledge, this study examined what children and parents/caregivers identify as (1) facilitators and barriers to engagement in treatment (2) anticipated facilitators and barriers to successful attainment of treatment outcomes (3) helpful or unhelpful interventions in previous treatment if they have had more than one episode of care.

Methods/Methodology

This records review study uses secondary data gathered from children and their parents/caregivers by clinicians during the assessment phase of treatment and includes a sample of 100 charts of children ages 3 to 12 from the partnering agency’s EMR. The data used for this study focuses on anticipated facilitators and barriers that may interfere with the treatment identified at the time of assessment and contracting. De-identified data was extracted for analysis. Qualitative analysis was used first to identify themes relating to the facilitators and barriers that emerged from the data. Once qualitative analysis was complete, the themes were coded into quantitative data and frequency distributions were analyzed.

Results
Children and families who had a prior treatment episode indicated the theme of therapist-driven facilitators as the most important, with 69% of families indicating that a good therapeutic alliance for the child and parent is key. At the time of treatment planning 88% of charts indicated that the child’s own natural strengths were expected to facilitate successful treatment. Pertaining to barriers, 57% of charts indicated that the child’s symptoms and behaviors bringing them to treatment were also identified as barriers to possible success. Families also identified trauma and family stress as significant barriers to successful treatment. Presenters will also share specific examples reflecting these barriers and facilitators in more depth.

Conclusions

Findings of this study emphasize the need for service delivery models and reimbursement models that accommodate the role of family and systemic supports as part of the core interventions, as well as ensuring the ability of clinicians to implement trauma-informed care. Additionally, the implications of the study include the need for adjustments to the assessment of the family and child to include readiness for change and level of understanding of the child’s mental health problem, as well as the role of trauma and family stress.