Changes in treatment engagement of youths and families with complex needs

This study examined changes in treatment engagement of 437 youths and their caregivers receiving mental health services in the United States. The youth sample had an average age of 12.03 years (SD = 2.98). Nearly two-thirds (64.1%) of the youth sample was male and approximately the same proportion was Caucasian. Youths were diagnosed primarily with externalizing (50.1%) and internalizing (46.0%) disorders. Most youths (86%) received services from intensive settings (i.e., behavioral health rehabilitation, treatment foster care, family-based services) that provide care beyond the scope of services provided to youths receiving services in traditional outpatient settings. Using KIDnet, an electronic outcomes management system, youths and their caregivers reported on three domains of treatment engagement: therapeutic alliance, satisfaction with services, and treatment participation at each 90-day reporting cycle until treatment termination. Youths and caregivers receiving services from high intensity treatment settings reported significantly lower initial engagement compared to youths and caregivers receiving less intensive outpatient services. Regardless of setting, treatment engagement reported by youths and caregivers increased over time. These promising findings suggest that families receiving intensive treatment develop connections to service providers and hold positive perceptions of services over time. These results provide the foundation for future research to examine the practices that are associated with changes in treatment engagement over time.