The contribution of consensus within staff and client groups as well as concordance between staff and clients to treatment engagement

Two nonspecific organizational factors—consensus, defined as agreement within staff and client groups, and concordance, defined as agreement between staff and client groups—were shown to influence client engagement in treatment in a national sample of 80 residential substance abuse treatment programs including 595 staff and 3,732 clients. Agreement was tested using a combined therapeutic community, cognitive–behavioral therapy, and 12-step treatment scale completed by staff and clients. Treatment engagement was measured by the combined scores on the three scales completed by the clients, including engagement, rapport with the counseling process, and confidence in treatment. Within-group consensus was measured by the standard deviations of the mean scores, whereas between-groups concordance was measured by the standard error of the difference between staff and client mean scores. Regression analyses showed that staff consensus was a significant independent predictor of client treatment engagement (p < .05), whereas client consensus approached significance (p < .10). Concordance was also a significant predictor of client engagement (p < .002) after controlling for staff and client consensus. The potential contribution of the findings to a better understanding of program quality and effectiveness of programmatic interventions is discussed.