GGzE Centre for Child and Adolescent Psychiatry, PO Box 909, 5600 AX, Eindhoven, The Netherlands.
Eur Child Adolesc Psychiatry. 2013 Aug;22(8):491-500. doi: 10.1007/s00787-013-0385-y. Epub 2013 Feb 28.
Motivation is considered a pivotal factor in treatment, but a better understanding of this topic is needed. Drieschner et al. (Clin Psychol Rev 23:1115-1137, 2004) proposed to distinguish treatment motivation and treatment engagement. This study aimed to discover whether it is possible to identify classes of adolescents with severe psychiatric problems having comparable profiles of treatment engagement. To this end, professionals filled out the Treatment Engagement Rating Scale 5 times for 49 adolescents (mean age 18.3 years; SD = 1.6) during the first year of case management treatment. Using a longitudinal latent class analysis, the number of profiles of treatment engagement was investigated and described. Results identified three profiles: high (19 clients, 39%), medium (20 clients, 41%) and low (10 clients, 20%). Adolescents with a high engagement profile were at first equally, and later on more engaged in treatment than clients with a medium engagement profile. Adolescents with a low engagement profile made the least effort to engage, except after 30 weeks. Adolescents with a low engagement profile were often substance-dependent males with the lowest scores on the Global Assessment of Functioning Scale after a year. Only adolescents with a high engagement profile improved on global functioning. In conclusion, it is possible to identify different treatment engagement profiles by asking one question about level of global treatment engagement. Frequent assessment of engagement of the individual client as well as including a behavioural component into assessment and treatment may help to improve case management treatment for adolescents with medium and low engagement profiles.
动机被认为是治疗的关键因素，但需要对这一主题有更深入的了解。Drieschner 等人（Clin Psychol Rev 23:1115-1137, 2004）提出区分治疗动机和治疗参与。本研究旨在发现是否有可能识别出患有严重精神疾病的青少年群体，他们具有相似的治疗参与特征。为此，专业人员在个案管理治疗的第一年期间，5 次填写了《治疗参与评定量表》，共涉及 49 名青少年（平均年龄 18.3 岁；SD=1.6）。使用纵向潜在类别分析，研究了治疗参与特征的数量，并对其进行了描述。结果确定了三种特征：高（19 名患者，39%）、中（20 名患者，41%）和低（10 名患者，20%）。高参与特征的青少年在开始时与中参与特征的青少年一样，后来更积极参与治疗。低参与特征的青少年参与治疗的努力最小，除了在 30 周之后。低参与特征的青少年通常是物质依赖的男性，一年后全球功能评估量表的得分最低。只有高参与特征的青少年在全球功能方面有所改善。总之，通过询问一个关于整体治疗参与水平的问题，可以识别出不同的治疗参与特征。频繁评估个体患者的参与情况，并在评估和治疗中纳入行为成分，可能有助于改善中低参与特征青少年的个案管理治疗。
