a Department of Psychiatry , University of Maryland , Baltimore.
b Department of Psychology , University of California , Los Angeles.
J Clin Child Adolesc Psychol. 2018 Jan-Feb;47(1):1-23. doi: 10.1080/15374416.2017.1326121. Epub 2017 Jun 2.
Poor engagement in child and adolescent mental health services is a significant public health concern. The purpose of this study was to synthesize the engagement literature using a multidimensional measurement framework to identify practice elements that are associated with improved engagement. We examined 50 randomized controlled trials of interventions targeting treatment engagement in youth mental health services published between 1974 and 2016. We utilized a multidimensional measurement framework that includes five engagement domains (i.e., Relationship, Expectancy, Attendance, Clarity, Homework [REACH]). We also used a distillation method (Chorpita & Daleiden, 2009; Chorpita, Daleiden, & Weisz, 2005) to identify specific practices common to interventions that were effective at increasing engagement within each REACH domain. Engagement was most frequently operationalized in intervention studies as Attendance. Individual practices distilled from effective interventions were successful when used with participants with diverse characteristics in a wide variety of contexts. Importantly, we found unique practice patterns associated with outcomes from each REACH domain. Findings suggest that practices such as assessment, psychoeducation, accessibility promotion, barriers to treatment, and goal setting might be used with all youth and families to promote engagement and that other practices could be introduced on an as-needed basis to target specific engagement domains (e.g., modeling to promote Clarity about therapy; therapist monitoring to promote Homework/participation). A substantial evidence base demonstrates that engagement can be improved through specific interventions, and findings highlight opportunities to advance the field's understanding of engagement through multidimensional measurement in future studies.
儿童和青少年心理健康服务参与度低是一个重大的公共卫生问题。本研究旨在使用多维测量框架综合参与度文献，以确定与改善参与度相关的实践要素。我们研究了 1974 年至 2016 年间发表的 50 项针对青少年心理健康服务中治疗参与度的干预措施的随机对照试验。我们采用了多维测量框架，包括五个参与度领域（即关系、期望、就诊、清晰度和家庭作业[REACH]）。我们还使用了一种提炼方法（Chorpita 和 Daleiden，2009；Chorpita、Daleiden 和 Weisz，2005），以确定在每个 REACH 领域中增加参与度的有效干预措施中常见的特定实践。在干预研究中，参与度最常被定义为就诊。从有效干预措施中提炼出来的个别实践在各种背景下对具有不同特征的参与者都取得了成功。重要的是，我们发现每个 REACH 领域的结果都与独特的实践模式相关。研究结果表明，评估、心理教育、促进可及性、治疗障碍和目标设定等实践可以用于所有青年和家庭，以促进参与度，而其他实践可以根据需要引入，以针对特定的参与度领域（例如，通过示范来提高对治疗的清晰度；通过治疗师监测来促进家庭作业/参与度）。大量证据表明，通过特定的干预措施可以提高参与度，研究结果强调了通过未来研究中的多维测量来提高该领域对参与度的理解的机会。
