Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Engagement and retention are critical elements in implementing successful family-based interventions. Research has shown that time in treatment (retention) is the single best predictor of positive outcomes, and that higher levels of engagement lead to increased retention. Engagement is typically defined across general dimensions of therapeutic involvement and session participation. Clients who are ‘engaged' are more likely to bond with counselors, endorse treatment goals, and participate in the therapeutic process. Treatment retention is an outcome closely associated with more distal outcomes at follow-up and it is an important criterion for judging the effectiveness of an intervention. The focus of the study was to develop and test methods aimed at increasing engagement and retention of youth and their families in a home-based family therapy intervention to prevent/reduce youth substance use and other high-risk behaviors.

Methods: Families were recruited if they had a child 12-17 years of age whose problems with family conflict, truancy, delinquency, or running away had lead to seeking services. Eighteen ‘engagement activities' were developed, adapted, and tested for appropriateness with youth and family members. One activity was applied during each of 12 in-home family treatment sessions provided to families in the experimental condition; control group families received services as usual, without engagement activities. Number of sessions completed (retention) were compared between groups. Qualitative, follow-up interviews were conducted with experimental families that received the ‘engagement activities' to assess the perceived effectiveness of the activities.

Results: To date, 85 youth and their families have completed treatment in the experimental and control conditions. Youth were approximately 15 years of age, female (62%), Latino (50%), and had run away at least once (54%). Parents involved in the treatment sessions were predominately mothers (76%), employed full-time (75%), and had more than high school education (55%). Preliminary findings suggest that 80% of families in the experimental condition completed all 12 sessions; 90% completed at least 10 sessions. None of the control families completed all sessions; 60% completed only 2.

Qualitative follow-up interviews suggest that the majority of experimental group families found the ‘engagement activities' helpful in opening dialogue between parent and child and helped them engage with each other and the counselor during each session much more rapidly. Several parents credited the activities with easing their apprehensive teenagers into participating in therapy while bringing conversations about sensitive topics to a deeper level than had been achieved in prior therapeutic encounters. During the presentation, the ‘engagement activities' will be detailed and available for review.

Implications/conclusions: Although findings are preliminary (study is on-going), it appears that the ‘engagement activities' delivered to families in their homes is related to greater retention and completion of all treatment sessions. Family interviews suggest that the family and counselor develop greater rapport and are more quickly drawn together for effective therapeutic interactions. These new techniques represent a novel and creative approach for counselors to engage the entire family in treatment, while also addressing the youth's high-risk behaviors.