A Review of Measures of Family Engagement in Behavioral Health Services

Purpose:Numerous studies have concluded that family engagement is an essential component of the treatment process for individuals with behavioral health disorders, resulting in improved client attendance and retention rates. Despite these findings, family engagement is inconsistently conceptualized and measured, which limits cross-study comparisons and knowledge building of this vital aspect of behavioral health treatment. The purpose of this study is to conduct a review of how family engagement is measured in behavioral health treatment settings in order to make recommendations for future assessment of this construct in behavioral health settings.

Methods:A systematic search strategy was used to identify studies that included measures of family engagement utilized in behavioral health treatment settings. Studies were included if they contained a self-report or observational measure of a family member’s engagement in a client’s behavioral health treatment. Studies were excluded if they were non-English language or if the instrument was not available (e.g. under development). Six electronic databases (Social Work Abstracts, Social Services Abstracts, PsychINFO, Academic Search Complete, CINAHL, ERIC) and three measurement clearinghouses (Health and Psychological Instruments, PSYCTests, Mental Measurements Yearbook) were searched for studies published between January 1998- September 2013, yielding 3652 results. An initial screen of article titles and abstracts resulted in 40 relevant articles. Reference lists of included articles were examined, generating 36 additional studies for review. We then reviewed each of the resulting 76 full-text articles and identified 12 instruments that met full inclusion criteria. We then extracted the following from each article: instrument format and administration; measurement reliability and validity; the populations and treatment settings in which the measure was used; and whether behavioral, attitudinal, and affective domains were measured.

Results:With regard to instrument format, eight instruments were self-report, and four were observer-rated. Eight instruments were evaluated in mental health treatment settings, two in substance abuse treatment settings and two in combined settings.  Three instruments demonstrated strong reliability and validity, and nine instruments demonstrated adequate reliability and validity. The instruments were used primarily with Caucasian, African-American, and Hispanic samples. Six instruments included behavioral engagement, nine included attitudinal engagement, and four reflected affective engagement. Seven instruments measured two of the constructs while none measured all three.

Implications: Accurate measurement of family engagement is important to Social Work’s commitment to provide evidence-informed, family-centered behavioral health services. Findings from this study indicate that there are few well-validated measures of family engagement available for use in behavioral health treatment settings. Our findings also reveal that the ambiguity around the conceptualization of family engagement is reflected in these existing engagement measures. We articulate an integrative conceptualization of family engagement for social work practice and make recommendations for advancing measurement of the construct in future social work research.