Increasing Parent Engagement: A Real World Randomized Controlled Trial in an Urban Multicultural Child Mental Health Center

Background:  This community collaborative research examines the effect of an enhanced engagement phone intake protocol for multistressed families seeking help for children with serious conduct problems in a large multicultural city. An alarmingly high rate of families fails to show for their initial appointment or drop out prematurely, with even higher rates for the most vulnerable families who face multiple barriers to accessing services. Attrition rates are especially high among families seeking services for child conduct problems. 

Methods:  Using a randomized design parents who contacted the agency (n=117) were allocated to phone Intake As Usual (IAU) or Enhanced Engagement Phone Intake (EEPI). Eighteen parents were lost prior to receiving the phone interview for an analytic sample of n=99 (EEPI: n=45, IAU, n=54). The sample was primarily female, diverse, mixed income, with 52% a single parent, divorced or separated. Child behavior was severe with high comorbidity, child age was 5-12 years (M=8.62), 69% were boys.  IAU consisted of a government mandated standardized child and family functioning screening questionnaire. EEPI, wrapped around the screening instrument, was a flexible approach, attuning to the parent’s concerns, help-seeking experience(s) and stressors and incorporating problem-solving and motivational interviewing.  Agency staff and social work interns conducted the phone intakes. Audiotaped calls were rated for fidelity. Bivariate analyses were conducted to examine differences between those lost and retained in the sample and between conditions. Chi-square analysis and logistic regression were used to test the hypotheses: (1) parents who receive an EEPI will show for their initial appointment significantly more often than parents in IAU; (2) EEPI parents will be more likely to continue in treatment subsequent to the initial appointment than IAU parents.

Results:  Using the limited demographics available for lost parents, there were no meaningful differences with those retained in the sample. Using chi-square and t-tests, the only significant difference between conditions for the analytic sample was children in the EEPI condition were slightly older. Results approach significance between condition and first face-to-face, x² = 3.59; df = 1; p <.058 and were significant for subsequent service use, x² = 3.81; df = 1; p <.05. Controlling for child gender, child age, income, and marital status in the logistic regressions, EEPI parents were three times more likely to attend both their initial appointment and subsequent treatment services.

Conclusion and implications:  These results add to our knowledge on implementation feasibility and effectiveness of early engagement approaches in the “real world” of community practice. The procedures were easily integrated into everyday practice and after initial training ongoing supervision was reflective of typical agency practice.  The key finding that a brief enhanced engagement component at intake call increases odds three fold that parents and children attend an initial appointment and any continued treatment suggests that from the very first contact focus needs to be on engaging families. This study contributes to building the evidence base for early engagement and highlights not only implications for agency practice and policy but for the integration of evidence-informed engagement practices into social work education.