Engaging Families in Mental Health Services: Do Attitudes or Behaviors Come First?

Background and Purpose: This study examined the relationship between caregivers’ attitudes and participation in a multiple family group treatment model (MFG) for children with behavioral problems. Research is clear that engaging caregivers in addressing children’s behavioral problems is vital for more positive child outcomes. However, engaging caregivers in mental health services can be challenging. Staudt (2007) attempted to better explain the process of engagement through the development of a conceptual framework that proposed that caregivers are first engaged attitudinally and then they are more likely to be behaviorally engaged. This study explored the role of attitudinal engagement through caregiver attitudes of program satisfaction, positive change, relationship with facilitator (provider), and relationship with other group members within the MFG. Being that research has shown linkages between attitudes and behaviors and that behaviors can precede or influence attitudes, this study explored the role of reciprocal causality between attitudinal and behavioral engagement within this MFG approach using longitudinal data.

Methods: Self-reported data collected from caregivers (n=225) participating in the MFGs with their children was used for this study. Caregivers were primarily low-income Latino (50%) and African American (29%) mothers (78%). The four attitudinal scales were examined to determine if they represented a superordinate, aggregate, or a set of distinct constructs by using confirmatory factor analyses.  Then, this study explored the relationship between the attitudinal engagement constructs and behavioral engagement (attendance) using cross-lagged panel analyses.

Results: Confirmatory factor analyses showed that they indeed are four distinct attitudinal engagement constructs. The obtained data did not match our theoretical prediction of a primary four-factor attitudinal engagement construct. Cross-lagged panel analyses explored the relationship between these four distinct attitudinal engagement constructs with behavioral engagement (attendance).The findings provided some support for Staudt’s original framework and did not show a reciprocal relationship. Caregivers’ attitudes towards program satisfaction did predict behavioral participation through attendance. However, caregivers’ attitudes towards the relationship with the facilitator showed an inverse relationship with attendance. Additional analyses were conducted to further evaluate these findings and only program satisfaction predicted attendance in the MFG.

Conclusions and Implications: This study expands upon the current literature by affirming the strong relationship between satisfaction and participation in treatment. Future research can further examine the connection between the relationship with the facilitator and attendance more closely to confirm or refute the findings. A clearer understanding of engagement processes in mental health services can support better caregiver participation and, in turn, child behavioral outcomes