Engaging families of child-welfare (CW) involved youth in the mental health (MH) assessment process is vital in obtaining information about the context affecting their safety, permanency, and wellbeing (Smithgall et al., 2015), and may enhance safety and wellbeing by addressing child and family needs, and promote permanency by engaging the family more directly in the treatment process (Ingram et al., 2015). As family functioning plays a role in successful reunification for youth in out-of-home care (OOHC), family engagement while youth are in OOHC may also increase the likelihood of buy-in and clinical treatment participation (Bossard et al., 2014). The purpose of this presentation is to explore the relationship between standardized assessment domains assessed at entry into treatment and the subsequent prescription of a family-focused treatment. The authors chose the word “prescribed” to reflect the clinical decision-making process that occurs when a clinician completes an assessment, and subsequently determines which treatment modality aligns with the needs of the client and the outcomes of the assessment.
This cross-sectional study utilized secondary data from a state-wide sample of youth in OOHC and referred for MH assessment. The standardized assessment tool used in this study was the Child and Adolescent Needs and Strengths assessment (CANS) (Praed Foundation, 2015) which is completed by the clinician, and consists of 6 domains. Family-focused treatment approaches were categorized into a dichotomous focus-of-treatment variable (DV). The focus-of-treatment variable allowed for a crosswalk between CANS outcomes, and prescribed family-focused treatment. Bivariate ANOVA and chi-square tests, and multivariate binary logistic regression were employed.
There were 2342 youth included in this study, of which 298 youth were prescribed a family-focused treatment. In the multivariate model, as CANS Life Domain (OR=1.11, p<.001) and Emotional/Behavioral needs domain (OR=1.06, p<.05) scores for youth increased, so too did the likelihood of being prescribed a family-focused treatment. Youth who received treatment from a community MH clinic as opposed to a residential provider were over two times more likely (OR=2.44, p<.001) to receive a family-focused treatment. Youth who were prescribed a trauma-focused (OR=2.06, p<.001), behavior-focused (OR=2.16, p<.05), or substance-used focused (OR=3.05, p<.001) treatment had an increased likelihood of being prescribed a family-focused treatment in conjunction. Nagelkerke pseudo R square explained 17% of the variance in family-focused treatment prescription.
Conclusion and implications:
The overall low rate of prescribed family-focused treatment may reflect barriers such as communication and collaboration between CW and MH providers, distance between family and placement, or a siloed approach to treating children in OOHC separate from their families. Decreased likelihood of family involvement for those in residential treatment may adversely impact clinical outcomes. Addressing these barriers through training and clinical supervision for clinicians tasked with assessing families’ needs and delivering family therapy is imperative. Cross-agency training regarding clinical approaches to address the needs of these youth and their families may increase prescription of such treatment. These approaches include understanding the familial context and role of family work, improving attitudes towards families, and skills for including them in the clinical decision-making process.