Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children

Abstract

Objective: This study investigated a quality indicator for children’s mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children’s community mental health services. Method: Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. Results: Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. Conclusions: Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.

ACKNOWLEDGMENTS

This study is funded by the National Institute of Mental Health R01MH100134 awarded to ASL and LBF. Further, the time and effort to prepare this manuscript was supported by K01MH110608 awarded to MLB and K23MH110602 awarded to NS. Time and effort for BW was supported by the Robert Wood Johnson Foundation (ID: 74805).

Additionally, the preparation of this article was supported in part by the Implementation Research Institute (IRI) at the Brown School, Washington University in St. Louis, through an award from the National Institute of Mental Health (R25 MH080916). MLB is a fellow of IRI and ASL, LBF, and NS are past fellows of IRI.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute of Mental Health [K01MH110608, K23MH110602, R01MH100134]; Robert Wood Johnson Foundation [74805].