A Multidimensional Examination of the Measurement of Treatment Engagement: Implications for Children’s Mental Health Services and Research

ABSTRACT

Objective

The gap between rates of children’s mental health problems and their participation in services highlights the need to address concerns related to engagement in mental health services more effectively. To identify, understand, and resolve engagement concerns appropriately requires effective measurement. In this study, we employed a multidimensional conceptual framework of engagement to examine the measurement of engagement in intervention studies focused on improving children’s and/or families’ engagement in services.

Method

We coded 52 randomized controlled trials (RCTs) of interventions designed to enhance treatment engagement published between 1974 and 2019 to examine what engagement constructs have been measured, how these constructs have been measured, who has provided information about engagement, and when and why engagement measures have been administered.

Results

Attendance was measured in 94.2% of studies, and 59.6% of studies measured only attendance. Furthermore, most studies (61.5%) measured only one engagement dimension. One hundred twelve unique indicators of treatment engagement were used (61.6% measuring attendance). Infrequent measurement of youth (19.2% of studies) or caregiver (26.9%) perspectives was apparent. About half (54.7%) of measures were completed on one occasion, with 53.7% of measures completed after treatment was concluded.

Conclusions

Results highlight how the field’s measurement of engagement has focused narrowly on attendance and on interventions that improve attendance. We consider promising new directions for capturing the multidimensional, dynamic, and subjective aspects of engagement, and for leveraging measurement in research and practice settings to feasibly and effectively identify, monitor, and address engagement challenges.

Acknowledgments

We wish to acknowledge Eric L. Daleiden, Ph.D., of Practicewise, LLC, and Richard P. Barth, Dean of the University of Maryland School of Social Work, for their leadership and contributions to the foundational work for this review.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Notes

¹ Sum of percentages exceed 100% because some studies were conducted in multiple settings.

² The sum of total unique indicators is 115 rather than 112 because two measures (noted in Table 3) assessed multiple domains.

Additional information

Funding

W.J. Bradley was supported by NIH-NIGMS (T32-GM081740). Publication contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NIH National Institutes of Health [T32-GM081740].