The primary goal of the proposed study is to identify factors which predict initial attendance and patterns of engagement in mental health services for low income, minority children. Initial attendance and engagement are proposed to be related, yet separate processes, influenced by specific characteristics of a child, their family and the service system, including factors related to agency procedures, providers, the service process, and the effectiveness of the service. More specifically, the proposed study aims to: 1) identify the impact of child psychopathology and demographic characteristics on initial attendance and patterns of engagement; 2) test whether specific barrier to engagement predict initial attendance and patterns of engagement; 3) determine which service system, service process and service provider characteristics explain patterns of engagement and/ (4) examine the relationship between parental reports of effectiveness of service and pattern of engagement. A single group, 16 week, longitudinal research design, with a 4 month follow-up will be use to examine 2 outcomes; 1) initial attendance (attending one mental health session) and; 2) patterns of engagement. We expect to identify 3 patterns of engagement: 1) minimally engaged (attending less than 3 scheduled appointments in a 16 week period:; 2) inconsistently engaged (attending at least 3 sessions, and missing more than 4 subsequently scheduled appointments); 3) consistently engaged (attending at least 3 sessions, and missing 4 or less subsequently scheduled appointments). Five hypotheses will be tested: (1) Demographic characteristics and level of child psychopathology will be directly related to initial attendance and patterns of engagement; family factors will be significantly more influential in predicting both initial attendance and patterns of engagement, than child needs and characteristics alone; (2) Barriers will explain initial attendance and pattern of engagement above and beyond that which can be explained by child and family factors; barriers will be more influential in predicting initial attendance, rather than engagement, (3) Adult caretakers satisfaction with service, motivation, and positive relationship with the service provider will explain patterns of engagement and will be more influential than child or therapist perspective; (4) The greater the discrepancy between therapists, adult caretakers and children in terms of process and provider characteristics the less consistently clients will be engaged over time; (5) Parental perception of a reduction in level of child psychopathology will directly affect patterns of engagement; the earlier that change occurs, the more likely families will be consistently engaged in ongoing services. A sample of 320 children will be identified based upon consecutive requests for mental health services at an urban child mental health agency. Caretakers, children and their therapists will be interviewed during this two year project. Data will be collected during the initial contact with the agency and at 4,8 and 16 weeks following initial request for services. Four months after the last data collection point, the clinic data base will be searched in order to identify a possible 4th pattern of engagement, families that drop out and later restart.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Small Research Grants (R03)
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Services Research Review Committee (SER)
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University of Illinois at Chicago
Schools of Medicine
United States
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McKay, Mary M; Lynn, Cynthia J; Bannon, William M (2005) Understanding inner city child mental health need and trauma exposure: implications for preparing urban service providers. Am J Orthopsychiatry 75:201-10
Harrison, Myla E; McKay, Mary M; Bannon Jr, William M (2004) Inner-city child mental health service use: the real question is why youth and families do not use services. Community Ment Health J 40:119-31