Youth and families, particularly those from ethnic minority backgrounds, demonstrate high levels of unmet need (Kataoka, Zhang, & Wells, 2002), and when they do initiate care, they often experience significant barriers to engagement in child mental health services (MHS; Kazdin, 1993; McCabe, 2002; Morrisey-Kane & Prinz, 1999). Active parent participation in child MHS has been associated with improved outcomes compared to individual child treatment (Dowell and Ogles 2010). Yet, parents are often uninvolved in their child's therapy, and this may be a particular problem in school-based mental health services (SBMHS). SBMHS offer the advantage of increasing access to care (Atkins, 2003), but there appears to be an overreliance on individual counseling (Cerio, 1997; Weist, 1997). Psychoeducation, a therapeutic practice used to present factual information about MH problems and treatments, may be a powerful tool for preparing families for treatment, thereby promoting parental engagement in care.
Study 1 examined the unique effect of therapists' use of psychoeducation strategies, over and above use of engagement strategies, on promoting parental engagement among an ethnically diverse sample of 46 families that received community-based child MHS for disruptive behavior problems. Families were randomized to receive treatment in an evidenced-based (a modular manualized treatment, MMT) or usual care (UC) treatment within the same community agencies. An observational coding system was developed to code recorded therapy sessions for therapists' in-session use of psychoeducation and engagement strategies in the early phase of treatment. Findings revealed that psychoeducation strategies employed by therapists early on uniquely predicted later parent attendance in treatment, over and above the use of other engagement strategies. Furthermore, therapists in MMT provided more psychoeducation and other engagement strategies compared to therapists in UC. Finally, treatment condition predicted parent attendance with parents in MMT attending a greater proportion of treatment sessions than parents in UC, and this difference was mediated by therapist's use of psychoeducation strategies.
Study 2 employed a mixed methods approach to investigate patterns of parental participation in a sample of ethnic minority families who received SBMHS. Administrative data on parent involvement was assessed, and a sample of 20 Latino and Chinese American parents of children that received SBMHS were interviewed to assess their level of participation in services and to document therapist implementation of basic psychoeducation practices in care. Findings from quantitative, administrative data suggest that parent participation in SBMHS was quite low. Qualitative interviews suggested that parents were motivated to be involved in their child's services, but encountered barriers to treatment participation, and their participation was often not solicited by therapists. A majority of parents reported that they were uninformed about their child's presenting problems and various aspects of the treatment process, suggesting limited use of even basic psychoeducation by therapists in their child's SBMHS. Together, findings from Study 1 and 2 suggest that there is a major opportunity to implement psychoeducation-based engagement practices upon entry into care to promote parent involvement in child MHS, whether in community clinics or school-based services.