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ABSTRACTAlthough engaging fathers effectively can bolster and sustain treatment outcomes, fathers participate in their children’s treatment at lower rates than mothers and have been left out of the literature on caregiver engagement. Because provider attitudes and behaviors shape the course of treatment, therapist perspectives on father attendance and engagement should be investigated. A mixed-method study design examined rates and predictors of father attendance in treatment and therapist perspectives on father engagement in Parent-Child Interaction Therapy (PCIT). Quantitative data were gathered through a survey distributed to PCIT therapists (n = 267) to identify the effects of: 1) therapist and caseload characteristics, 2) therapist confidence working with fathers, 3) therapist use of father engagement strategies, and 4) organizational practices for engaging fathers, on father attendance rates. Qualitative interviews with 23 therapists were thematically analyzed to expand upon therapist experiences engaging fathers. Therapists reported that on average, 60.97% of cases with a father available had regular session attendance by the father. Only frequency of therapist use of father engagement strategies predicted father attendance rate. Qualitative interviews expanded on the many barriers therapists face to engaging fathers and the variety of strategies they employ to engage fathers. Rates of father attendance in PCIT are higher than what has been previously reported in the literature but still show room for improvement. Despite barriers, therapists remain dedicated to developing solutions to elicit father engagement. Future research should evaluate whether therapist-reported engagement strategies effectively increase father participation and can be more widely disseminated.

ABSTRACTEngaging caregivers in their children’s mental health treatment is critical for delivering high quality, evidence-based care, particularly for young children with externalizing behaviors. Lay health workers (LHWs), including peer providers and promotoras de salud, have been identified as important workforces in addressing structural and stigma-related barriers to engagement in mental health services. Importantly, research has suggested that LHWs may be integral in efforts to address engagement disparities in evidence-based behavioral parent training programs (BPTs) for Latinx caregivers. The purpose of the study was to understand how different LHW workforces engage caregivers within their usual services, in order to inform strategies that improve access to and engagement in BPTs. Qualitative interviews were conducted with two different LHW workforces: volunteer LHWs (i.e., promotoras de salud) (n= 14), who were part of a community-embedded network, and paid LHWs (i.e., parent support partners, home visitors) (n= 9) embedded within children’s mental health agencies. Participants were predominately Latinx (79%) and female (96%). Qualitative analyses revealed three primary themes related to engagement strategies used by LHWs to address barriers to care: 1.) Building Trust, 2.) Empowerment, 3.) Increasing Access. Although the majority of themes and sub-themes were consistent across the two LHW workforces, agency-embedded LHWs often discussed having the means to provide resources through their organizations, whereas community-embedded LHWs discussed acting as a bridge to services by providing information and conducting outreach. Findings have implications for partnering with different workforces of LHWs to increase equity in access to BPTs.

ABSTRACTLife stressors, or emergent life events, have the potential to interfere with child and family therapy processes and have been cited as barriers to implementing evidence-based practices (EBPs) for child mental health in community settings. The purpose of this study is to characterize the discussion of emergent life events in therapy sessions and examine its association with therapist delivery of EBP strategies, all within the context of system-driven implementation of multiple EBPs. Data were drawn from 680 audio-recorded psychotherapy sessions in which an EBP was delivered to 274 youth receiving care from 103 community therapists in 14 mental health agencies. Emergent life events were mentioned in 143 sessions (21.0%), with 77 sessions (11.3%) containing a mild intensity emergent life event and 66 sessions (9.7%) containing an emergent life event of at least moderate intensity (moderate to severe). Multi-level analyses found that session/EBP-, child-, therapist-, and agency-related factors were associated with the reporting of emergent life events in session. In addition, the reporting of an emergent life event of at least moderate intensity (moderate to severe) was associated with less extensive observed delivery of EBP strategies within the same session, whereas the reporting of an emergent life event of mild intensity was not significantly associated with the extensiveness of EBP strategy delivery. Emergent life events can influence the delivery of EBP strategies in community mental health services.