Table 1.
Randomized-controlled trials of interventions to improve engagement and retention: pre-treatment or early treatment strategies
| Study | Sample/setting | Intervention | Measures | Impact of intervention on outcomes? |
|
|---|---|---|---|---|---|
| Engagement | Retention | ||||
| Watt et al. (2007) | 262 families requesting treatment for conduct problems at two family outpatient therapy clinics in Australia Families scheduling initial appointments were consecutively assigned to groups |
Pre-treatment telephone reminders I = call reminder prior to appt. (n not reported) C = outpatient treatment as usual (no reminders) (n not reported) |
Engagement % of first 5 appts. attended Retention % of enrolled families who later refused treatment |
No I > C for families with higher conduct problems (subgroup analyses) |
No |
| McKay et al. (1996a); McKay and Bannon (2004) | 107 low-income, inner-city families requesting child mental health services in urban child outpatient clinic Families scheduling initial appointments were consecutively assigned to providers with training (I) or without training (C) |
Brief first session engagement interview I = provider received training to conduct engagement interview to clarify roles and therapy process, identify practical barriers, develop collaborative plan (n = 33) C = outpatient treatment as usual (providers received no training) (n = 74) |
Engagement % returning for 2nd session # of completed sessions in 18-week period |
Yes I > C (97 vs. 83%) attended 2nd session I > C (7.1 vs. 5.4 completed sessions) |
N/A |
| McKay et al. (1996b) | 109 low-income, inner-city families requesting child mental health services in urban child outpatient clinic Randomization in two steps: (1) intake requests were evenly divided among three groups; (2) after intake appointment was scheduled, I & I-2 families were randomly assigned to providers with (I) or without (I-2) engagement interview training |
Combined brief telephone and first session engagement interview I = combined condition; intake worker delivered 30-min telephone engagement discussion ? provider addressed engagement in 1st session (n = 35) I-2 = telephone engagement discussion only (n = 35) C = outpatient therapy as usual (no engagement intervention) (n = 39) |
Engagement # of completed sessions in 18-week period<vr>% of scheduled sessions completed |
Yes I > I-2 & C (7.3 vs. 5.0 vs. 5.9 completed sessions) I > I-2 & C(74 vs. 49 vs. 58% scheduled sessions completed) |
N/A |
| Szapocznik et al. (1988) | 108 Hispanic families with adolescents with substance use problems requesting family therapy at University community mental health center No information on type of randomization |
Brief telephone and early sessions Strategic Structural-Systems Engagement (SSSE) intervention I = prior to therapy, clinician implemented levels of the SSSE model (n = 56):
|
Retention % oompleted treatment |
N/A | Yes I > C (77 vs. 25%) (ITT) I > C (83 vs. 59%) (of enrolled families) |
| Santisteban et al. (1996) | 193 Hispanic families with adolescents with substance use problems requesting family therapy at University community mental health center No information on type of randomization |
SSSE (Szapocznik et al. 1988; see above) I = providers delivered SSSE prior to family therapy (n = 52) C = outpatient family therapy as usual (n = 67) C-2 = outpatient group-based family therapy as usual (n = 74) |
Engagement % adolescent and 1 family member attended intake and 1 session Retention % completing at least 8 h of therapy and termination assessment |
Yes I > C & C-2 (81 vs. 57 vs. 63%) (ITT) |
No |
| Coatsworth et al. (2001) | 104 Hispanic and African-American families with adolescents with behavior problems identified by parents or teachers referred to a University child mental health services center and community mental health agency Stratified randomization by ethnicity, after intake assessment |
SSSE (Szapocznik et al. 1988, see above) I = providers delivered SSSE (n = 53) C = outpatient family therapy at community agency as usual (n = 51) |
Engagement For I families, % adolescent and one family member attended intake and 1 session; for C families, % at least one family member attended 1 session Retention % completing clinician’s recommended treatment |
Yes I > C (81 vs. 61%) (ITT) |
Yes I > C (58 vs. 25%) (ITT) I > C (72 vs. 42%) (of enrolled families) For conduct problem families, I > C (subgroup analyses) |
| Dakof et al. (2003) | 103 low income, black mothers of infants exposed to drugs in utero referred to outpatient and inpatient drug rehabilitation clinics Stratified randomization (type of drug treatment, age, HIV status, extent of child welfare involvement) |
Brief provider support intervention I = specialist met with mother to enhance therapeutic relationship, review life history, address barriers for 8 weeks; once enrolled, specialist met with mother for 1st 4 weeks of treatment (n = 51) C = outpatient and inpatient treatment as usual (n = 52) |
Engagement % in treatment after 4 weeks Retention # of days in treatment over 90 day period |
Yes I > C (67 vs. 38%) (ITT) |
No |
| Spoth and Redmond (1994) | 387 families from 6 low-income rural school districts interested in a substance use prevention program for 6th–7th grade students at a University prevention research center Multiple step randomization: (1) 425 families randomly selected from school district lists and assigned to I or C group; (2) 387 were eligible and agreed to participate in study |
Offering partial then full vs. full prevention program I = families invited to participate in brief assessment, then 5- session drug prevention program (n = 137) C = traditional recruitment (recruited directly into 5 session prevention program) (n = 250) |
Engagement % attending each session Retention % completing program (5 sessions) |
No | No |
Note: N/A not assessed/not applicable, I intervention condition, C control condition, ITT intent-to-treat analyses. We note when there is more than one intervention condition with I-2, I-3, or I-4