Building Bridges: Engaging Families
in Child Mental Health Services
Tierra Sydnor-Diggs, LGSW
Objectives
• 1. Identify common barriers to engagement from
both the perspective of the service provider and
the family
• 2. Identify goals of engagement at each stage of
the treatment process from the start of services
up until the moment of discharge.
• 3. Understand critical elements necessary for
engaging families.
• 4. Participants will learn to go beyond barriers
and myths often associated with disengaged
families.
Roll Call !!!!!
Understanding Engagement
• Family engagement is a family centered and
strengths-based approach to partnering with families
in making decisions, setting goals, and achieving
desired outcomes.
• It supports the disclosure of culture, family
dynamics, and personal experiences in order to meet
the individual needs of every child and family.
• Engagement is the foundation and essential process
in the clinician-client relationship from the moment a
family is considered for treatment until they are
discharged.
Understanding Engagement Continued
• Although attendance is important and a necessary component of
engagement, research shows that there are key behavioral components as
well.
• According to a review by Staudt (2007), the following behavioral
components are essential to gage a families level of engagement.
-Attendance
-Participating in sessions (e.g., talking about relevant topics,
practicing new skills.
-Completion of homework assignments
-demonstration of progress towards goals
-discussing feelings and engaging in efforts outside of sessions
(Cunningham & Henggeler,1999; Hansen & Warner, 1994; Prinz & Miller,
1999; Staudt, 2007)
Benefits of Family Involvement in Child
Mental Health
• Minimizes stigma and feelings of distrust by improving
communication (Linhorst & Eckert, 2003)
• Improves activation in seeking care (Alegria et al., 2008)
• Improves self-efficacy- i.e., active participation in
decision-making (Heflinger & Bickman, 1997; Bickman et
al.; 1998)
• Improves knowledge and beliefs about children’s mental
health and this is associated with use of higher quality of
services for children (Fristad et al., 2003; 2008)
More on the Benefits of Family
Engagement
• Enhances the helping relationship
• Promotes family “buy in”
• Problematic behaviors exhibited by the child
decrease
• Enhances the fit between family needs and
services
(Child Welfare Information Gateway)
Let’s Chat
In a small group discuss obstacles and/or barriers
that you have encountered as you tried to involve
children and their families in mental health
services. Look at the perspective of the family and
as the professional.
Barriers to Engagement
• Barriers can reside with the family, the provider
and/or the system in which the provider works.
• Common concrete obstacles may include time,
other priorities, transportation, child care ,
agency waiting list
• Common perceptual obstacles may include
attitudes about mental health, stigma, prior
experiences, race, ethnic/cultural issues,
recognition of poverty, safety and the parents’
personal needs and stressors.
Research Findings on Barriers to
Engagement
• Addressing perceptual barriers may be more
important than focusing only on concrete
obstacles.
• Perceptual barriers (e.g.; parent stressors) and
prior negative experiences have been shown
to have the greatest influence on initial and
ongoing engagement.
Family Engagement Video
Key Elements Needed for Fostering Healthy,
Supportive and Trusting Relationships in the Family
Engagement Process
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Clear, honest, and respectful communication
Commitment to family centered practices
Sufficient frequency and length of contact
A strengths based approach
Shared decision-making and participatory planning
Broad based involvement
Understanding the role of confidentiality
Appropriate individualized treatment plans
Address concrete needs
Praise and recognition of parents/families
Key Elements From a Systems Perspective to
Foster Effective Family Engagement
• Agency leadership that demonstrate a commitment to family
centered practices.
• Organizational culture that models desired behaviors,
actions, and communication.
• Program improvement plans that detail strategies for family
and youth involvement.
• Policy and standards that clearly define expectations and
identify requirements for family engagement.
• Professional training and coaching on skills such as family
engagement techniques, effective communication skills and
cultural diversity.
LET’S CHAT
Think about some of your favorite stores that you
patronize on a regular basis. What are factors that keep
you going back to shop at the store? What are factors
that will cause you not to return to a particular store?
How do you think some of the same factors effect
families decisions as to whether or not they will continue
to participate in mental health services?
Tools For Building the Bridge Between
Families and Mental Health Services
Just like building an actual bridge, engaging
families in mental health services is a
process which often requires patience,
time and the right tools.
Goals of Early Engagement
• Help the family process and clarify the need
for mental health care
• Increase caregiver investment
• Assist caregivers with discussing attitudes
about previous experiences with mental
health care services and institutions
• Problem-solve around obstacles (concrete and
perceptual) to care
Goals of Retaining Families
• Setting and maintaining a strengths based tone to
treatment through empowerment and keeping them
involved in the treatment process.
• Friendly reminders of appointments.
• Continue discussions identifying barriers to ongoing
involvement in treatment.
• Identify barriers that impact the change process.
• Encourage parents to attempt new strategies and
problem-solving skills in their daily lives.
Interventions That Promote
Engagement
• Early Engagement Strategies:
-Use of telephone prompts/scripts during initial
contact with the clinic.
-Use of reminder phone calls and/or letters
about appointment dates and times.
-Having paraprofessionals and clinical staff
available to address parents concerns.
Interventions That Promote
Engagement
• Technology Based Interventions
-Telephone reminders about appointments,
especially directly from the therapist or helping
professional.
-Text message reminders about appointments
-Web-based appointment system that allows
clinicians and staff to make, change and confirm
appointments
Interventions That Promote
Engagement
• Use of paraprofessional staff
-Utilizing trained parents or family advocates
who have special needs children themselves.
-Family advocates are trained and coached to
help support families in need of mental health
services utilizing the skills they have already
developed in obtaining services for their own
children.
Interventions That Promote
Engagement
• Strengths based: Motivational Interviewing
-MI is a counseling approach developed by
clinical psychologist Professor William R. Miller,
Ph.D. and Professor Stephen Rollnick, Ph.D.
-MI is goal oriented and client centered.
-MI techniques can be used in the work done
with families for eliciting behavior change by
helping them to explore and resolve
ambivalence.
A Day in the Life of a Family At Your
Site…….
Think about a first contact with a parent and
their child at your site. Based on our discussion
today, describe what would make the
experience perfect for that parent and child.
What might you do different from what you may
have previously done during your interaction
with families in the past?
Steps Moving Forward
Improving how we engage our families in mental health
services should be a continuous process involving
careful planning, monitoring, evaluation and use of the
findings to refine your agencies family engagement
plan.
Q&A
Questions/Remarks
References
Gopalan,G., Goldstein, L., Hoagwood K., Rodriguez J., Murray L., Legerski J. (2010). Engaging Families into Child
Mental Health Treatment: Updates and Special Considerations. Canadian Academy of Child and Adolescent
Psychiatry, 19(3): 182-196
Mckay MM, Bannon WMJ. Engaging Families in Child Mental Health Services. Child and Adolescent Psychiatric
Clinics of North America. 2004; 13(4): 905-921 [PubMed]
Mckay MM, Hilbert R, Hoagwood K, Rodriguez J, Murray L, Legerski J. Integrating Evidence-Based Engagement
Interventions Into “Real World” Child Mental Health Settings. Brief Treatment and Crisis Intervention Vol. 4,
No. 2, 2004
www.childwelfare.gov/pubs/f_fam_engagement/
Video: Centre of Excellence: What is Family Engagement
(www.youtube.com)
Resources
1.Family Navigators: www.mdcoalition.org
2.Federation of Families for Children’s Mental
Health: www.ffcmh.org
3.Motivational Interviewing Training in
Maryland:
https://theinstitute.umaryland.edu/topics/ebpp
/interview.cfm
4.Motivational Interviewing:
http://www.motivationalinterver.org
Contact Info
Tierra Sydnor-Diggs, LGSW
Tsydnor@psych.umaryland.edu