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in the literature, along with attempts by researchers to develop a common understanding of the term. For the purposes of this chapter, engagement is defined as including both (1) active and collaborative participation in treatment and (2) a process involving all activities from identification of families in need of mental health services to completion of treatment. Both of these components are keys to understanding the effective engagement of families in treatment. Engagement as Participation in Treatment Our conceptualization of engagement as participation emphasizes quality of participation in treatment, in addition to attendance. Although important, attendance alone does not correspond to genuine engagement, effort, response to treatment, or improved behavioral outcomes as much as does active and collaborative participation in treatment (Cunningham & Henggeler, 2004; Nix, Bierman, & McMahon, 2009; Yatchmenoff, 2005). Active and collaborative participation thus implies some level of client intentionality or motivation in completing treatment tasks and requires the therapist and client to participate equally in the treatment process. Engagement, from this perspective, has both behavioral components (e.g., attendance, completion of homework) and attitudinal components (e.g., motivation , commitment, belief in the treatment, confidence in the therapist) (Staudt, 2007; Yatchmenoff, 2005). Attitudinal components can distinguish between those who complete treatment and achieve the treatment goals and those who drop out prematurely or do not achieve behavioral change. For example, research shows that families are more likely to drop out of treatment early if they do not have confidence that the treatment will help and if they have not established a comfortable working relationship with their therapist (Kazdin, Holland, & Crowley, 1997; GENERAL CONSIDERATIONS As noted throughout this book, there are several evidencesupported and innovative approaches for treating children and families who have experienced abuse and other types of traumatic events. Unfortunately, these evidence-supported treatments are still not readily available and accessible to all children and families who need them (Burns et al., 2004). In particular, children affected by maltreatment and trauma exposure may be less likely than other children with mental health needs to be identified and referred for services (Chadwick Center for Children and Families, 2004) and also less likely to be engaged and retained in services once their family makes contact with a treatment provider (Lau & Weisz, 2003). Thanks to burgeoning research, there is a growing understanding of the factors that contribute to the service-need gap for families in community care settings and urban areas, and we have identified specific evidence-based strategies and skills for engaging families in effective services (e.g., McKay et al., 2004; Nock & Kazdin, 2001; Szapocznik et al., 1990). In this chapter we define what is meant by engagement, review common challenges to engaging families affected by child maltreatment and trauma in treatment, and focus on the role of the therapist in family engagement and the importance of cultural competence. We describe specific examples of effective and theoretically derived therapeutic engagement strategies for connecting children and families with evidence-supported treatments (ESTs). DEFINITIONS AND DESCRIPTIONS OF ENGAGEMENT IN CHILD MENTAL HEALTH SERVICE DELIVERY Several definitions of “engagement” in the context of child and family mental health service delivery have been offered The Importance of Therapist and Family Engagement in Treatment Implementation MARCELA M. TORRES, PH.D. MONICA M. FITZGERALD, PH.D. KIMBERLY L. SHIPMAN, PH.D. 25 The Therapist and Family Engagement in Treatment Implementation 263 identified and be referred for treatment, a large disparity remains between need and access to care for this group of children, particularly those who remain in their homes (Leslie et al., 2005; Stiffman et al., 1997). When conceptualizing engagement as a process, it becomes evident that successful engagement is not reliant on family behavior alone. Successful engagement depends also on the referring professional’s awareness of (1) children’s mental health treatment needs; (2) types of ESTs that can meet those needs; and (3) the type of communication and collaboration required to link families with appropriate treatment and to monitor treatment progress. Much work remains to be done in this area, although some promising pilot programs have been developed to address this need. For example, Project Focus is a training and consultation program for caseworkers and supervisors in child welfare. It is designed to enhance caseworkers’ awareness of mental health needs for children involved with child welfare and to provide training and consultation around linking children and families to ESTs (Dorsey et al., 2012; Kerns et al., 2010). Communication and collaboration with therapists is heavily emphasized to identify treatment components that address specific child mental health...

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