UCLA

Despite high mental health need among youth, a majority do not receive any mental health services (MHS), which suggests a disconnect between identification of need and connection to services. Equally troubling, among those who do enroll in MHS, engagement in those services is low, as reflected, in part, by poor attendance and high rates of dropout. Problems in either “initial” engagement, or the identification of need and connection to services, and “ongoing” engagement, such as completion of treatment once the presenting problem is resolved and positive attitudes towards treatment, may negatively impact improvement in youths’ mental health.

The goal of this dissertation was to examine treatment engagement in order to have the knowledge to strategically increase the impact of evidence-based treatments (EBTs). In light of noted discrepancy between mental health need and uptake into services, the first study examined the feasibility, acceptability, and preliminary efficacy of an engagement protocol (EP) designed to enhance school nurses’ utilization of evidence-based engagement practice elements when referring youth to MHS. School nurses reported positive attitudes towards the EP. There were also small increases in their use of engagement practices and adolescents’ readiness for services following training in the EP. The purpose of the second study was to examine the relationship between non-routine termination from services and long-term outcome trajectories in the context of a mental health system implementing EBTs. The impact of routine termination was most substantial for those receiving a modular treatment, though not for those receiving usual care or a standard EBT. The primary aim of the third study was to explore the impact of life stressors on ongoing engagement issues, such as poor attendance, low treatment satisfaction, and non-routine termination, by highly impoverished youth seeking treatment in community mental health clinics. Though certain demographic factors (e.g., youth age) and clinical factors (e.g., initial severity) affected engagement, the presence of life stressors did not. In sum, these dissertation findings suggest that both initial and ongoing treatment engagement are valuable quality improvement targets to raise enrollment in MHS and increase the impact of evidence-based practice for youth mental health conditions.