(PS6-13) Factors Influencing Engagement in Youth Community-based Effectiveness Trials

Background:  

While there is some understanding of who participates in academic research trials, less is known about who participates in community-based effectiveness trials. An understanding of which individual characteristics are associated with study consent and participation in youth community-based effectiveness trials may inform recruitment efforts and provide an indicator of generalizability of study results. The current study examined which factors influenced engagement in services in a randomized controlled trial of a principle-guided approach to psychotherapy for youth in community settings. 

Methods:  

Youths aged 7-16 were eligible for participation in the study (n = 223) and referred for study participation by partner community mental health clinics during usual intake processes. Exclusion criteria included suicidality, primary treatment concern of ADHD, or a previous diagnosis of a developmental disability, intellectual disability, psychosis, or an eating disorder. Demographic variables available from study screening included child age in years (M = 11.29, SD = 2.43), sex (male, female, other) and primary language spoken at home (English, other). The Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001) was used to indicate caregiver-reported elevated levels of internalizing and externalizing symptoms (clinical cutoff of above 65); clinically elevated scores on the CBCL were required. Consent indicated caregiver agreement to participate in the study after an initial phone screen. Engagement in treatment was operationalized as attending an initial treatment session at the partner clinics. Multiple logistic regression analyses were run using IBM SPSS Statistics (Version 29.0.2.0).

Results:  

Of the eligible youths screened, 90.1% consented to participating in the clinical trial (n = 201), and, of the consenting youths that were not excluded, 57.6% attended a first psychotherapy study session (n = 102). The majority of participants were male (49.78%, n = 111) and spoke English at home (91.03%, n = 203). None of the demographic characteristics (e.g., child age, child sex, and English as primary language) were significant predictors of consent (all p’s > 0.092) nor attendance (all p’s > 0.206).  Clinically elevated externalizing symptoms were a significant predictor of both consent to study participation (p = 0.049) and treatment engagement  (p = 0.046). Clinical elevation of internalizing symptoms did not predict consent for study participation (p = 0.756) or treatment engagement (p = 0.239). 

Discussion:  

The results of the current study indicate that caregivers whose children have clinically significant externalizing symptoms are more likely to consent to participate in community-based effectiveness trials and to engage in treatment. These findings align with previous literature that demonstrates higher amounts of service utilization for youth with elevated externalizing problems (Sourander et al., 2001; Thurston et al., 2015; Wahlin & Deane, 2012). This suggests that factors influencing engagement in youth community-based effectiveness trials may mirror those influencing treatment engagement in routine care. Limitations, future directions, and implications will be discussed.