Child & Youth Care Forum

, Volume 48, Issue 1, pp 55–75 | Cite as

Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings

  • R. GellatlyEmail author
  • L. Brookman-Frazee
  • M. Barnett
  • J. C. Gonzalez
  • J. J. Kim
  • A. S. Lau
Original Paper



The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families.


The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists’ self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children’s mental health services.


One hundred and three therapists reported on two types of engagement challenges—Limited Client Engagement and Expressed Client Concerns—in 702 sessions with 274 clients.


Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists’ report of their ability to carry out intended activities in the same session.


Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.


Community mental health Dissemination and implementation Barriers EBP implementation Engagement 



This study was funded by NIMH (R01MH100134).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Access to Data

Resham Gellatly, M.A., Anna Lau, Ph.D., and Lauren Brookman-Frazee, Ph.D. take responsibility for the integrity of the data and the accuracy of the data analysis.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of California, Los AngelesLos AngelesUSA
  2. 2.University of California, San DiegoLa JollaUSA
  3. 3.Child and Adolescent Services Research CenterSan DiegoUSA
  4. 4.University of California, Santa BarbaraSanta BarbaraUSA

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