Modification of an observational tool to evaluate how community health workers engage low-income latino parents in parent–child interaction therapy

Abstract

Background Caregiver engagement in behavioral parent training (BPT) interventions can have a significant impact on treatment outcomes and retention. Yet, low-income families of color often experience low rates of engagement in treatment due to structural and sociocultural barriers. BPT models partnering with community health workers (CHWs) have shown promise in addressing these barriers and increasing treatment engagement. The current study examines the engagement strategies utilized by CHWs when providing support to families receiving Parent–Child Interaction Therapy (PCIT + CHW) by identifying common CHW engagement strategies utilized in treatment (e.g., active listening, psychoeducation) and how they influence components of engagement (e.g., alliance, attendance). Methods Among families receiving a telehealth delivered PCIT + CHW model (n = 26), two recorded sessions (i.e., first session and a second randomly selected session throughout treatment) per family were coded for engagement strategy delivery. Families included primarily Latino children (96%) and their primary caregivers. Data about caregiver perceived therapeutic alliance, treatment attendance, homework completion, and PCIT skill acquisition were collected. Results Findings suggest that, on average, CHWs utilized total strategies (i.e., sum of all strategies) and alliance-based strategies (i.e., active listening, conveying partnership, and positive regard) to a moderate extent. Alliance strategies delivered during the first session were associated with caregiver-perceived therapeutic alliance, caregiver-perceived effectiveness of the tasks guiding treatment, and caregiver homework completion in the first phase of treatment. Conclusion Findings indicate CHWs use a range of engagement strategies, and early use of alliance-based strategies influence multiple components of engagement. Implications for training and involving CHWs in children's mental health services are discussed.