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Family Influences on Treatment Refusal in School-linked Mental Health Services

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Abstract

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their families participated. Results indicated that (1) family environment factors explained a significant amount of variance in treatment refusal after controlling for demographic factors, (2) families of children with predominantly internalizing symptoms were at greater risk for refusing treatment than families of children with predominantly externalizing symptoms, and (3) lower level of family cohesion was an individual risk factor for refusing treatment. Incorporating an evaluation of family environment within SLMHS assessments may aid in the identification of areas wherein intervention may be beneficial in preventing treatment refusal.

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References

  • Abidin, R. R. (1995). Parenting stress index clinical manual. Charlottesville, VA: Pediatric Psychology Press.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • Angold, A., Erkanli, A., Farmer, E. M. Z., Fairbank, J. A., Burns, B. J., Keeler, G., & Costello, E. J. (2002). Psychiatric disorder, impairment, and service use in rural African American and White youth. Archives of General Psychiatry, 59, 893–904.

    Article  PubMed  Google Scholar 

  • Angold, A., Messer, S., Stangl, D., Farmer, E. M. Z., Costello, E. J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88, 75–80.

    PubMed  Google Scholar 

  • Armbruster, P., & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children’s mental health clinic. American Journal of Orthopsychiatry, 64, 577–585.

    Article  PubMed  Google Scholar 

  • Armbruster, P., Gerstein, S. H., & Fallon, T. (1997). Bridging the gap between service need and service utilization: A school-based mental health program. Community Mental Health Journal, 33, 199–211.

    Article  PubMed  Google Scholar 

  • Armbruster, P., & Kazdin, A. E. (1994). Attrition in child psychotherapy. Advances in Clinical Child Psychology, 16, 81–107.

    Google Scholar 

  • Armbruster, P., & Lichtman, J. (1999). Are school based mental health services effective? Evidence from 36 inner city schools. Community Mental Journal, 35, 493–504.

    Article  Google Scholar 

  • Brannan, A. M., & Heflinger, C. A. (2005). Predictors of child mental health service utilization patterns: Comparison of managed care and fee-for-service Medicaid systems. Mental Health Services Research, 7, 197–211.

    Article  Google Scholar 

  • Brannan, A. M., Heflinger, C. A., & Foster, E. M. (2003). The role of caregiver strain and other familyvariables in children’s use of mental health services. Journal of Emotional and BehavioralDisorders, 11, 77–91.

    Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Campbell, C., Richie, S. D., & Hargrove, D. S. (2003). Poverty and rural mental health. In B. H. Stamm (Ed.), Rural behavioral health care: An interdisciplinary guide (pp. 41–51). Washington, D.C.: American Psychological Association.

    Chapter  Google Scholar 

  • Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20, 155–164.

    Article  PubMed  Google Scholar 

  • Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40, 313–332.

    Article  PubMed  Google Scholar 

  • Dierker, L., Nargiso, J., Wiseman, R., & Hoff, D. (2001). Family predictors of attrition within a community initiated system of care. Journal of Child and Family Studies, 10, 367–383.

    Article  Google Scholar 

  • DuPaul, G. J., & Eckert, T. L. (1997). The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis. School Psychology Review, 26, 5–27.

    Google Scholar 

  • Evans, G. D., & Rey, J. (2001). In the echoes of gunfire: Practicing psychologists’ responses to school violence. Professional Psychology: Research & Practice, 32, 157–164.

    Article  Google Scholar 

  • Farmer, E. M. Z., Burns, B. J., Angold, A., & Costello, E. J. (1997). Impact of children’s mental health problems on families: Relationship with service use. Journal of Emotional and Behavioral Disorders, 5, 230–238.

    Article  Google Scholar 

  • Foster, E. M. (1998). Does the continuum of care influence time in treatment? Evaluation Review, 22, 447–469.

    Article  Google Scholar 

  • Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70, 439–443.

    Article  PubMed  Google Scholar 

  • Garfield, S. L. (1989). Giving up on child psychotherapy: Who drops out? Comment on Weisz, Weiss, and Langmeyer. Journal of Consulting and Clinical Psychology, 57, 168–169.

    Article  PubMed  Google Scholar 

  • Greeno, C. G., Anderson, C. M., Stork, E., Kelleher, K. J., Shear, M. K., & Mike, G. (2002). Return to treatment after assessment in a community children’s mental health clinic. Psychiatric Services, 53, 624–626.

    Article  PubMed  Google Scholar 

  • Harrison, M. E., & McKay, M. M. (2004). Inner-city child mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40, 119–131.

    Article  PubMed  Google Scholar 

  • Haynes, S. N., & O’Brien, W. H. (2000). Principles and practice of behavioral assessment. Dordrecht, Netherlands: Kluwer Academic Publishers.

    Google Scholar 

  • Hoagwood, K., & Erwin, H. D. (1997). Effectiveness of school-based mental health services for children: A 10-year research review. Journal of Child and Family Studies, 6, 435–451.

    Article  Google Scholar 

  • Huey, S. J. Jr., Henggeler, S. W., Brondino, M. J., & Pickrel, S.G. (2000). Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology, 68, 451–467.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2004). Psychotherapy for children and adolescents. In A. E. Bergin, & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (5th ed., pp. 543–589). New York: John Wiley & Sons, Inc.

    Google Scholar 

  • Kazdin, A. E., & Mazurick, J. L. (1994). Dropping out of child psychotherapy: Distinguishing early and late dropouts over the course of treatment. Journal of Consulting and Clinical Psychology, 62, 1069–1074.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65, 453–463.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Mazurick, J. L., & Siegel, T. C. (1994). Treatment outcome among children with externalizing disorder who terminate prematurely versus those who complete psychotherapy. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 549–558.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65, 883–888.

    Article  PubMed  Google Scholar 

  • Masia-Warner, C., Klein, R. G., Crisp, H., Fisher, P. H., Alvir, J., Albano, A. M., & Cuardino, M. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology, 33, 707–722.

    Article  PubMed  Google Scholar 

  • Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Moos, R. H., & Moos, B. S. (2002). Family environment scale manual: Development, applications, research, 3rd ed. Palo Alto, CA: Mind Garden, Inc.

    Google Scholar 

  • McCormick, M. C., Kass, B., Elixhauser, A., Tompson, J., & Simpson, L. (2000). Annual report on access to and utilization of health care for children and youth in the United States—1999. Pediatrics, 105, 219–230.

    Article  PubMed  Google Scholar 

  • Nordal, K. C., Copans, S. A., & Stamm, B. H. (2003). Children and adolescents in rural, frontier areas. In B. H. Stamm (Ed.), Rural behavioral health care: An interdisciplinary guide (pp. 159–170). Washington, D. C.: American Psychological Association.

    Chapter  Google Scholar 

  • Owens, J. S., & Murphy, C. E. (2004). Effectiveness research in the context of school-based mental health. Clinical Child and Family Psychology Review, 7, 195–209.

    Article  PubMed  Google Scholar 

  • Paternite, C. E. (2005). School-based mental health programs and services: Overview and introduction to the special issue. Journal of Abnormal Child Psychology, 33, 657–663.

    Article  PubMed  Google Scholar 

  • Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). A social interactional approach: Vol 4. Antisocial boys. Eugene, OR: Castalia.

    Google Scholar 

  • Perrino, T., Coatsworth, J. D., Briones, E., Pantlin, H., & Szapocznik, J. (2001). Initial engagement in parent-centered preventive intervention: A family systems perspective. The Journal of Primary Prevention, 22, 21–44.

    Article  Google Scholar 

  • Phillips, D. R., Schwean, V. L., & Saklofske, D. H. (1997). Treatment effect of a school-based cognitive-behavioral program for aggressive children. Journal of School Psychology, 13, 60–67.

    Google Scholar 

  • Prinz, R. J., & Miller, G. E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62, 645–650.

    Article  PubMed  Google Scholar 

  • Prodente, C. A., Sander, M. A., & Weist, M. D. (2002). Furthering support for expanded school mental health programs. Children’s Services: Social Policy, Research, and Practice, 5, 173–188.

    Google Scholar 

  • Reynolds, C. R., & Kamphaus, R. W. (1998). Behavior assessment system for children manual. Circle Pines, MN: American Guidance Service, Inc.

    Google Scholar 

  • Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3, 223–240.

    Article  PubMed  Google Scholar 

  • Sanford, K., Bingham, C. R., & Zucker, R. A. (1999). Validity issues with the Family Environment Scale: Psychometric resolution and research application with alcoholic families. Psychological Assessment, 11, 315–325.

    Article  Google Scholar 

  • Sayger, T. V., & Heid, K. O. (1990). Counseling the impoverished rural client: Issues for family therapists. Psychotherapy Patient, 7, 161–168.

    Article  Google Scholar 

  • Snell-Johns, J., Mendez, J. L., & Smith, B. H. (2004). Evidence-based solutions for overcoming access barriers, decreasing attrition, and promoting change with underserved families. Journal of Family Psychology, 18, 19–35.

    Article  PubMed  Google Scholar 

  • Storch, E. A., & Crisp, H. L. (2004). Taking it to the schools—Transporting empirically-supported treatments for childhood psychopathology to the school setting. Clinical Child and Family Psychology Review, 7, 191–193.

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services (USDHHS). (1999). Mental health: A report of the surgeon general. Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  • Vanderbleek, L. M. (2004). Engaging families in school-based mental health treatment. Journal of Mental Health Counseling, 26, 211–224.

    Google Scholar 

  • Weissman, M. M., Wolk, S., Wickramaratne, P., Goldstein, R. B., Adams, P., Greenwald, S., Ryan, N. D., Dahl, R. E., & Steinberg, D. (1999). Children with prepubertal onset major depressive disorder and anxiety grown up. Archives of General Psychiatry, 56, 794–801.

    Article  PubMed  Google Scholar 

  • Weist, M. D., & Paternite, C. E. (2006). Building an interconnected policy-training-practice-research agenda to advance school mental health. Education and Treatment of Children, 29, 173–196.

    Google Scholar 

  • Weist, M. D., Evans, S. W., & Lever, N. A. (2003). Advancing mental health practice and research in schools. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 1–7). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Weist, M. D., Paskewitz, D. A., Warner, B. S., & Flaherty, L. T. (1996). Treatment outcome of school-based mental health services for urban teenagers. Community Mental Health Journal, 32, 149–157.

    Article  PubMed  Google Scholar 

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Correspondence to Mary L. Keeley.

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Keeley, M.L., Wiens, B.A. Family Influences on Treatment Refusal in School-linked Mental Health Services. J Child Fam Stud 17, 109–126 (2008). https://doi.org/10.1007/s10826-007-9141-6

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  • DOI: https://doi.org/10.1007/s10826-007-9141-6

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