Children with antisocial, aggressive and disruptive behaviours pose considerable concern to families, educators and the wider community. A major barrier to implementing effective interventions is treatment non-attendance and attrition. The dissertation examines treatment participation among children with conduct problems, and their families, referred to child and youth mental health services. First, a model of treatment engagement was proposed that included Structural strategies (clinic service operations, such as service accessibility) and Therapy Process strategies (aspects of the interaction between the clinician and the family of the referred child). Consistent with the model of engagement, parent-report and clinician-report measures were developed and evaluated in the local Queensland Child and Adolescent Mental Health Services. The next study explored and manipulated Structural aspects in a randomised control trial evaluating the impact of telephone reminder calls. Families of children with conduct problems, in comparison to children without conduct problems, were more likely to miss appointments and to drop out of treatment. The low rate of treatment attendance for conduct problem children was diminished among those assigned to the telephone reminder condition. In the final study, the impact of a clinician training program covering the proposed engagement model was evaluated. Utilising a multiple-staggered baseline design, the training impact on clinician behaviour (n = 30) and client outcomes (n = 221) was evaluated across three mental health services. The training program was associated with a significant increase in clinicians' appraisal and use of the engagement strategies based on clinician report and chart audit measures, but not on the parent report measure. In comparison to clients referred during a baseline period, clients referred after the clinician training program had significantly higher rates of treatment attendance and lower attrition. Greater improvement in mental health functioning was found for clients referred after the training intervention on the clinician rated measure, but not for the parent report of child psychopathology. The study was limited by the use of previously un-validated engagement measures, lack of follow-up for outcome measures, and non-random allocation to conditions. The staggering of interventions across clinics and the comparability of client groups, however, minimised potential confounding explanations. Overall the results show that targeting Structural and Therapy Process aspects can enhance engagement, reduce drop-out, and improve selected outcomes in the treatment of child conduct problems.
| Identifer | oai:union.ndltd.org:ADTP/242978 |
| Date | January 2007 |
| Creators | Watt, Bruce David, Psychology, Faculty of Science, UNSW |
| Publisher | Awarded by:University of New South Wales. Psychology |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Bruce David Watt, http://unsworks.unsw.edu.au/copyright |
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