Gaps in Detection: Comparing Provider- and Client-Reported Indicators of Engagement in Youth Telemental Health.

Abstract

OBJECTIVE Detecting engagement problems is crucial for delivering timely engagement intervention. Telemental health services (TMH) present challenges to how providers assess engagement. This study examined how providers detected low engagement, both broadly and at the level of specific engagement dimensions, and how they characterized low and high engagement among active cases. METHOD Youth and/or caregivers (N = 153) receiving TMH completed a survey based on an empirically validated framework assessing five engagement dimensions, yielding scores indicating risk for low engagement. School-based providers (N = 49) completed a survey on which they identified indicators of low and/or high engagement for participating cases. Indicators were qualitatively coded across these five dimensions. RESULTS Nearly 40% of cases met a predefined cutoff for low engagement on the self-report survey; however, 79% of these cases were not identified by providers as at risk. For the 21% of cases in which low engagement was detected, provider-reported indicators matched the self-reported engagement dimension(s) 23% of the time. Low engagement was more likely to be accurately detected for participation-oriented dimensions (i.e. attendance, homework/in-session participation) than for process-oriented dimensions (i.e. relationship, expectancy, clarity) (p = .004). Providers predominantly reported indicators of high and low engagement consistent with attendance and homework/in-session participation. CONCLUSION Low engagement in TMH - especially when reflected in process-oriented engagement dimensions - is less consistently identified by providers. Tools such as multidimensional engagement surveys may facilitate early and ongoing detection of low engagement in service delivery, which could improve providers' ability to address engagement concerns.