Facilitators and Barriers: Engagement, Retention, and Treatment of Young Children in Outpatient Mental Health Services

This study aimed to enhance understanding of barriers and facilitators to engagement and retention of children and families in outpatient mental health care from the perspective of young children, parents/caregivers, and clinicians as reflected in clinical treatment charts using an exploratory sequential mixed-methods design. Secondary data collaboratively recorded by the clinician in 100 charts representing cases of young children at the time of assessment and treatment planning was extracted from a partnering agency's electronic medical record. The data was first analyzed qualitatively to identify themes describing facilitators and barriers as collaboratively documented in the sample charts, followed by quantitative analysis of the frequency of the themes as well as to determine any significant relationships among themes and the identified race group or presenting problems in cases. Results include the child's own natural strengths, inclusion of the family and the child's larger support system, and a strong therapeutic alliance as key facilitators. Significant barriers identified are challenges associated with externalized behaviors, trauma exposure, family stress, and readiness to change. Implications of this study emphasize the need for social work interventions, service delivery models, and reimbursement models that accommodate both the individual child and the role of family and systemic supports as part of core interventions, as well as ensuring attention to trauma and readiness for change as part of assessment.