Engaging Families in Treatment: Whose Responsibility Is It?

The original mission of Children’s Advocacy Centers (CACs) was to improve a community’s response to the investigation of child abuse. The advances in our knowledge of trauma and the availability of mental health treatments effective in reducing the negative impact of trauma expanded the focus of CACs to include helping children and families heal.

In support of this expanded focus, National Children’s Alliance (NCA) included access to and delivery of these evidence-based mental health services as part of our Mental Health Standard in the 2017 Standards for Accredited Members and has focused resources to support training CAC therapists to deliver evidence-based services. These efforts have clearly increased families’ access to treatment, but all the news isn’t good. According to feedback collected through NCA’s Outcome Measurement System, 81% of caregivers could identify that they received information about treatment options for their children. However, when looking at follow-up on those referrals, just 46% of all children served by CACs in 2018 actually participated in treatment according to caregivers. Additional data showed that a primary barrier to participating in available treatment was caregivers’ belief that their child did not need such services. This is disturbing, as participation in evidence-based treatment (EBT) is critical to the goal of healing and improved child well-being outcomes.

Research has identified the caregiver as critical to improving children’s outcomes. Clearly, in order to increase participation in EBTs, we must engage their caregivers—but whose job is it? Through my own experience as a mental health provider and as a multidisciplinary team (MDT) partner, I realized that it was expected that the family that was motivated would engage, and those who weren’t motivated would not. Most often, the response was to leave the decision up to the family, and when a family failed to follow through with mental health treatment, the system response was often to “blame” the family. Overwhelmed families in crisis were commonly left to follow through on their own. This type of response fails to consider the impact of the crisis of abuse on the family and their lack of knowledge about how treatment could benefit them. In addition we know sometimes mental health services are “court-ordered,” and failing to participate can result in negative “system” consequences for the family that can further exacerbate already existing trauma.

If we as CAC professionals are committed to improving outcomes for those we serve, we must rethink these responses. Our MDT must take responsibility to learn and utilize strategies to engage the caregiver/family and accept an expanded definition of family engagement beyond the family showing up at the first appointment. Family engagement involves attendance and participation in treatment to completion. Family engagement also involves collaboration with the family by listening to and involving the family in identifying their strengths, needs, and problems. And to learn what is important to them and to their child by identifying them as the expert regarding these issues. And perhaps mostly importantly, we have to (1) involve the family in the development and implementation of intervention plans; (2) develop a relationship that can begin to increase trust; (3) provide support and help reduce barriers to treatment; and (4) communicate to the child and family our belief that they deserve effective services to heal from any negative impact of their abuse and traumatic experience.

The Mental Health Standard in the 2017 Standards for Accredited Members defines the services available to support healing from the trauma of abuse. To benefit from these services requires family participation. I invite Accredited NCA members to go to learn.nationalchildrensalliance.org/family-engagement-training (login required) to learn about an exciting training opportunity for CACs designed to strengthen their ability to engage families in believing in the value of treatment and to increase participation in mental health treatment to support healing and child well-being.

Do the children and families we serve deserve anything less?

Libby Ralston is director emeritus of Dee Norton Child Advocacy Center in Charleston, S.C., and co-director of Project BEST. This is the first of three posts from Libby about family engagement.