Modification of an observational tool to evaluate how community health workers engage low-income latino parents in parent-child interaction therapy.

Background: Caregiver engagement in behavioral parent training (BPT) interventions can have a significant impact on treatment outcomes and retention. Yet, low-income families of color often experience low rates of engagement in treatment due to structural and sociocultural barriers. BPT models partnering with community health workers (CHWs) have shown promise in addressing these barriers and increasing treatment engagement. The current study examines the engagement strategies utilized by CHWs when providing support to families receiving Parent-Child Interaction Therapy (PCIT + CHW) by identifying common CHW engagement strategies utilized in treatment (e.g., active listening, psychoeducation) and how they influence components of engagement (e.g., alliance, attendance). Methods: Among families receiving a telehealth delivered PCIT + CHW model ( Results: Findings suggest that, on average, CHWs utilized total strategies (i.e., sum of all strategies) and alliance-based strategies (i.e., active listening, conveying partnership, and positive regard) to a moderate extent. Alliance strategies delivered during the first session were associated with caregiver-perceived therapeutic alliance, caregiver-perceived effectiveness of the tasks guiding treatment, and caregiver homework completion in the first phase of treatment. Conclusion: Findings indicate CHWs use a range of engagement strategies, and early use of alliance-based strategies influence multiple components of engagement. Implications for training and involving CHWs in children's mental health services are discussed.