Eleanor Wu

Date of Award

Fall 2020

Document Type

Open Access Dissertation



First Advisor

Kimberly D. Becker


Promoting and maintaining client engagement has proven to be a significant challenge across community mental health settings, including within the context of implementing evidence-based treatments (EBTs) (De Haan et al., 2013). Few efforts have been made to equip providers with empirically-sourced engagement strategies outside of the limited set of engagement procedures covered in EBT protocols. To inform efforts for improving EBT accessibility, the current study characterizes the delivery of engagement practices from the literature within the context of EBT implementation, and examines provider integrity of engagement practice use according to two information sources (i.e., the provider’s EBT training history and delivered treatment protocol). Engagement practices from the literature were observationally coded in a sample of early treatment sessions (N=193) from the Child STEPs effectiveness trial (Chorpita et al., 2017). To assess integrity, EBT protocols that therapists were trained in were coded for engagement practices and two sets of expected values were established for each session according to the presence of different engagement practices in (1) the provider’s training history, and (2) the delivered treatment protocol. Fisher’s exact tests revealed a greater number of significant associations between provider-delivered protocols and engagement practice occurrence than provider training history and practice occurrence. Additionally, it was found that a narrow subset of engagement practices (n=5) from the literature occurred frequently across sessions, while the majority of coded practices (n=15) occurred in 30% or less of sessions. These findings highlight the opportunity to train therapists in a wider set of engagement practices beyond what is typically covered in EBT manuals. Providers’ tendency to stick to the protocol for engagement practice delivery indicates that it may be valuable to develop resources that support therapists to select and apply engagement practices that match their client’s specific engagement challenges, so to maximize the impact of EBTs on the well being of youth and families.


© 2020, Eleanor Wu