Wendy Chu

Date of Award

Spring 2022

Document Type

Open Access Thesis



First Advisor

Kimberly D. Becker


Racially marginalized youth experience barriers that impact their ability to maximally benefit from mental health services; thus, efforts to identify strategies that support youth treatment engagement may address mental health and treatment disparities. This study examined the role of youth race, youth-therapist racial matching, and youthreported therapist cultural understanding on youth’s early treatment engagement in mental health services. The youth sample (n = 1159; Mage = 13.8 years, SD = 2.9; 52.1% female) comprised of 778 (67.1%) Latinx, 221 (19.1%) African American, 139 (12.0%) White, and 21 (1.8%) Asian American clients. The therapist sample (n = 126; Mage = 38.0 years, SD = 9.7; 92.9% female) comprised of 60 (47.6%) Latinx, 46 (36.5%) African American, 16 (12.7%) White, and 4 (3.2%) Asian American providers. Engagement was measured multidimensionally approximately four weeks after the first session using the My Thoughts about Therapy. Cultural understanding was measured using an item that asked youth to indicate the extent to which their therapist “understands their culture and values.” Three multivariate multiple linear regression models were conducted to assess the predictive power of race, racial matching, and cultural understanding on youth treatment engagement. Results revealed that youth race and racial matching was not a significant predictor of any domain of treatment engagement after controlling for age, gender, and state, p’s > .12. Cultural understanding was a significant predictor for all five engagement domains after controlling for demographic variables, p’s < .001. Cultural understanding had the highest average effect size (ηp2 ) across the five treatment engagement domains (28%) compared to youth race (0%) and racial matching (0%). Race did not moderate the effects of racial matching and cultural understanding on engagement, p’s > .10. These findings demonstrate that youth race and racial matching were not associated with youth treatment engagement. Also, youth-reported therapist cultural understanding was positively associated with treatment engagement in the early phase of treatment, regardless of youth race. Building therapist’s cultural competence and increasing youth’s perception of their therapist’s cultural understanding may be an impactful strategy for engaging racially marginalized youth early in mental health services.


© 2022, Wendy Chu