Identifying factors of parent engagement in a school-based mental health intervention : an mHealth approach




Smith, Lauren Tiffany

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African American and Latinx youth display higher rates of mental health concerns when compared to their White peers (SAMSA, 2015), while also demonstrating low rates of mental health care access. Systemic factors are typically linked to access to care (e.g., financial constraints, transportation, experiences of racism, and stigma) are often cited as culturally based, and are linked to the presence and exacerbation of mental health concerns (Garcia & Duckett, 2009; Gary, 2009; Hines-Martin, Malone, Kim, & Brown-Piper, 2009; Nadeem et al., 2007; Young & Rabiner, 2015). School-based mental health services improve access to care for historically underserved populations by alleviating commonly cited barriers to care (Green et al., 2013). Parental engagement in interventions help to support sustained positive outcomes over time (Shochet et al., 2001; Walczak, Esbjorn, Breinholst, & Reinholdt-Dunne, 2016). Cognitive-behavioral and family systems school-based interventions in particular view parents as integral to the process of change (Carpentier et al., 2007; Frazier, Abdul-Adil, Gathright, & Jackson, 2007; Gillham et al., 2006) yet minimal effort has been made to completely engage parents in the intervention itself. Parental engagement in school-based interventions is often hindered by factors (e.g., work demands, transportation) that prevent access to child mental health care overall (Koonce & Harper, 2011). mHealth (i.e., text message/SMS) interventions may increase parental engagement through the use of smartphones (Franklin, Waller, Pagliari, & Greene, 2006). Although mHealth interventions have indicated success in improving attrition rates through the convenience of accessing intervention content from a cell-phone (Howells et al., 2014; Martin, 2012), there is an absence of mHealth literature examining the efficacy of this approach as a tool for parental engagement in school-based mental health interventions. The purpose of the current study was to examine parent engagement an mHealth component in a school-based intervention as a measure of parent engagement, using a mixed methods design. A total of 34 parents participated (91% mothers, 80% Latinx, 21% Spanish-speaking). Correlation and regression analyses were conducted to examine research questions, and thematic analysis was used to interpret qualitative findings. Results indicated that the majority (74%) of parents responded < 40% of the time to weekly text messages. Correlation and regression results were not statistically significant for the relationship between text message response rate, socioeconomic status, and neighborhood factors, and effect sizes were small or close to zero (r’s from -.22 to .19). Qualitative data highlighted that technology, parent’s literacy level, community resources, transportation accessibility, and parent’s outcome expectancies can affect engagement in school-based services. A total of 10 themes emerged from the data. Findings from the study suggests that mHealth approaches require consideration of systemic factors that impact African American and Latinx parent’s interactions with services. Clinical implications are discussed.


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