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Articles   |    
Characteristics of Community Mental Health Clinics Associated With Treatment Engagement
Gabriela L. Stein, Ph.D.; Catherine S. N. Lee, M.D.; Ping Shi, Ph.D.; Benjamin L. Cook, Ph.D., M.P.H.; Dea Papajorgji-Taylor, M.A.I.S., M.P.H.; Nicholas J. Carson, M.D., F.R.C.P.C.; Margarita Alegría, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300231
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Dr. Stein is with the Department of Psychology, University of North Carolina, Greensboro (e-mail: glstein@uncg.edu). Dr. Lee is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island. Dr. Shi is with the Forsyth Institute, Cambridge, Massachusetts. Dr. Cook, Dr. Carson, and Dr. Alegría are with the Department of Psychiatry, Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston. Ms. Papajorgji-Taylor is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  Past literature documents many individual predictors of treatment engagement among mental health clients in community settings, but few studies have examined clinic characteristics that may be associated with treatment engagement. With data from a patient activation and self-management trial, this study examined the variation in demographic and clinic characteristics across community mental health clinics and whether this variation predicted differences in treatment engagement in mental health services.

Methods  Chart reviews were conducted for 638 clients of 12 community mental health clinics. Client attendance records were collected for a one-year period to examine engagement (defined as the ratio of kept versus scheduled appointments). Adjusting for client variability, the investigators examined which clinic-level characteristics were associated with treatment engagement.

Results  Clinics varied significantly in their clients’ demographic characteristics and engagement in mental health care. Providing case management and offering transportation vouchers or free parking at the clinic were associated with lower engagement. However, offering outreach was associated with greater engagement.

Conclusions  The results of this study suggest that certain clinic characteristics are associated with engagement in mental health services. These results demonstrate the difficulties faced by community mental health clinics in reducing no-show rates even in the face of strong efforts to improve engagement.

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Table 1Sociodemographic characteristics of study participants at 12 community mental health clinicsa
Table Footer Note

a All between-site differences except gender were significant at p<.001.

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Table 2Characteristics of 12 community mental health clinics, by site and total
Table Footer Note

a Proportion of scheduled appointments attended

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Table 3Predicted rates of engagement in mental health care after adjustment for individual-level characteristicsa
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a Predicted rates were generated by the “recycled predictions” method, which generates predictions with and without the area-level predictor of interest after adjustment for individual-level factors.

Table Footer Note

b The sample size was 417 because the comparison was limited to Latinos.

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*p<.05, **p<.001

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