The Influence of Treatment Engagement on Positive Outcomes in the Context of a School-Based Intervention for Students with Externalizing Behavior Problems

Michael A Lindsey, Meghan Romanelli, Mesha L Ellis, Edward D. Barker, Caroline L Boxmeyer, John E Lochman

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

We examined the stability of and cross-influences between externalizing behaviors and intervention engagement among children participating in a randomized clinical trial of an intervention for disruptive behavioral youth. Analyses also accounted for the influence
of caregiver depression, family relationship quality, and sociodemographic factors (race, income) on the relationship between behaviors and intervention engagement. Analyses were based on 118 children participating in the Coping Powerintervention. Composite variables were created to represent externalizing behaviors and intervention engagement constructs. Associations between these composite variables were examined over 24 treatment sessions. Findings indicated a regressive relationship among externalizing behaviors, i.e., baseline externalizing behaviors were positively associated with immediate follow-up behaviors. There were also dynamic relationships
observed among engagement constructs. Notably, engagement with in-session activities during sessions 1–8 was positively associated with out-of-session activity engagement during the same treatment time period. Engagement with out-of-session activities during
sessions 1–8 was positively associated with in-session activity engagement during sessions 9–16, indicating a complete mediation between early and middle in-session engagement through the mechanism of early out-of-session engagement. A crosslag relationship was observed: middle in-session engagement was negatively associated with externalizing behaviors at immediate follow-up. Finally, an interaction of race by income on immediate follow-up externalizing behaviors was observed, such that Black children’s externalizing behaviors remain static regardless of income level while White children’s behaviors decreased with higher income. Our findings support
the contention that focusing on intervention engagement may be especially important in prevention interventions
Original languageEnglish
Pages (from-to)1437-1454
Number of pages18
JournalJournal of Abnormal Child Psychology
Volume47
Issue number9
Early online date8 Mar 2019
DOIs
Publication statusPublished - 15 Sept 2019

Keywords

  • Caregiver depression
  • Child behavior problems
  • Engagement
  • Family income
  • Prevention intervention

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