Low engagement is a significant problem in youth mental health services. In clinical practice, assessment of a problem is integral to its successful resolution, and yet little is known about what methods providers use to assess treatment engagement or what indicators they use to infer high or low engagement. Thirty-five providers serving youth and families primarily through school-based mental health services in an urban setting participated in a workshop training on engagement procedures. Prior to the training, providers responded to open-ended questions about their own clients demonstrating high and low treatment engagement. Behavioral observation was the method reported most by providers to assess client engagement (94.3%), followed by spontaneous self-report by the youth or caregiver (22.9%). No providers reported using psychometric instruments to assess engagement. Types of engagement indicators used also differed according to level of engagement. For low engagement, 74.3% of providers reported using their observations of attendance, whereas for high engagement, 68.6% of providers described relying on observations of in-session participation or out-of-session homework. Few providers described using indicators related to the therapeutic relationship, client expectancies related to treatment, or client comprehension of the treatment approach and related goals. These results highlight opportunities for improving resources to support the assessment of engagement. Such resources could help providers know not only which clients need support but also where to focus that support and how to do so early enough to create a larger window of opportunity for change.

参与度低是青年心理健康服务的一个重大问题。在临床实践中，对问题的评估是其成功解决不可或缺的一部分，但对于提供者使用什么方法评估治疗参与度或他们使用哪些指标来推断高参与度或低参与度，我们知之甚少。在城市环境中，主要通过以学校为基础的心理健康服务为青年和家庭提供服务的 35 名提供者参加了关于参与程序的研讨会培训。在培训之前，提供者回答了关于他们自己的客户表现出的高和低治疗参与度的开放式问题。行为观察是提供者报告最多的评估客户参与度的方法 (94.3%)，其次是青年或照顾者自发的自我报告 (22.9%)。没有提供者报告使用心理测量工具来评估参与度。使用的参与指标类型也因参与程度而异。对于低参与度，74.3% 的提供者报告使用了他们对出勤率的观察，而对于高参与度，68.6% 的提供者表示依赖于对会议中参与或课外作业的观察。很少有提供者使用与治疗关系相关的指标、与治疗相关的客户期望或客户对治疗方法和相关目标的理解来描述。这些结果突出了改进资源以支持参与评估的机会。