Speakers
Description
Authors: Carlie J. Sloan (Arizona State University), Elizabeth Stormshak (University of Oregon), Joanna J. Kim (Arizona State University), Lindsey H. Rosenthal (Arizona State University), Haylie M. Schramm (University of Colorado Boulder), Jordyn M. Richard (University of Colorado Boulder), Laney Karpel (Arizona State University), Leslie Leve (University of Oregon), Liana Cass (University of Colorado Boulder), Mary Kuckertz (Arizona State University), Nancy A. Gonzales (Arizona State University), Nivedha Jayaprakash (University of Colorado Boulder), Tamar Kodish (University of Colorado Boulder)
Chair: Carlie J. Sloan
Discussant: Joanna J. Kim
Background: Participant engagement is key for the success of preventive interventions. Yet, engagement research is complicated by 1) ambiguous definitions of engagement (Staudt, 2007), 2) a dearth of effective strategies for promoting engagement (Ingoldsby, 2010), and 3) the emergence of digital modalities (e.g., mobile apps) in which the dimensions and effects of engagement are not well understood (Breitenstein et al., 2014).
Aims: This symposium will address gaps in engagement research by contributing to definitions of engagement, understanding how to promote engagement, and determining the role of engagement in the effectiveness of digital health interventions. We explore these themes in the context of caregiver engagement in preventive interventions. This interdisciplinary symposium brings together themes from psychology, family sciences, digital health, and dissemination and implementation science.
Presentations: The first presentation examines the ways caregiver engagement is operationalized across youth suicide prevention programs in a meta-analysis. Results highlight the diversity of conceptualizations even among interventions with specific shared goals. The second presentation uses a qualitative approach to characterize parent-generated promoters of one component of engagement—home practice—in a universal family-based prevention program. Parents strategies for engagement covered several dimensions, and they can be useful for informing engagement-promoting interventions. The third presentation explores engagement within four clinical trials of a digital family-based intervention. Time spent using the intervention tool was associated with greater parent and youth positive outcomes, suggesting a dosage effect. Families characterized by greater risk were more likely to engage with the intervention, adding to a growing body of literature supporting the viability of digital interventions for families with diverse needs.
Discussion: Our presentations span the prevention continuum from universal to indicated, as well as representing different phases of the research-to-practice continuum, from efficacy trials to widespread community implementations. Following the presentations, discussant Dr. Joanna Kim will summarize findings across the three studies, highlighting areas of similarities (e.g., operationalization of parent engagement) and places of divergence as a means to understand how to optimize parent engagement for improved preventive effects.
Abstract 1
Examining caregiver involvement and engagement in adolescent suicide prevention programs: Preliminary results of a scoping review
Lindsey H. Rosenthal (Arizona State University), Laney Karpel (Arizona State University), Tamar Kodish (University of Colorado Boulder), Liana Cass (University of Colorado Boulder), Nivedha Jayaprakash (University of Colorado Boulder), Jordyn M. Richard (University of Colorado Boulder), Haylie M. Schramm (University of Colorado Boulder), Joanna J. Kim (Arizona State University)
Background: Suicide is a significant public health issue and is currently the third leading cause of death among 15-29-year-olds (WHO, 2025). Suicide prevention programs that involve caregivers or trusted adults appear to be the most effective (Asarnow & Mehlum, 2019). However, the nature of caregiver involvement within adolescent suicide prevention programs is unclear. This scoping review aims to (1) determine the types of caregiver involvement, (2) determine operationalizations of engagement, and (3) describe rates of engagement.
Methods: Searches were conducted across PsychInfo, PubMed, and SCOPUS, identifying 7,345 independent records. Each record was double-screened through the title/abstract and full text screening processes with rater agreements of 96.1% and 87.7%, respectively. Inclusion criteria included discussion of a suicide prevention intervention for youth aged 11-25, engagement data, caregiver involvement, suicide-related outcomes, and peer-review publication status. Records were ineligible if they featured a review or meta-analysis, addressed non-suicidal self-injury only, or exclusively examined pharmacological therapies.
Results: Thirty-two empirical articles met criteria and were included in this review. Caregiver involvement included sharing safety plans with caregivers, caregiver psychoeducation groups, family skills training, and family therapy. Engagement was operationalized in a variety of ways, ranging from reporting intervention completion rates and number of sessions attended to caregiver-reported program satisfaction and acceptability. Nearly all studies (90.25%) presented program drop-out data with an average attrition rate of 16.32%; Half of included studies reported on caregiver session attendance rates, reporting mean number of sessions attended or completion rates per each session in the intervention protocol; 14 studies (43.75%) reported caregiver program satisfaction data or acceptability ratings.
Discussion: Preliminary findings demonstrate variability in the types of caregiver involvement featured in youth suicide prevention programs as well as how caregiver engagement is operationalized. Implications for different types of caregiver involvement and their association with intervention effectiveness will be discussed.
Abstract 2
Parent-generated promoters of home practice engagement: A novel classification framework and applications in a family-based prevention program
Carlie J. Sloan (Arizona State University), Joanna J. Kim (Arizona State University), Mary Kuckertz (Arizona State University), Lindsey H. Rosenthal (Arizona State University), Nancy A. Gonzales (Arizona State University)
Background: Skill uptake in behavior change interventions requires in situ practice outside of sessions (i.e., home practice). Research suggests on average half of parents in intervention programs do not complete assigned home practice (Chacko et al., 2016), limiting the impact and durability of programs. This study aimed to identify promoters of parents’ home practice engagement within Bridges, a substance use prevention program for families of adolescents.
Methods: Participants were 305 parents (261 families) participating in Bridges with their adolescent. Parents were encouraged to practice specific skills each week. Parents responded each week to the open-ended item, “What would help you get over your difficulty using [skill name],” using a written worksheet. The item was repeated for seven skills, yielding in 943 responses.
Results: Our qualitative analysis found that parent-identified promoters of home practice fell on three dimensions: from internal to observable, personal to relational, and stopping/removing behaviors to doing more of/adding behaviors. This framework guided our classification of responses into discrete categories. Example categories include Planning (e.g., “Setting a time to do it”), Removing Distractions (e.g., “Turn off the TV”), using Reminder Strategies (e.g., “Create a reminder on my planner and phone”), and Parent Attunement either to their adolescents’ needs (e.g., “Pay more attention to her”) or to their own emotions (e.g., “Stay more focused”).
Discussion: Parents’ perceptions of promoters of home practice ranged from internal to observable, personal to relational, and stopping a behavior to doing more of a behavior. The generalizability of this framework to other programs—and to promoters outside of those for home practice—should be evaluated. Furthermore, it is important to determine whether the promoters identified here translate into effective intervention strategies for enhancing engagement in behavioral training programs. This is a critical next step toward improving the impact of evidence-based prevention programs.
Abstract 3
Engaging parents in digital health tools to support behavioral health in children
Elizabeth Stormshak (University of Oregon), Leslie Leve (University of Oregon)
Background: Our research focuses on embedding family-centered prevention and intervention in schools and community health agencies to support child mental health and behavior. To date, we have examined outcomes of the Family Check-Up Online, an evidence-based digital tool, on parenting skills and mental health across 4 distinct clinical trials, but we have not yet integrated findings across these trials to examine how engagement in the digital app improves outcomes.
Methods: Participants across 4 clinical trials included N = 1,120 parents who were predominantly low-income, resided in both rural and urban areas of the U.S., and had a range of risk factors. Families were randomly assigned to treatment (the Family Check-Up Online) or control. Engagement data was collected via the digital tool, and included data such as time on the app, number of visits, and number of modules visited.
Results: Across the clinical trials random assignment to the FCU-O intervention led to improved parenting skills, which in turn predicted lower rates of mental health symptoms in youth. Engagement with the app ranged from 88 to 110 minutes. The average number of visits to the app ranged from 5-10, with high levels of provider support and app usage linked to higher levels of risk (e.g., children with greater behavioral concerns), and subsequent greater reductions in targeted outcomes.
Discussion: The results provide support for the Family Check-Up Online as a viable tool for preventing mental health problems. Parents who spent more time on the app were more likely to have greater risks, such as family stress, parent depression, or concerns about their children’s behavior. Engagement with the app predicted greater outcomes for at-risk families across the 4 different studies.
| Conflict of interest | None |
|---|
