This study aimed to enhance understanding of barriers and facilitators to engagement and retention of children and families in outpatient mental health care from the perspective of young children, parents/caregivers, and clinicians as reflected in clinical treatment charts using an exploratory sequential mixed-methods design. Secondary data collaboratively recorded by the clinician in 100 charts representing cases of young children at the time of assessment and treatment planning was extracted from a partnering agency’s electronic medical record. The data was first analyzed qualitatively to identify themes describing facilitators and barriers as collaboratively documented in the sample charts, followed by quantitative analysis of the frequency of the themes as well as to determine any significant relationships among themes and the identified race group or presenting problems in cases. Results include the child’s own natural strengths, inclusion of the family and the child’s larger support system, and a strong therapeutic alliance as key facilitators. Significant barriers identified are challenges associated with externalized behaviors, trauma exposure, family stress, and readiness to change. Implications of this study emphasize the need for social work interventions, service delivery models, and reimbursement models that accommodate both the individual child and the role of family and systemic supports as part of core interventions, as well as ensuring attention to trauma and readiness for change as part of assessment.

本研究旨在从幼儿、父母/照顾者和临床医生的角度，加强对儿童和家庭参与和保留门诊精神卫生保健的障碍和促进因素的理解，如临床治疗图表中所反映的那样，使用探索性序贯混合方法设计。临床医生在 100 个图表中合作记录了辅助数据，这些图表代表了评估和治疗计划时幼儿病例的情况，这些数据是从合作机构的电子病历中提取的。首先对数据进行定性分析，以确定描述促进因素和障碍的主题，如示例图表中协作记录的那样，随后对主题的频率进行定量分析，并确定主题与已识别的种族群体或案例中存在的问题之间的任何显着关系。结果包括孩子自身的自然优势、家庭和孩子更大的支持系统的包容性，以及作为关键促进因素的强大治疗联盟。发现的重大障碍是与外在行为、创伤暴露、家庭压力和改变准备程度相关的挑战。这项研究的意义强调需要社会工作干预措施、服务提供模式和报销模式，以适应个别儿童以及家庭和系统支持的作用，作为核心干预措施的一部分，并确保对创伤的关注和为变革做好准备作为评估的一部分。