Where Did You Hear About Us?: Examining How Referral Sources Impact Recruitment and Retention Within a Behavioral...

Behavior problems in young children, especially among families from disadvantaged backgrounds (e.g., facing greater risk of poverty, social exclusion, discrimination, and violence), often result in referrals to mental health clinics. However, low-income families from historically marginalized racial and ethnic backgrounds disproportionately experience barriers to accessing, engaging, and completing treatment. This study examined the recruitment and referral network of a parenting program providing Parent-Child Interaction Therapy (PCIT) in a large urban academic medical center and affiliated community-embedded clinics, as well as the impact of recruitment/referral sources on screening paperwork completion, intake attendance, and treatment completion. Data from 2510 families referred between 2018 and 2022 were analyzed, considering demographic factors and recruitment adaptations during COVID-19. Referral sources included but were not limited to community agencies, social media, and healthcare providers. Logistic regression analyses determined the likelihood of completing the screening paperwork, attending intake, and completing treatment based on recruitment/referral sources. Every recruitment/referral source increased the likelihood of screening paperwork completion (except community outreach). Every source increased the likelihood of attending intake (except previously enrolled families). Treatment completion was significantly more likely for those referred from pediatricians, friends, behavioral health, and Google. After COVID-19 (post March 2020), families were more likely to complete the screening paperwork, attend intake, and complete treatment compared to families screened before COVID-19. Effective recruitment and retention strategies are crucial for engaging families in mental health services. Findings emphasize the role of community and healthcare providers, word-of-mouth, and Google and the benefits of telehealth (indicated by post-COVID-19 results), in improving treatment access and retention, highlighting the need for flexible service delivery methods.