Date of Award

Spring 2014

Document Type


Degree Name

Doctor of Philosophy (PhD)


Counselor Education and Counseling Psychology

First Advisor

Fox, Robert A.

Second Advisor

Lopez, Francesca

Third Advisor

Edwards, Lisa


Young children typically experience challenging behaviors. However, 10-15% of young children experience clinical behaviors that can impact the child's typical development. These challenging behaviors are even more common in children from low-income, urban settings. If left untreated, such challenging behaviors may lead to more severe behaviors including aggression, violence, and anti-social behaviors. Research has demonstrated that participation in parent and child therapy (PCT) programs significantly reduces problematic child behaviors while increasing positive behaviors in both the child and the parent. However, PCT programs report rates of early termination as high as 70%. Research to reduce these early termination rates has historically focused on barriers to treatment including logistical conflicts, race, socioeconomic status, child age, and symptom severity. Despite attempts to address these variables and reduce early termination rates, progress has been slow in advancing the research in this area. In addition, few measures have been designed that are available to accurately assess how barriers to treatment impact treatment attendance and participation, particularly for families of young children living in poverty. The purpose of this study was to develop and pilot a clinician-report screening tool, the Treatment Barriers Scale (TBS), to assess barriers to treatment participation in primarily low-income, urban minority families receiving home-based therapy for their young child's challenging behaviors. Data from 330 families referred to a mental health clinic for behavior problems were analyzed to identify the utility of this new tool in screening treatment barriers in this population. The resulting 17-item scale consisted of two factors, labeled Treatment Process Barriers and the Operational Barriers. Each factor demonstrated acceptable levels of internal consistency (.82 and .80, respectively). Results indicated that children with more severe challenging behaviors and African American children had higher TBS scores, while children with an identified developmental delay had lower TBS scores than typically developing children. Moreover, children with more severe challenging behavior at pretest were more likely to be appropriate treatment terminators. Alternately, families with higher TBS scores were more likely to drop out of treatment prematurely. Limitations of the study and implications for future research and practice for similar programs were discussed.