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Shifting the Treatment Model: Impact on Engagement in Outpatient Therapy

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Abstract

Attrition in youth outpatient mental health clinics ranges from 30 to 70 % and often occurs early in treatment. We implemented specific treatment planning strategies designed to reduce early attrition. Following implementation, 14.3 % of clients dropped out during the first five sessions compared to 26.1 % in the historical control (p < 0.001). During treatment, 33.6 % of clients dropped out in the intervention compared to 55.5 % in the historical control (p < 0.001). Engagement is central to the therapeutic process and may be particularly relevant early in treatment. Implementing evidence-based strategies to promote a collaborative relationship between the family and the clinician may increase engagement and decrease attrition.

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References

  • Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5(4), 237–249.

    Google Scholar 

  • Armbruster, P., & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children’s mental health clinic. American Journal of Orthopsychiatry, 64(4), 577–585.

    Article  CAS  PubMed  Google Scholar 

  • Armbruster, P., & Kazdin, A. E. (1994). Attrition in child psychotherapy. Advances in Clinical Child Psychology, 16, 81-108.

    Google Scholar 

  • Arnold, L. E., Vitiello, B., McDougle, C., Scahill, L., Shah, B., Gonzalez, N. M., et al. (2003). Parent-defined target symptoms respond to risperidone in RUPP autism study: Customer approach to clinical trials. Journal of the American Academy of Child and Adolescent Psychiatry, 42(12), 1443–1450.

    Article  PubMed  Google Scholar 

  • Bannon, W. M, Jr, & McKay, M. M. (2005). Are barriers to service and parental preference match for service related to urban child mental health service use? Families in Society, 86(1), 30–34.

    Article  Google Scholar 

  • Bearss, K., Warnick, E.M., Weersing, V. R., Scahill, L., & Woolston, J. (2010). Increasing engagement in parent training in a community mental health clinic. Symposium presented at the annual meeting of the Association for Behavioral and Cognitive Therapies, San Francisco, CA.

  • Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236.

    Article  CAS  PubMed  Google Scholar 

  • De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483–509.

    Article  PubMed  Google Scholar 

  • Dierker, L., Nargiso, J., Wiseman, R., & Hoff, D. (2001). Factors predicting attrition within a community initiated system of care. Journal of Child and Family Studies, 10(3), 367–383.

    Article  Google Scholar 

  • Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70(2), 439–443.

    Article  PubMed  Google Scholar 

  • Gonzalez, A., Weersing, V. R., Warnick, E. M., Scahill, L. D., & Woolston, J. L. (2011). Predictors of treatment attrition among a community clinic sample of youths with anxiety. Administration and Policy in Mental Health and Mental Health Services Research, 38(5), 356–367.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gould, M. S., Shaffer, D., & Kaplan, D. (1985). The characteristics of dropouts from a child psychiatry clinic. Journal of the American Academy of Child Psychiatry, 24(3), 316–328.

    Article  CAS  PubMed  Google Scholar 

  • Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343.

    Google Scholar 

  • Hawley, K. M., & Weisz, J. R. (2003). Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: the therapist’s dilemma and its implications. Journal of Consulting and Clinical Psychology, 71(1), 62–70.

    Article  PubMed  Google Scholar 

  • Jensen-Doss, A., & Weisz, J. R. (2008). Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics. Journal of Consulting and Clinical Psychology, 76(5), 711-722.

    Google Scholar 

  • Johnson, E., Mellor, D., & Brann, P. (2009). Factors associated with dropout and diagnosis in child and adolescent mental health services. Australian and New Zealand Journal of Psychiatry, 43(5), 431–437.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Mazurick, J. L. (1994). Dropping out of child psychotherapy: distinguishing early and late dropouts over the course of treatment. Journal of Consulting and Clinical Psychology, 62(5), 1069–1074.

    Article  CAS  PubMed  Google Scholar 

  • Kazdin, A. E., Mazurick, J. L., & Bass, D. (1993). Risk for attrition in treatment of antisocial children and families. Journal of Clinical Child Psychology, 22(1), 2–16.

    Article  Google Scholar 

  • Kazdin, A. E., & Wassell, G. (2000). Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research, 2(1), 27–40.

    Article  CAS  PubMed  Google Scholar 

  • Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65(5), 883–888.

    Article  CAS  PubMed  Google Scholar 

  • Kourany, R. F., Garber, J., & Tornusciolo, G. (1990). Improving first appointment attendance rates in child psychiatry outpatient clinics. Journal of the American Academy of Child and Adolescent Psychiatry, 29(4), 657–660.

    Article  CAS  PubMed  Google Scholar 

  • Masi, M. V., Miller, R. B., & Olson, M. M. (2003). Differences in dropout rates among individual, couple, and family therapy clients. Contemporary Family Therapy, 25(1), 63–75.

    Article  Google Scholar 

  • McCabe, K. M. (2002). Factors that predict premature termination among Mexican-American children in outpatient psychotherapy. Journal of Child and Family Studies, 11, 347–359.

    Article  Google Scholar 

  • McKay, M. M., & Bannon, W. M. (2004). Engaging families in child mental health services. Child and Adolescent Psychiatric Clinics of North America, 13, 905–921.

    Article  PubMed  Google Scholar 

  • McKay, M. M., Nudelman, R., McCadam, K., & Gonzales, J. (1996). Evaluating a social work engagement approach to involving inner-city children and their families in mental health care. Research on Social Work Practice, 6(4), 462–472.

    Article  Google Scholar 

  • Miller, L. M., Southam-Gerow, M. A., & Allin, R. B. (2008). Who stays in treatment? Child and family predictors of youth client retention in a public mental health agency. Child & Youth Care Forum, 37, 153–170.

    Article  Google Scholar 

  • Nock, M. K., & Ferriter, C. (2005). Parent management of attendance and adherence in child and adolescent therapy: A conceptual and empirical review. Clinical Child and Family Psychology Review, 8(2), 149–166.

    Article  PubMed  Google Scholar 

  • Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73, 872–879.

    Article  PubMed  Google Scholar 

  • Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (2000). The Ohio youth problem, functioning, and satisfaction scales: Technical manual, Ohio mental health consumer outcomes initiative. Ohio: Ohio University.

    Google Scholar 

  • Prinz, R. J., & Miller, G. E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62(3), 645–650.

    Article  CAS  PubMed  Google Scholar 

  • Robbins, M. S., Turner, C. W., Alexander, J. F., & Perez, G. A. (2003). Alliance and dropout in family therapy for adolescents with behavior problems: Individual and systemic effects. Journal of Family Psychology, 17(4), 534–544.

    Article  PubMed  Google Scholar 

  • Rotherham-Borus, M. J., Piacentini, J., Van Rossem, R., & Graae, F. (1996). Enhancing treatment adherence with a specialized emergency room program for adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry, 35(5), 654–663.

    Article  Google Scholar 

  • Shuman, A. L., & Shapiro, J. P. (2002). The effects of preparing parents for child psychotherapy on accuracy of expectations and treatment attendance. Community Mental Health Journal, 38(1), 3–16.

    Article  PubMed  Google Scholar 

  • Sirles, E. A. (1990). Dropout from intake, diagnostics, and treatment. Community Mental Health Journal, 26(4), 345–360.

    Article  CAS  PubMed  Google Scholar 

  • Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L., Conners, C., Abikoff, H. B., et al. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 168–179.

    Article  CAS  PubMed  Google Scholar 

  • Swanson, J. M., Sergeant, J. A., Taylor, E., Sonuga-Barke, E., Jensen, P. S., & Cantwell, D. P. (1998). Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet, 351, 429–433.

    Article  CAS  PubMed  Google Scholar 

  • Walker, P., Weersing, V. R., Warnick, E. M., Findley, D., Scahill, L., & Woolston, J. (2008). Predictors of youth therapist technique use in community care. Poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies, Orlando, FL.

  • Warnick, E., Gonzalez, A., Weersing, V. R., Scahill, L., & Woolston, J. (2011). Defining dropout: How definitions shape outcomes. Child and Adolescent Mental Health,. doi:10.1111/j.1475-3588.2011.00606.x.

    Google Scholar 

  • Wenning, K., & King, S. (1995). Parent orientation meetings to improve attendance and access at a child psychiatric clinic. Psychiatric Services, 46(8), 831–833.

    CAS  PubMed  Google Scholar 

  • Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195.

    Google Scholar 

  • Zeller, M., Kirk, S., Claytor, R., Khoury, P., Grieme, J., Santangelo, M., et al. (2004). Predictors of attrition from a pediatric weight management program. The Journal of Pediatrics, 144(4), 466–470.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for this study was provided in part by a Child Health Innovation Grant Award from Children’s Fund of Connecticut as well as funding from the Connecticut Department of Children and Families (DCF) to the Yale Child Study Center to support the operations of the Outpatient Clinic. This publication does not express the views of the Connecticut Department of Children and Families or the State of Connecticut. The views and opinions expressed are those of the authors. We acknowledge the contribution of the clinicians and administrative staff in the Outpatient Clinic, and we thank the many youth and families who participated in this project and made this work possible.

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Authors and Affiliations

  1. Child Study Center, Yale University, 40 Temple St, Suite 7C, New Haven, CT, 06510, USA

    Erin M. Warnick, Karen Bearss, Lawrence Scahill & Joseph Woolston

  2. San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA

    V. Robin Weersing

  3. School of Nursing, Yale University, New Haven, CT, USA

    Lawrence Scahill

Authors
  1. Erin M. Warnick
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  2. Karen Bearss
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  3. V. Robin Weersing
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  4. Lawrence Scahill
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  5. Joseph Woolston
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Correspondence to Erin M. Warnick.

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Warnick, E.M., Bearss, K., Weersing, V.R. et al. Shifting the Treatment Model: Impact on Engagement in Outpatient Therapy. Adm Policy Ment Health 41, 93–103 (2014). https://doi.org/10.1007/s10488-012-0439-3

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