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Who Stays in Treatment? Child and Family Predictors of Youth Client Retention in a Public Mental Health Agency

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Abstract

The present study examined predictors of youth client retention in therapy in a large community-based sample. We used several conceptualizations of retention, including (a) “intake retention” (i.e., returned to treatment after intake session); (b) “mutual termination” (i.e., termination agreed upon by family and therapist), (c) “mean treatment duration” (i.e., completing the mean number of sessions in the agency), and (d) “total treatment duration” (i.e., total number of sessions). Archival data from over 400 children and adolescents who sought treatment at a large public mental health clinic were analyzed using regression analyses. Although different predictors were identified across the various conceptualizations, a few robust predictors emerged including ethnicity and client symptom severity. Clinical implications and future research directions are discussed.

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Notes

  1. In some cases, where the point of therapy initiation is defined as the first phone call to obtain mental health services, the construct of “preintake attrition” is examined. This refers to the phenomenon of an individual making an appointment with a mental health provider and failing to attend their first scheduled appointment (Masi et al. 2003; Sparks et al. 2003). Preintake attrition is distinct from therapy attrition in that there has not been any face-to-face contact between the mental health services provider and the client(s). This can be viewed as a related construct within the umbrella of therapy attrition.

  2. Some individuals had more than one “episode of care”, that is, they received services from the clinic for more than one discrete time period. It should be noted that some information was archived so it cannot be determined whether a client received services prior to July 1995.

  3. These data are similar to those found in the locality, as reported in 2000 Census data (http://www.dataplace.org/area_overview/Chesterfield%20County,%20VA), though the proportion of African-Americans in the clinic was larger than that found in the locality as a whole (17% in the population, 27% in the sample).

  4. These estimates also take into account the number of individuals dependent on the income.

  5. As noted earlier, a large number (n = 168) fell into an “other” category for which information about therapist’s perception of termination was not available. These participants were not included in subsequent analyses for the mutual termination conceptualization.

  6. Preliminary analyses suggested that variances were unequal between groups—thus, the degrees of freedom were adjusted accordingly.

  7. Preliminary analyses suggested that variances were unequal between groups—thus, the degrees of freedom were adjusted accordingly.

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

  • Anderson, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly: Health and Society, 51, 95–124.

    Google Scholar 

  • Attride-Stirling, J., Davis, H., Farrell, L., Groark, C., & Day, C. (2004). Factors influencing parental engagement in a community child and adolescent mental health service: A qualitative comparison of completers and non-completers. Clinical Child Psychology and Psychiatry, 9, 347–361. doi:10.1177/1359104504043918.

    Article  Google Scholar 

  • Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82, 738–783. doi:10.1037/h0077132.

    Article  PubMed  Google Scholar 

  • Bauman, L. J. (2000). A patient-centered approach to adherence: Risks for nonadherence. In D. Drotar (Ed.), Promoting adherence to medical treatment in chronic childhood illness (pp. 71–93). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

  • Becker, M. H., Drachman, R. H., & Kirscht, J. P. (1972). Predicting mothers’ compliance with pediatric regimens. Journal of Pediatrics, 81, 843–854.

    Google Scholar 

  • Becker, M. H., Radius. S. M., Rosenstock, I. M., Drachman, R. H., Shuberth, K. C., & Teets, K. C. (1978). Compliance with a medical regimen for asthma: A test of the Health Belief Model. Public Health Reports, 93, 268–277.

  • Boggs, S. R., Eyberg, S. M., & Edwards, D. L. (2004). Outcomes of parent–child interaction therapy: A comparison of treatment completers and study dropouts one to three years later. Child & Family Behavior Therapy, 26, 1–22. doi:10.1300/J019v26n04_01.

    Article  Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Chorpita, B. F., & Southam-Gerow, M. A. (2006). Treatment of anxiety disorders in youth. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (3rd ed., pp. 271–335). New York: Guilford Press.

    Google Scholar 

  • Chorpita, B. F., Yim, L. M., Donkervoet, J. C., Arensdorf, A., Amundsen, M. J., McGee, C., et al. (2002). Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii empirical basis to services task force. Clinical Psychology: Science and Practice, 9, 165–190.

    Google Scholar 

  • Chronis, A. M., Gamble, S. A., Roberts, J. E., & Pelham, W. E. (2006). Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder. Behavior Therapy, 37, 143–158. doi:10.1016/j.beth.2005.08.001.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum.

    Google Scholar 

  • Cunningham, P. B., Foster, S. L., & Henggeler, S. W. (2002). The elusive concept of cultural competence. Children’s Services, 5, 231–243. doi:10.1207/S15326918CS0503_7.

    Article  Google Scholar 

  • Dierker, L., Nargison, J., Wiseman, R., & Hoff, D. (2001). Factors predicting attrition within a community initiated system of care. Journal of Child and Family Studies, 10, 367–383. doi:10.1023/A:1012581027044.

    Article  Google Scholar 

  • Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. B. (2000). Treatment preferences among depressed primary care patients. Journal of General Internal Medicine, 15, 527–534. doi:10.1046/j.1525-1497.2000.08035.x.

    Article  PubMed  Google Scholar 

  • Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: Patterns of care for children’s mental health services across one year. Community Mental Health Journal, 35, 31–46. doi:10.1023/A:1018743908617.

    Article  PubMed  Google Scholar 

  • Friedman, I. M., & Litt, I. F. (1987). Adolescents’ compliance with therapeutic regimens: Psychological and social aspects and intervention. Journal of Adolescent Health Care, 8, 52–67.

    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, 439–443. doi:10.1037/0022-006X.70.2.439.

    Article  PubMed  Google Scholar 

  • Glisson, C. (2007). Assessing and changing organizational culture and climate for effective services. Research on Social Work Practice, 17, 736–747. doi:10.1177/1049731507301659.

    Article  Google Scholar 

  • Hammen, C., Rudolph, K., Weisz, J., Rao, U., & Burge, D. (1999). The context of depression in clinic-referred youth: Neglected areas in treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 64–71. doi:10.1097/00004583-199901000-00021.

    Article  PubMed  Google Scholar 

  • Harpaz-Rotem, I., Leslie, D., & Rosenheck, R. A. (2004). Treatment retention among children entering a new episode of mental health care. Psychiatric Services (Washington, DC), 55, 1022–1028. doi:10.1176/appi.ps.55.9.1022.

    Google Scholar 

  • Huey, S., & Polo, A. (2008). Evidence-based psychosocial treatments for ethnic minority youth: A review and meta-analysis. Journal of Clinical Child and Adolescent Psychology, 37, 262–301. doi:10.1080/15374410701820174.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (1996). Dropping out of child psychotherapy: Issues for research and implications for practice. Clinical Child Psychology and Psychiatry, 1, 133–156. doi:10.1177/1359104596011012.

    Article  Google Scholar 

  • Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Clinical and Consulting Psychology, 65, 453–463. doi:10.1037/0022-006X.65.3.453.

    Article  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, 1069–1074. doi:10.1037/0022-006X.62.5.1069.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Kazdin, A. E., & Wassell, G. (1998). Treatment completion and therapeutic change among children referred for outpatient therapy. Professional Psychology, Research and Practice, 29, 332–340. doi:10.1037/0735-7028.29.4.332.

    Article  Google Scholar 

  • Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65, 883–888. doi:10.1037/0022-006X.65.5.883.

    Article  PubMed  Google Scholar 

  • Klein, E. B., Stone, W. N., Hicks, M. W., & Pritchard, I. L. (2003). Understanding dropouts. Journal of Mental Health Counseling, 25, 89–100.

    Google Scholar 

  • LaGreca, A. M., & Bearman, K. J. (2003). Adherence to pediatric treatment regimens. In M. C. Roberts (Ed.), Handbook of pediatric psychology (3rd ed., pp. 119–140). New York: The Guilford Press.

  • Lasalvia, A., Bonetto, C., Tansella, M., Stefani, B., & Ruggeri, M. (2007). Does staff-patient agreement on needs for care predict better mental outcome? A 4-year follow-up in a community service. Psychological Medicine, 38, 123–133.

    PubMed  Google Scholar 

  • Lau, A. S. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295–310. doi:10.1111/j.1468-2850.2006.00042.x.

    Article  Google Scholar 

  • Lau, A. S., & Weisz, J. R. (2003). Reported maltreatment among clinic-referred children: Implications for presenting problems, treatment attrition, and long-term outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1327–1334. doi:10.1097/01.CHI.0000085754.71002.14.

    Article  PubMed  Google Scholar 

  • Mak, W. W. S., Law, R. W., Alvidrez, J., & Pérez-Stable, E. J. (2007). Gender and ethnic diversity in NIMH-funded clinical trials: Review of a decade of published research. Administration and Policy in Mental Health and Mental Health Services Research, 34, 497–503. doi:10.1007/s10488-007-0133-z.

    Article  PubMed  Google Scholar 

  • Martinez, C. R., & Eddy, J. M. (2005). Effects of culturally adapted parent management training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psychology, 73, 841–851. doi:10.1037/0022-006X.73.5.841.

    Article  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, 63–75.

    Google Scholar 

  • McClure, E. B., Connell, A. M., & Zucker, M. (2005). The Adolescent Depression Empowerment Project (ADEPT): A culturally sensitive family treatment for depressed African American girls. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 149–164). Washington, DC: American Psychological Association.

    Google Scholar 

  • McMahon, R. J., Wells, K. C., & Kotler, J. S. (2006). Conduct problems. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (3rd ed., pp. 137–268). New York: Guilford Press.

    Google Scholar 

  • McMiller, W. P., & Weisz, J. R. (1996). Help-seeking preceding mental health clinic intake among African-American, Latino, and Caucasian youths. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1086–1094. doi:10.1097/00004583-199608000-00020.

    Article  PubMed  Google Scholar 

  • Meichenbaum, D., & Turk, D. C. (1987). Facilitating treatment adherence: A practitioner’s guidebook. New York: Plenum Press.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford.

  • Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10, 155–180. doi:10.1023/A:1016699424731.

    Article  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. doi:10.1037/0022-006X.73.5.872.

    Article  PubMed  Google Scholar 

  • Pina, A. A., Silverman, W. K., Weems, C. F., Kurtines, W. M., & Goldman, M. L. (2003). A comparison of completers and noncompleters of exposure-based cognitive and behavioral treatment for phobic and anxiety disorders in youth. Journal of Consulting and Clinical Psychology, 71, 701–705. doi:10.1037/0022-006X.71.4.701.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Pumariega, A. J., Glover, S., Holzer, C. E., & Nguyen, H. (1998). Utilization of mental health services in a tri-ethnic sample of adolescents. Community Mental Health Journal, 34, 145–156.

    Google Scholar 

  • Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services (Washington, DC), 52, 1190–1197. doi:10.1176/appi.ps.52.9.1190.

    Google Scholar 

  • Siqueland, L., Crits-Cristoph, P., Gallop, R., Barber, J. P., Griffin, M. L., Thase, M. E., et al. (2002). Retention in psychosocial treatment of cocaine dependence: Predictors and impact on outcome. The American Journal on Addictions, 11, 24–40. doi:10.1080/10550490252801611.

    Article  PubMed  Google Scholar 

  • Southam-Gerow, M. A. (2005, Summer). Using partnerships to adapt evidence-based mental health treatments for use outside labs. Report on Emotional & Behavioral Disorders in Youth, 5, 58–60, 77–79.

  • Southam-Gerow, M. A., Austin, A. A., & Marder, A. M. (2008a). Transportability and dissemination of psychological treatments: Research models and methods. In D. McKay (Ed.), Handbook of research methods in abnormal and clinical psychology (pp. 203–224). Newbury Park, CA: Sage.

    Google Scholar 

  • Southam-Gerow, M. A., Chorpita, B. F., Miller, L. M., & Gleacher, A. A. (2008b). Are children with anxiety disorders privately-referred to a university clinic like those referred from the public mental health system? Administration and Policy in Mental Health and Mental Health Services Research, 35, 168–180. doi:10.1007/s10488-007-0154-7.

    Article  PubMed  Google Scholar 

  • Southam-Gerow, M. A., Ringeisen, H. L., & Sherrill, J. T. (2006). Introduction to special issue: Integrating interventions and services research: Progress and prospects. Clinical Psychology: Science and Practice, 13, 1–8. doi:10.1111/j.1468-2850.2006.00001.x.

    Article  Google Scholar 

  • Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2003). Youth with anxiety disorders in research and service clinics: Examining client differences and similarities. Journal of Clinical Child and Adolescent Psychology, 32, 375–385. doi:10.1207/S15374424JCCP3203_06.

    Article  PubMed  Google Scholar 

  • Sparks, W. A., Daniels, J. A., & Johnson, E. (2003). Relationship of referral source, race, and wait time on preintake attrition. Professional Psychology: Research and Practice, 5, 514–518.

    Google Scholar 

  • Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. The American Psychologist, 53, 440–448. doi:10.1037/0003-066X.53.4.440.

    Article  PubMed  Google Scholar 

  • United States Public Health Service. (1999). Mental health: A report of the surgeon general. Washington, DC: United States Public Health Service.

    Google Scholar 

  • United States Public Health Service. (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Washington, DC: United States Public Health Service.

    Google Scholar 

  • Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132, 132–149. doi:10.1037/0033-2909.132.1.132.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Southam-Gerow, M. A., Gordis, E. B., & Connor-Smith, J. K. (2003). Primary and secondary control enhancement training for youth depression: Applying the deployment-focused model of treatment development and testing. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based treatments for children and adolescents (pp. 165–183). New York: Guilford.

    Google Scholar 

  • Werba, B. E., Eyberg, S. M., & Boggs, S. R. (2006). Predicting outcome in parent–child interaction therapy: Success and attrition. Behavior Modification, 30, 618–646. doi:10.1177/0145445504272977.

    Article  PubMed  Google Scholar 

  • Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology, Research and Practice, 24, 190–195. doi:10.1037/0735-7028.24.2.190.

    Article  Google Scholar 

  • Yeh, M., McCabe, K., Hough, R. L., Lau, A., Fakhry, F., & Garland, A. (2005). Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use. Journal of Consulting and Clinical Psychology, 73, 800–807. doi:10.1037/0022-006X.73.5.800.

    Article  PubMed  Google Scholar 

  • Zimmerman, F. J. (2005). Social and economic determinants of disparities in professional help-seeking for child mental health problems: Evidence from a national sample. Health Services Research, 40(5 Pt 1), 1514–1533. doi:10.1111/j.1475-6773.2005.00411.x.

    Article  PubMed  Google Scholar 

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Acknowledgments

Preparation of this article was supported in part through a grant from the National Institute of Mental Health Grant K23 MH69421. Portions of this manuscript were submitted in partial fulfillment of a Master’s in Science degree by Lauren M. Miller.

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  1. Department of Psychology, Virginia Commonwealth University, 806 W. Franklin St., Richmond, VA, 23284-2018, USA

    Lauren M. Miller & Michael A. Southam-Gerow

  2. Chesterfield County Community Mental Health Services, Chesterfield, VA, USA

    Robert B. Allin Jr.

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  1. Lauren M. Miller
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  2. Michael A. Southam-Gerow
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  3. Robert B. Allin Jr.
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Correspondence to Michael A. Southam-Gerow.

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Miller, L.M., Southam-Gerow, M.A. & Allin, R.B. 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 (2008). https://doi.org/10.1007/s10566-008-9058-2

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