Skip to main content
Top
Published in: Administration and Policy in Mental Health and Mental Health Services Research 1/2014

01-01-2014 | Original Article

Shifting the Treatment Model: Impact on Engagement in Outpatient Therapy

Authors: Erin M. Warnick, Karen Bearss, V. Robin Weersing, Lawrence Scahill, Joseph Woolston

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 1/2014

Login to get access

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.
Literature
go back to reference 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. 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.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference Armbruster, P., & Kazdin, A. E. (1994). Attrition in child psychotherapy. Advances in Clinical Child Psychology, 16, 81-108. Armbruster, P., & Kazdin, A. E. (1994). Attrition in child psychotherapy. Advances in Clinical Child Psychology, 16, 81-108.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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. 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.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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. 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.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65(5), 883–888.PubMedCrossRef Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65(5), 883–888.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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. 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.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference Sirles, E. A. (1990). Dropout from intake, diagnostics, and treatment. Community Mental Health Journal, 26(4), 345–360.PubMedCrossRef Sirles, E. A. (1990). Dropout from intake, diagnostics, and treatment. Community Mental Health Journal, 26(4), 345–360.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
go back to reference 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. 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.
go back to reference Wenning, K., & King, S. (1995). Parent orientation meetings to improve attendance and access at a child psychiatric clinic. Psychiatric Services, 46(8), 831–833.PubMed Wenning, K., & King, S. (1995). Parent orientation meetings to improve attendance and access at a child psychiatric clinic. Psychiatric Services, 46(8), 831–833.PubMed
go back to reference Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195. Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
Metadata
Title
Shifting the Treatment Model: Impact on Engagement in Outpatient Therapy
Authors
Erin M. Warnick
Karen Bearss
V. Robin Weersing
Lawrence Scahill
Joseph Woolston
Publication date
01-01-2014
Publisher
Springer US
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 1/2014
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-012-0439-3

Other articles of this Issue 1/2014

Administration and Policy in Mental Health and Mental Health Services Research 1/2014 Go to the issue