This qualitative study explored clinicians’ perceptions about unplanned terminations from outpatient mental health treatment among economically disadvantaged, inner-city adolescents. Findings revealed that most terminations were unplanned, unannounced, and unilaterally initiated by adolescents. Planned terminations occurred only when short-term treatment and situational factors for clients or clinicians dictated termination. Client, clinician, and clinic factors that contributed to unplanned terminations, or treatment dropout, included normative adolescent development, the ways clinicians conducted treatment, and the agency context. Although clinicians believed that the process of termination and closure was important, they rarely initiated it. Implications for practice include reconceptualizing termination; developing collaborative, consistent goals between adolescents and clinicians; use of problem-focused, intermittent, time-limited interventions; and development of organizational and clinical structures to guide case review and closure.

Schools of social work are continually challenged to provide professional training which effectively prepares students for the ever-changing and increasingly demanding contemporary practice context. This paper provides an overview of emerging clinical, organizational, and research trends and challenges within agency-based social work practice in the past decade. Implications of these changes for the profession will be discussed and recommendations will be offered for ways in which academic and field educators can best equip social work students with the skills needed to meet these challenges of the current agency-based practice context. These recommendations for social work practice, education, and research include the development of an integrated set of clinical, organizational, and research skills; directions for curriculum renewal and expansion; and academic field partnerships for future research.

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