Attrition in parent-child interaction therapy

Abstract

Attrition is a significant problem in child psychotherapy (De Haan, Boon, De Jong, Hoeve, & Vermeiren, 2013) and has serious implications. These include limited effectiveness of interventions for mental and behavioral health problems and decreases in staff productivity, access to services, and the number of people an agency can serve (Barrett et al., 2008). Predictors of attrition include those at the client, family, therapist, and treatment levels. The current study investigated the pattern of and variables associated with attrition in Parent-Child Interaction Therapy (PCIT), an evidence-based parent training program for families with young children (ages 2.5-to 7-years-old) with disruptive behavior disorders. Client-(i.e., child gender, child minority status, intensity of externalizing behavior); parent-(i.e., parent income, parent-to-child ratio, depression symptoms); and treatment-level (wait time for treatment, parent satisfaction with PCIT, therapist satisfaction with PCIT) variables; and competing activities and life stressors were examined. The sample of 134 parent-child dyads and 36 therapists recruited from 21 licensed psychiatric outpatient clinics across one state were part of a larger study (RO1 MH09750; A Statewide Trial to Compare Three Training Models for Implementing an EBT; PI: Herschell). The current study found an attrition rate of 73%. Families were more likely to leave early in treatment, with 53% of families leaving therapy after attending six or fewer sessions. Hierarchical Linear Modeling was used to examine predictors. Lower income, a smaller ratio of parents to children, longer wait time for PCIT, more reported life stressors and obstacles, and lower parent satisfaction with PCIT were all significantly associated with attrition. Qualitative data regarding additional therapist-reported reasons for attrition are reported. Limitations, suggestions for future research, and clinical implications are discussed.

Emotion Regulation and Attrition in Parent-Child Interaction Therapy

“…Anecdotally, there were many families in this sample who had extenuating circumstances which limited their abilities to continue with treatment (e.g., moved away, changed work schedules, had surgery, were removed from the study). Although unmeasured in the current study, these explanations, in addition to the other factors shown to predict attrition in previous research, such as number of children in the home (De Haan et al, 2013, Liebsack, 2016, may have complicated our findings on parenting stress and attrition. In addition, because of our small sample size (n = 57) included in attrition analyses, we may not have had enough statistical power to detect a potentially small effect of parenting stress on attrition.…”

“…This procedure was employed to allow inclusion of all initial participants' data given our limited power and small sample size. xmax = 40) with 20% of families attending more than 25 sessions (Liebsack, 2016;Werba et al, 2006). Paired-samples t-tests were calculated to understand differences among the following treatment variables collected at pre-, mid-, and post-treatment: ECBI Intensity, ECBI Problem, CBCL Total Score, and PSI-SF Total Stress (see Table 4).…”

A Randomized Controlled Trial of Parent-Child Interaction Therapy with and without Incentives in a Community Mental Health Setting

“…In turn, many families, regardless of group status, dropped out of treatment early (prior to reaching CDI mastery) which is also a common finding in the literature (Liebsack, 2016;McKay et al, 2002). It is believed that conducting the research project at the Riverside agency did not impact client attrition in such a way to explain the lack of differences between incentive groups.…”

“…As another example, the Hayes and colleagues' (2000) study which required families to sign a contract to attend four consecutive appointments before receiving a $30 coupon had only three enrolled families and provided a short duration of treatment (four sessions vs. unknown number of sessions before attaining mastery criteria) to receive the incentive. In turn, the literature has shown that a large number of families drop out after four sessions of family therapy (Liebsack, 2016;McKay, Harrison, Gonzáles, Kim, & Quintana, 2002); it is possible that the $30 coupon and signed contract provided an additional incentive to reach four sessions, but many families typically attend at least four sessions regardless of incentives.…”

The Parent-Child Interaction Therapy Family Experiences and Feedback Study: A Follow-up Examination of Attrition in an Evidence-Based Treatment in Community Settings Statewide

“…A fifth study of predictors of attrition in PCIT was my thesis study (Liebsack, Herschell, McNeil, & Genzler, 2016), for which the current study will serve as a follow-up. In this pilot study, we examined patterns and predictors of attrition in a sample of 134 families receiving PCIT in various community settings across one state, with the aim to replicate and expand upon previous studies of attrition in child and adolescent therapies, and PCIT specifically.…”