Outcomes of Parent–Child Interaction Therapy in an urban community clinic: A comparison of treatment completers and dropouts

Danko, Christina M.; Garbacz, Lauren L.; Budd, Karen S.

doi:10.1016/j.childyouth.2015.11.007

Cited by 70 publications

(48 citation statements)

References 56 publications

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“…Most studies of dropout and outcome with children and adults have supported this assumption. 11,[13][14][15][16][17][18][19][20] However, little evidence for an association of dropout and clinical outcomes was found in this study, particularly by the final follow-up at 86-weeks, suggesting that dropping out of treatment for many adolescents with depression may not be a signature of poor long-term outcome, when defined as ending treatment without agreement from the therapist. These findings should be viewed as exploratory and a sufficiently powered study to test the prognostic implications of treatment dropout is required.…”

Section: Mcontrasting

confidence: 75%

“…Interestingly, and in contrast to the results presented here, research with child and adult patients has found dropout to be associated with poorer clinical outcomes. 11,[13][14][15][16][17][18][19][20] This age effect may reflect a developmental difference in the meaning of depressive symptoms and/or syndrome. Adolescents have distinctive developmental tasks, including formation of identity, becoming more autonomous and questioning adult authority.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Several studies found children with conduct problems (and/or their parents) who drop out have poorer clinical outcomes by the end of treatment, compared with those who complete treatment. [14][15][16][17][18] One study investigated longer-term outcomes associated with dropout, and found that poorer outcomes were maintained approximately 20-months after treatment began. 16 However, two of these studies reported that dropouts were more impaired at baseline, suggesting that difference in outcomes may in part be due to pre-treatment factors.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Implications for Adolescents With Depression Who Drop Out of Psychological Treatment During a Randomized Controlled Trial

O’Keeffe

Martin

Goodyer

et al. 2019

Journal of the American Academy of Child & Adolescent Psych

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Objective: High therapy dropout rates among adolescents have been reported, but little is known about whether dropout is associated with poor outcomes. This study aimed to examine clinical outcomes in adolescents with depression who dropped out of psychological therapy and to determine if this varied by treatment type. Method: Data was drawn from the IMPACT study; a randomised controlled trial, comparing a Brief Psychosocial Intervention, Cognitive-Behavioral Therapy and Short-Term Psychoanalytic Psychotherapy in the treatment of adolescent major depression. The sample comprised 406 adolescents with a diagnosis of major depression, 169 of whom dropped out of treatment prior to the planned end of therapy. Primary outcome was self-report Mood and Feelings Questionnaire (MFQ); secondary outcomes were Health of the Nation Outcome Scale for Children and Adolescents, Revised Children's Manifest Anxiety Scale, Modified Leyton Obsessional Inventory and Clinical Diagnosis. Results: During follow-up there was a non-significant trend for dropouts to report higher depressive symptoms than completers. However, modeling showed insufficient evidence for an association between dropout and outcomes. Conclusion: In contrast to studies of adult therapy, there was no strong evidence that adolescent patients who dropped out had poorer clinical outcomes compared with those who completed therapy, when dropout was defined as ending treatment without agreement of the therapist. This challenges us to understand why adolescents stop going to therapy, how dropout should be defined, and whether what is prescribed is what is always needed.

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Section: Mcontrasting

confidence: 75%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Implications for Adolescents With Depression Who Drop Out of Psychological Treatment During a Randomized Controlled Trial

O’Keeffe

Martin

Goodyer

et al. 2019

Journal of the American Academy of Child & Adolescent Psych

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“…Harwood and Eyberg (2006) found significant decreases in parenting stress, increases in positive parenting practices, and decreases in the child's disruptive behavior during CDI. Danko, Garbacz, and Budd (2016) also found that families who completed only CDI experienced early treatment benefits. In an early study examining the components of PCIT, however, Eisenstadt, Eyberg, McNeil, Newcomb, and Funderburk (1993) found that PDI was necessary for reducing noncompliance and disruptiveness.…”

Section: Future Researchmentioning

confidence: 87%

“…These issues can lead to families attending fewer PCIT sessions than are needed to graduate. While research shows better outcomes, in general, for families who complete and graduate from PCIT (Danko et al, 2016), there is also evidence that rapid response can occur in PCIT (Hakman et al, 2009;Harwood & Eyberg, 2006) and that shortened adaptations of PCIT may also be effective (Franco et al, 2005;Nixon et al, 2003). Time-limited or ultra-brief, intensive versions of PCIT need further examination, but may be good solutions for families who find it difficult to attend one hour sessions each week for 12 to 14 weeks.…”

Section: Implications and Clinical Recommendationsmentioning

confidence: 99%

Attrition in parent-child interaction therapy

Liebsack¹

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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.

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