Revisiting Unplanned Termination: Clinicians’ Perceptions of Termination from Adolescent Mental Health Treatment

Abstract

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.

Enhancing Collaborative Treatment Planning with Young People in Mental Health Settings: A Narrative Scoping Review

“…These were seen as enhancing the young person's interactions with the health care system (Day, 2008;Howe et al, 2011;Mirabito, 2006) by increasing their control and influence (Amodeo & Collins, 2007;Day, 2008;Holum, 2012;LeFrançois, 2008;Prilleltensky, Peirson, Gould, & Nelson, 1997;Walker, Thorne, Powers, & Gaonkar, 2009) and improving their quality of life. …”

“…• New skills and an increased sense of mastery (Day, 2008;Holum, 2012;Howe et al, 2011;Mirabito, 2006), enhanced ability to manage their own goals (Holum, 2012), as well as better functional outcomes (Kjellberg, Kåhlin, Haglund, & Taylor, 2012;Pavkov et al, 2010;Schauer et al, 2007).…”

“…A shift from a pathology focus to normalising young people's behaviour in an adolescent framework (Amodeo & Collins, 2007;Green et al, 2012), and reframing avoidant coping strategies, was emphasised (Amodeo & Collins, 2007). It is clear, however, that the strategies should be flexible, age-appropriate and reflect youth culture and lifestyle (Green et al, 2012;Mirabito, 2006).…”

“…• Identifying the young person's readiness for change, starting "where the client is at" (Amodeo & Collins, 2007;Green et al, 2012;Mirabito, 2006) and seeing the clients as "experts" in their own care (Brown et al, 2010).…”

“…One article highlighted the importance of caregivers supporting the treatment goals generated by young people (Mirabito, 2006). It was accentuated that parental understanding of treatment goals promoted and increased young people's engagement generally (Oruche et al, 2014;Warnick et al, 2014).…”