Who drops‐out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Abstract

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop‐out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop‐out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

“…For dropout, the patient variables identified were similar to those reported elsewhere: greater symptom severity at intake (Kazdin, Mazurick, & Siegel, 1994); younger age (e.g., Edlund et al, 2002), and non- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w white ethnicity and unemployment, which may be proxy measures of socio-economic deprivation (Garfield, 1994;Wierzbiki & Pekarik, 1993;Williams, Ketring, & Salts, 2005). In addition, and possibly of greater concern, was the finding that patients at risk of harming themselves or others were more likely to dropout than patients with no risk, a finding that supports previous research from a single service study using CORE risk items (Saxon, Ricketts & Heywood, 2010). We found that patients who had been 'physically violent to others' were 39% more likely to dropout than those who had not.…”

Exploration of Client Profile and Clinical Outcome in a University Psychology Clinic

“…A number of other factors may also explain differences between the two groups. Previous studies have found lower socio-economic status (SES) (Braet, Jeanin, Mels, Moens, & Van Winckel, 2010;Chisholm, Crowther, & Ben-Porath, 1997) and unemployment (Saxon, Ricketts, & Heywood, 2010) to be significant predictors of dropout.…”

Individual Factors Predicting Mental Health Court Diversion Outcome

“…In fact, all of the studies reporting a significant relationship between the participant's age and treatment program completion found older offenders to be more successful than younger offenders (Edlund et al, 2009;Hickert et al, 2009;Mateyoke-Scrivner et al, 2004;Miller & Shutt, 2001;Olfson et al, 2009;Rempel & Destefano, 2002;Reneses et al, 2009;Rossi et al, 2002;Saum et al, 2001;Saxon et al, 2010). Rempel and Destefano (2002) theorized that younger substance abusing clients might be at a higher risk for dropout due to pressures from deviant peer groups.…”

“…Specifically, individuals who had a greater number of housing transitions over the 12 months prior to service delivery were more likely to fail to complete programming. Other studies reviewed did not examine the relationship between housing and program completion (Brown, 2010;Butzin et al, 2002;Edlund et al, 2009;Evans et al, 2009;Hartley & Phillips, 2001;Hickert et al, 2009;Miller & Shutt, 2001;Redlich et al, 2010;Rempel & Destefano, 2002;Reneses et al, 2009;Roll et al, 2005;Saum et al, 2001;Saxon et al, 2010;Sechrest & Shicor, 2001).…”