Who Stays in Treatment? Child and Family Predictors of Youth Client Retention in a Public Mental Health Agency

Abstract

The present study examined possible predictors of youth client retention in therapy in a large community-based sample. We used several conceptualizations of retention, including (a) "intake retention" (i.e., returned to treatment after intake session); (b) "mutual termination" (i.e., termination agreed upon by family and therapist), (c) "mean treatment duration" (i.e., completing the mean number of sessions in the agency), and (d) "total treatment duration" (i.e., total number of sessions). Archival data from over 400 children and adolescents who sought treatment at a large public mental health clinic were analyzed using regression analyses. Although different predictors were identified across the various conceptualizations, a few robust predictors emerged including ethnicity and client symptom severity. Clinical implications and future research directions are discussed.Keywords public mental health; child mental health; attrition Epidemiological studies estimate that 10-20% of children have mental health problems involving functional impairment (United States Public Health Service, 1999). Fortunately, a body of research has accumulated demonstrating the potency of several treatment approaches with youth, referred to as evidence-based or empirically-supported treatments (hereafter, EBTs; e.g., Chorpita & Southam-Gerow, 2006;McMahon, Wells, & Kotler, 2006;Weisz et al., 2006). However, for any treatment to be effective, it is likely that clients must attend therapy sessions and follow treatment recommendations. Indeed, some research has suggested that dropping out of therapy early leads to an attenuation of outcomes (e.g., Boggs et al., 2004; Prinz & Miller, 1994). Unfortunately, studies have shown that client attrition is commonplace, with between 40 and 60% of clients ceasing treatment before termination is recommended (Baekeland & Lundwall, 1975;Wierzbicki & Pekarik, 1993). Accordingly, researchers have sought to identify risk factors for attrition so that clients at risk for early termination can be identified early in the therapy process. Such factors can guide research in the development and implementation of strategies for enhancing therapy attendance (e.g., Nock & Kazdin, 2005 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptSeveral related constructs have been discussed within the spectrum of therapy adherence (e.g., Meichenbaum & Turk, 1987), including therapy initiation (i.e., the process of calling a mental health provider, scheduling an appointment, and attending at least one session), attrition/ retention, and adherence to therapy recommendations, often operationalized as homework compliance. The focus of the present investigation, attrition/retention, has been defined in a variety of ways in the literature: 1) the client discontinuing therapy before the therapist feels the client is ready for treatment termination (Garcia & Weisz, 2002;Klein, Stone, Hicks, & Pritchard, 2003); 2) the client missing a scheduled session (Wierzbicki & Pekarik, 1993); 3) the client fail...

Predictors of Treatment Engagement in Ethnically Diverse, Urban Children Receiving Treatment for Trauma Exposure

“…Interestingly, despite these well-documented differences between children mandatorily and voluntarily referred to treatment, studies that have directly compared treatment engagement between these two groups have found no statistically significant differences (Inueste-Montes & Montes, 1988;Koverola et. al, 2007;Miller, Southam-Gerow & Allin, 2008).…”

“…Relatively few studies of treatment engagement include children (Kazdin & Mazurick, 1994;Miller, Southam-Gerow & Allin, 2008). This is problematic because, as Costello et.…”

“…al, 1999;Garland et. al, 2005;Kendall & Sugarman, 1997;Miller, Southam-Gerow & Allin, 2008;Stahmer et. al, 2005;Zahner, Pawelkiewicz, DeFrancesco & Adnopoz, 1992).…”

“…al, 2008b;Pumariega et. al, 1998;Southam-Gerow & Allin, 2008;Zimmerman, 2005). The literature on these variables is summarized below.…”

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