Advertisement

Predicting Dropout from Children’s Mental Health Services: Using a Need-Based Definition of Dropout

Abstract

Dropout from children’s mental health services has negative impacts on children, families and service providers. To target interventions aimed to reduce dropout, it is essential to predict individuals who drop out. This study compares predictors of dropout using a novel need-based definition, to existing definitions of dropout. Children (N = 650; 61% male) aged 5–13 attended five children’s mental health agencies in Ontario. A mixed effects logistic regression was used to model binary outcome variables (i.e., dropout or treatment completion), for each definition of dropout. Using the need-based definition, older child age, lower child problem presentation, higher child risk behaviors, higher caregiver needs, and more child strengths predicted an increased likelihood of dropout. The need-based definition results in different predictors of dropout than existing definitions in the literature. High caregiver needs was the only predictor of dropout across all definitions. Caregiver needs represent a prospective target when distributing interventions aimed to reduce dropout.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

References

  1. 1.

    de Haan AM, Boon AE, de Jong JTVM, Hoeve M, Vermeiren RRJM (2013) A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clin Psychol Rev 33(5):698–711

  2. 2.

    Klein E, Stone W, Hicks M, Pritchard I (2003) Understanding dropouts. J Ment Health Couns 25(2):89–100

  3. 3.

    Armbruster P, Kazdin A (1994) Attrition in child therapy. In: Prinz J, Ollendick TH (eds). Advances in clinical child psychology. Plenum, New York, pp 81–108

  4. 4.

    Kazdin A, Mazurick J, Siegel T (1994) Treatment among children woth externalizing disorders who terminatie prematurely versus thos who complete. J Am Acad Child Adolesc Psychiatry 33(4):549–557

  5. 5.

    Miller LM, Southam-Gerow MA, Allin RB (2008) Who stays in treatment? Child and family predictors of youth client retention in a Public Mental Health Agency. Child Youth Care Forum 37(4):153–170

  6. 6.

    Wierzbicki M, Pekarik G (1993) A meta-analysis of psychotherapy dropout. Prof Psychol Res Pr 24(2):190–195

  7. 7.

    Johnson E, Mellor D, Brann P (2008) Differences in dropout between diagnoses in child and adolescent mental health services. Clin Child Psychol Psychiatry 13:515–530

  8. 8.

    Garfield SL (1994) Research on client variables in psychotherapy. In: Bergin AE, Garfield SL (eds) Handbook of psychotherapy and behavior change. John Wiley & Sons, Oxford, England, pp 190–228

  9. 9.

    Todd DM, Deane FP, Bragdon RA (2003) Client and therapist reasons for termination: a conceptualization and preliminary validation. J Clin Psychol 59(1):133–147

  10. 10.

    Dossett K, Reid G (2017) Defining dropout from children’s mental health services: a novel need-based definition of dropout. Under review

  11. 11.

    Farmer EMZ, Stangl DK, Burns BJ, Costello EJ (1999) Use, persistence, and intensity: patterns of care for children’s mental health across one year. Community Ment Health J 35(1):31–46

  12. 12.

    Kopta S, Howard K, Lowry J, Beutler L (1994) Patterns of symptomatic recovery in psychotherapy. J Consult Clin Psychol 62(5):1009–1016

  13. 13.

    Warnick EM, Gonzalez A, Robin Weersing V, Scahill L, Woolston J (2012) Defining dropout from youth psychotherapy: how definitions shape the prevalence and predictors of attrition. Child Adolesc Ment Health 17(2):76–85

  14. 14.

    Ogles BM, Melendez G, Davis DC, Lunnen KM (2000) The Ohio youth problem, functioning, and satisfaction scales: technical manual, Ohio Mental Health Consumer Outcomes Initiative. Ohio University, Ohio

  15. 15.

    Reid GJ, Stewart SL, Barwick M, Carter J, Leschied A, Neufeld R et al (2017) Predicting patterns of service utilization within children’s mental health agencies. Manuscript in preparation

  16. 16.

    Reid G, Stewart S, Zaric G, Carter J, Neufeld R, Tobon J et al (2015) Defining episodes of care in children’s mental health using administrative data. Adm Policy Ment Health 42(6):737–747

  17. 17.

    Lyons JS (1999) The child and adolescent needs and strengths for children with mental health challenges and their families. Northwestern University, Chicago, IL

  18. 18.

    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428

  19. 19.

    Dilley J, Weiner D, Lyons J, Martinovich Z (2007) The validity of the child and adolescent needs and strengths assessment. Online Submission, 1–17

  20. 20.

    Anderson RL, Lyons JS, Giles DM, Price JA, Estle G (2003) Reliability of the child and adolescent needs and strengths-mental health (CANS-MH) scale. J Child Fam Stud 12(3):279–289

  21. 21.

    Chor KHB, McClelland GM, Weiner DA, Jordan N, Lyons JS (2012) Predicting outcomes of children in residential treatment: a comparison of a decision support algorithm and a multidisciplinary team decision model. Child Youth Serv Rev 34(12):2345–2352

  22. 22.

    Lyons JS, Griffin G, Quintenz S, Jenuwine M, Shasha M (2003) Clinical and forensic outcomes from the Illinois mental health juvenile justice initiative. Psychiatr Serv 54(12):1629–1634

  23. 23.

    Kisiel C, Summersett-Ringgold F, Weil LE, McClelland G (2017) Understanding strengths in relation to complex trauma and mental health symptoms within child welfare. J Child Fam Stud 26(2):437–451

  24. 24.

    Radigan M, Wang R (2013) Relationships between youth and caregiver strengths and mental health outcomes in community based public mental health services. Community Ment Health J 49(5):499–506

  25. 25.

    Chow WY, Mettrick JE, Stephan SH, Von Waldner CA (2014) Youth in group home care: youth characteristics and predictors of later functioning. J Behav Health Ser R 41(4):503–519

  26. 26.

    Sim F, Li D, Chu CM (2016) The moderating effect between strengths and placement on children’s needs in out-of-home care: a follow-up study. Child Youth Serv Rev 60:101–108

  27. 27.

    Kazdin A, Holland L, Crowley M (1997) Family experience of barriers to treatment and premature termination from child therapy. J Consult Clin Psychol 65(3):453–463

  28. 28.

    Lipman EL, Offord DR, Boyle MH (1997) Single mothers in Ontario: sociodemographic, physical and mental health characteristics. CMAJ 156(5):639–645

  29. 29.

    Turner D, Finkelhor D, Ormrod R (2006) The effect of lifetime victimization on the mental health of children and adolescents. Soc Sci Med 62(1):13–27

  30. 30.

    Kalton G, Flores-Cervantes I (2003) Weighting methods. J Off Stat 19(2):81–97

  31. 31.

    Tabachnick B, Fidell L (2000) Using multivariate statistics, 4th edn. Allyn & Bacon, Boston

  32. 32.

    Cameron C, Gelbach J, Miller D (2008) Bootstrap-based improvements for inference with clustered errors. Rev Econ Stat 90(3):414–427

  33. 33.

    Barwick M, Vlad C (2015) A decade of outcomes for children and youth receiving mental health service in Canada: 2004–2014

  34. 34.

    McCabe KM (2002) Factors that predict premature termination among Mexican-American children in outpatient psychotherapy. J Child Fam Stud 11(3):347–359

  35. 35.

    Peters S, Calam R, Harrington R (2005) Maternal attributions and expressed emotion as predictors of attendance at parent management training. J Child Psychol Pychiatry 46(4):436–448

  36. 36.

    Baruch G, Fearon P, Varouva I (2009) A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community. Child Adolesc Ment Health 14(2):69–75

  37. 37.

    Armbruster P, Fallon T (1994) Clinical, sociodemographic, and systems risk factors for attrition in a children’s mental health clinic. Am J Orthopsychiatry 64:577–585

  38. 38.

    Kazdin A, Mazurick J (1994) Dropping out of child psychotherapy: distinguishing early and late dropouts over the course of treatment. J Consult Clin Psychol 62(5):1069–1074

  39. 39.

    Dierker L, Nargiso J, Wiseman R, Hoff D (2001) Factors predicting attrition within a community initiated system of care. J Child Fam Stud 10(3):367–383

  40. 40.

    Thornicroft G, Tansella M (2004) Components of a modern mental health services: a pragmatic balance of community and hospital care. Br J Psychiatry 185(4):283–290

  41. 41.

    Haaga DAF (2000) Introduction to the special section on stepped care models in psychotherapy. J Consult Clin Psychol 68(4):547–548

  42. 42.

    Ruma PR, Burke RV, Thompson RW (1996) Group parent training: is it effective for children of all ages? Behav Ther 27(2):159–169

  43. 43.

    Cobham V, Dadds M, Spence S (1998) The role of parental anxiety in the treatment of childhood anxiety. J Consult Clin Psychol 66(6):893–905

  44. 44.

    Burns B, Costello E, Angold A, Tweed D, Stangl D, Farmer E, Erkanli A (1995) Children’s mental health service use across service sectors. Health Aff 14:147–159

  45. 45.

    Gonzalez A, Weersing VR, Warnick EM, Scahill LD, Woolston JL (2011) Predictors of treatment attrition among an outpatient clinic sample of youths with clinically significant anxiety. Adm Policy Ment Health 38:356–367

  46. 46.

    Gopalan G, Goldstein L, Klingenstein K, Sicher C, Blake C, Mckay M (2010) Engaging families into child mental health treatment : updates and special considerations. J Can Acad Child Adolesc Psychiatry 19(3):182–196

  47. 47.

    Staudt M (2007) Treatment engagement with caregivers of at-risk children: gaps in research and conceptualization. J Child Fam Stud 16(2):183–196

  48. 48.

    Ingoldsby EM (2011) Review of interventions to improve family engagement and retention in parent and child mental health programs. J Child Fam Stud 19(5):629–645

  49. 49.

    Garcia JA, Weisz JR (2002) When youth mental health care stops: therapeutic relationship problems and other reasons for ending youth outpatient treatment. J Consult Clin Psychol 70(2):439–443

  50. 50.

    Sarmiento C (2017) Predictors of re-accessing mental health services for children and adolescents. https://ir.lib.uwo.ca/etd/4660

  51. 51.

    Pekarik G (1992) Relationship of clients' reasons for dropping out of treatment to outcome and satisfaction. J Clin Psychol 48(1):91–98

Download references

Author information

Correspondence to Kimberly W. Dossett.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material 1 (DOCX 79 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dossett, K.W., Reid, G.J. Predicting Dropout from Children’s Mental Health Services: Using a Need-Based Definition of Dropout. Child Psychiatry Hum Dev 51, 13–26 (2020). https://doi.org/10.1007/s10578-019-00906-4

Download citation

Keywords

  • Dropout
  • Attrition
  • Mental health services
  • Children’s mental health
  • Ontario