Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

A Correction to this article was published on 22 April 2020

This article has been updated

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 via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Change history

  • 22 April 2020

    The original version of this article was unfortunately published with an error in Table 2. The confidence intervals listed in Table 2 were published incorrectly. The correct version of confidence intervals in Table 2 should read as below.

References

  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

    PubMed  Google Scholar 

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

    Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    PubMed  PubMed Central  Google Scholar 

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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

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

  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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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. 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

    PubMed  Google Scholar 

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

    Google Scholar 

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

    PubMed  Google Scholar 

  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. 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

    Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  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

    PubMed  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

  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

    PubMed  PubMed Central  Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    PubMed  Google Scholar 

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

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

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Western University, London, Canada

    Kimberly W. Dossett & Graham J. Reid

  2. Department of Family Medicine, Western University, London, Canada

    Graham J. Reid

  3. Department of Paediatrics, Western University, London, Canada

    Graham J. Reid

  4. Children’s Health Research Institute, London, Canada

    Graham J. Reid

Authors
  1. Kimberly W. Dossett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Graham J. Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

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

Check for updates. 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

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-019-00906-4

Keywords

Search

Navigation