Original Article

Administration and Policy in Mental Health and Mental Health Services Research

, Volume 41, Issue 1, pp 93-103

First online:

Shifting the Treatment Model: Impact on Engagement in Outpatient Therapy

  • Erin M. WarnickAffiliated withChild Study Center, Yale University Email author 
  • , Karen BearssAffiliated withChild Study Center, Yale University
  • , V. Robin WeersingAffiliated withSan Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California
  • , Lawrence ScahillAffiliated withChild Study Center, Yale UniversitySchool of Nursing, Yale University
  • , Joseph WoolstonAffiliated withChild Study Center, Yale University

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Attrition in youth outpatient mental health clinics ranges from 30 to 70 % and often occurs early in treatment. We implemented specific treatment planning strategies designed to reduce early attrition. Following implementation, 14.3 % of clients dropped out during the first five sessions compared to 26.1 % in the historical control (p < 0.001). During treatment, 33.6 % of clients dropped out in the intervention compared to 55.5 % in the historical control (p < 0.001). Engagement is central to the therapeutic process and may be particularly relevant early in treatment. Implementing evidence-based strategies to promote a collaborative relationship between the family and the clinician may increase engagement and decrease attrition.


Child mental health Attrition Dropout Child guidance clinic