Factors Predicting Attrition Within a Community Initiated System of Care
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
We designed this study to elucidate child, family, and service level characteristics that may influence attrition from a continuum of care developed and maintained by a community initiated collaboration of local clinics and agencies. Subjects included 117 children and adolescents referred to the Middlesex County system of care from 1992–1999. Data were collected through a retrospective case review. The strongest predictors of attrition from the system of care both before and after the establishment of an individualized service plan included depressed/isolated symptoms, substance abuse, general risk for psychiatric problems, number of referral reasons and urgency status at program intake. Among youth exiting residential placement, those completing recommended services were more likely to be returned home earlier or within the expected time frame than were dropouts. Our study presents important preliminary findings regarding characteristics related to treatment adherence within a community initiated systems of care.
- APA. (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th Ed.). Washington, D.C.: American Psychiatric Association Press.
- Armbruster, P. & Kazdin, A. E. (Eds.). (1994). Attrition in child psychotherapy. (Vol. 16). New York: Plenum Press.
- Bickman, L. (1996). A continuum of care: More is not always better. American Psychologist, 51 689-701.
- Bickman, L. (1997). Resolving issues raised by the Fort Bragg evaluation: New directions for mental health services research. American Psychologist, 52 562-565.
- Bickman, L., Summerfelt, W. T. & Bryant, D. (1996). The quality of services in a children's mental health managed care demonstration. Journal of Mental Health Administration, 23 30-39.
- Bickman, L., Summerfelt, W. T. & Noser, K. (1997). Comparative outcomes of emotionally disturbed children and adolescents in a system of services and usual care. Psychiatric Services, 48 1543-1548.
- Bruns, E. J., Burchard, J. D. & Yoe, J. T. (1995). Evaluating the Vermont system of care: Outcomes associated with community-based wraparound services. Journal of Child & Family Studies, 4 321-339.
- Burns, B. J., Farmer, E. M. Z., Angold, A., Costello, E. J., & Behar, L. (1996). A randomized trial of case management for youths with serious emotional disturbance. Journal of Clinical Child Psychology, 25 476-486.
- Burns, B. J., Hoagwood, K. & Maultsby, L. T. (1998). Improving Outcomes for Children and Adolescents with Serious Emotional and Behavioral Disorders: Current and Future Directions. In M. H. Epstein, K. Kutash, & A. Duchinowski (Eds.), Outcomes for children and adolescents with behavioral and emotional disorder and their families (pp. 685-704). Austin: Pro-Ed.
- Crome, I. B. (1999). Substance misuse and psychiatric comorbidity: Towards improved service provision. Drugs-Education Prevention & Policy, 6 151-174.
- Cutler, D. L. (1999). A historical overview of community mental health centers in the United States.In S. Cooper, T. H. Lentner, (Eds.), Innovations in community mental health (pp. 1-22). Sarasota, FL, USA: Professional Resource Press/Professional Resource Exchange, Inc.
- Duchnowski, A. J., Johnson, M. K., Hall, K. S., Kutash, K., & Friedman, R. M. (1993). TheAlternatives to Residential Treatment Study: Initial findings. Journal of Emotional & Behavioral Disorders, 1(1), 17-26.
- Epstein, M. H., Cullinan, D., Quinn, K. P., & Cumbald, C. (1994). Characteristics of children with emotional and behavioral disorders in community-based programs designed to prevent placement in residential facilities. Journal of Emotional and Behavioral Disorders, 2 51-57.
- Farmer, E. M. Z., Burns, B. J., Angold, A., & Costello, E. J. (1997). Impact of children's mental health problems on families: Relationships with service use. Journal of Emotional & Behavioral Disorders, 5 230-238.
- Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: Patterns of care for children's mental health across one year. Community Mental Health Journal, 35 31-46.
- Gaines, T., Jr. (1978). Factors influencing failure to show for a family evaluation. International Journal of Family Counseling, 6 57-61.
- Goldman, S. K. & Faw, L. (1998). Three wraparound models as promising approaches. Promising Practices in Children's Mental Health, 4 17-32.
- Gould, M. S., Shaffer, D., & Kaplan, D. (1985). The characteristics of dropouts from a child psychiatry clinic. Journal of the American Academy of Child Psychiatry, 24 316-328.
- Hamner, K. M., Lambert, E. W., & Bickman, L. (1997). Children's mental health in a continuum of care: Clinical outcomes at 18 months for the Fort Bragg demonstration. Journal of Mental Health Administration, 24 465-471.
- Hoagwood, K. (1997). Interpreting nullity: The Fort Bragg experiment-A comparative success or failure? American Psychologist, 52 546-550.
- Joint Commission on the Mental Health of Children (1969). Crisis in child mental health: Challenge for the 1970s. New York: Harper & Row Publishers.
- Kazdin, A. E. (1990). Premature termination from treatment among children referred for antisocial behavior. Journal of Child Psychology and Psychiatry, 31 415-425.
- Kazdin, A. E., Mazurick, J. L., & Bass, D. (1993). Risk for attrition in treatment of antisocial children and families. Journal of Clinical Child Psychology, 22 2-16.
- Knitzer, J. (1982). Unclaimed children. Washington, D.C.: Children;s Defense Fund.
- Koroloff, N. M., Elliott, D. J., Koren, P. E., & Friesen, B. J. (1996). Linking low-income families to children's mental health services: An outcome study. Journal of Emotional and Behavioral Disorders, 4 2-11.
- Kournay, R. F. C., Garber, J., & Tornusciolo, G. (1990). Improving first appointment attendance rates in child psychiatry outpatient clinics. Journal of the American Academy of Child Psychaitry, 29 657-660.
- Lambert, W. E. & Guthrie, P. R. (1996). Clinical outcomes of a children's mental health managed care demonstration. Journal of Mental Health Administration, 53 51-68.
- Landrum, T. J., Singh, N. N., Nemil, M. S., Ellis, C. R., & Best, A. M. (1995). Characteristics of children and adolescents with serious emotional disturbance in systems of care. Part II: Community-based services. Journal of Emotional and Behavior Disorders, 3 141-149.
- Marin, B. V., Marin, G., Padilla, A. M., & De La Rocha, C. (1982). Utilization of Traditional and Nontraditional Sources of Health Care Among Hispanics. Spanish Speaking Mental Health Research Center, 14 1-18.
- McAdoo, W. G. & Roeske, N. E. (1973). A comparison of defectors and continuers in a child guidance clinic. Journal of Consulting & Clinical Psychology, 40 328-334.
- Novick, J., Benson, R., & Rembar, J. (1981). Patterns of termination in an outpatient clinic for children and adolescents. Journal of the American Academy of Child Psychiatry, 20 834-844.
- Pekarik, G. & Stephenson, L. A. (1988). Adult and child client differences in therapy dropout research. Journal of Clinical Child Psychology, 17 316-321.
- Prinz, R. J. & Miller, G. E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting & Clinical Psychology, 62 645-650.
- Pumariega, A. J., Glover, S., Holzer, C. E., & Nguyen, H. (1998). Utilization of mental health services in a tri-ethnic sample of adolescents. Community Mental Health Journal, 34 145-156.
- Quinn, K. P. & Epstein, M. H. (1998). Characteristics of children, youth, and families served by local interagency systems of care In M. H. Epstein, K. Kutash, & A. Duchinowski (Eds.), Outcomes for children and adolescents with behavioral and emotional disorder and their families (pp. 81-111). Austin: Pro-Ed.
- Saxe, L. & Cross, T. P. (1997). Interpreting the Fort Bragg Children's Mental Health Demonstration Project: The cup is half full. American Psychologist, 52 553-556.
- Siegfried, N. (1998). A review of comorbidity: Major mental illness and problematic substance use. Australian & New Zealand Journal of Psychiatry, 32 707-717.
- Singh, H., Janes, C. L. & Schechtman, J. M. (1982). Problem children's treatment attrition and parent's perception of the diagnostic evaluation. Journal of Psychiatric Treatment Evaluation, 4 257-263.
- Sirles, E. A. (1990). Dropout from intake, diagnostics, and treatment. Community Mental Health Journal, 26 345-360.
- Summerfelt, T., Foster, M., & Saunders, R. C. (1996a). Mental Health Services Utilization in Children's Mental Health Managed Care Demonstration. The Journal Of Mental Health Administration, 23 80-91.
- Summerfelt, W. T., Foster, E. M., & Saunders, R. C. (1996b). Mental health services utilization in a children's mental health managed care demonstration. Journal of Mental Health Administration, 23 80-91.
- Swartz, M. S., Wagner, H. R., Swanson, J. W., Burns, B. J., George, L., & Padgett, D. K. (1998). Administrative Update: I. Comparing Use of Public and Private Mental Health Services: The Enduring Barriers of Race and Age. Community Mental Health Journal, 34 133-144.
- U.S. Department of Health and Human Services (1999). Mental health: A report of the surgeon general-Executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
- Viale-Val, G., Rosenthal, R. H., Curtiss, G., & Marohn, R. C. (1984). Dropout from adolescent psychotherapy: A preliminary study. Journal of the American Academy of Child Psychiatry, 23 562-568.
- Weisz, J. R., Han, S. S. & Valeri, S. M. (1997a). More of What? Issues raised by the Fort Bragg study. American Psychologist, 52 541-545.
- Weisz, J. R., Walter, B. R., Weiss, B., Fernandez, G. A., & Mikow, Victoria A. et al. (1997b). Arrests among emotionally disturbed violent and assaultive individuals following minimal versus lengthy intervention through North Carolina's Willie M Program. Journal of Consulting & Clinical Psychology, 58 720-728.
- Weisz, J. R., Weiss, B., & Langmeyer, D. B. (1987). Giving up on child psychotherapy: Who drops out? Journal of Consulting & Clinical Psychology, 55 916-918.
- Wierzbicki, M. & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology-Research & Practice, 24 190-195.
- Factors Predicting Attrition Within a Community Initiated System of Care
Journal of Child and Family Studies
Volume 10, Issue 3 , pp 367-383
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- severe emotional and behavioral disorders (SED)
- treatment adherence
- Author Affiliations
- 1. Department of Psychology, Wesleyan University, Middletown, CT
- 2. Middlesex County, Child and Adolescent Service System Program, Middletown, CT
- 3. Psychiatric Services, Middlesex Hospital, Middletown, CT