Child & Youth Care Forum

, Volume 37, Issue 4, pp 153–170 | Cite as

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

  • Lauren M. Miller
  • Michael A. Southam-Gerow
  • Robert B. AllinJr.
Original Paper


The present study examined 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.


Public mental health Child mental health Attrition 


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
  2. Anderson, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly: Health and Society, 51, 95–124.Google Scholar
  3. Attride-Stirling, J., Davis, H., Farrell, L., Groark, C., & Day, C. (2004). Factors influencing parental engagement in a community child and adolescent mental health service: A qualitative comparison of completers and non-completers. Clinical Child Psychology and Psychiatry, 9, 347–361. doi:10.1177/1359104504043918.CrossRefGoogle Scholar
  4. Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82, 738–783. doi:10.1037/h0077132.PubMedCrossRefGoogle Scholar
  5. Bauman, L. J. (2000). A patient-centered approach to adherence: Risks for nonadherence. In D. Drotar (Ed.), Promoting adherence to medical treatment in chronic childhood illness (pp. 71–93). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  6. Becker, M. H., Drachman, R. H., & Kirscht, J. P. (1972). Predicting mothers’ compliance with pediatric regimens. Journal of Pediatrics, 81, 843–854.Google Scholar
  7. Becker, M. H., Radius. S. M., Rosenstock, I. M., Drachman, R. H., Shuberth, K. C., & Teets, K. C. (1978). Compliance with a medical regimen for asthma: A test of the Health Belief Model. Public Health Reports, 93, 268–277.Google Scholar
  8. Boggs, S. R., Eyberg, S. M., & Edwards, D. L. (2004). Outcomes of parent–child interaction therapy: A comparison of treatment completers and study dropouts one to three years later. Child & Family Behavior Therapy, 26, 1–22. doi:10.1300/J019v26n04_01.CrossRefGoogle Scholar
  9. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.Google Scholar
  10. Chorpita, B. F., & Southam-Gerow, M. A. (2006). Treatment of anxiety disorders in youth. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (3rd ed., pp. 271–335). New York: Guilford Press.Google Scholar
  11. Chorpita, B. F., Yim, L. M., Donkervoet, J. C., Arensdorf, A., Amundsen, M. J., McGee, C., et al. (2002). Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii empirical basis to services task force. Clinical Psychology: Science and Practice, 9, 165–190.Google Scholar
  12. Chronis, A. M., Gamble, S. A., Roberts, J. E., & Pelham, W. E. (2006). Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder. Behavior Therapy, 37, 143–158. doi:10.1016/j.beth.2005.08.001.PubMedCrossRefGoogle Scholar
  13. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum.Google Scholar
  14. Cunningham, P. B., Foster, S. L., & Henggeler, S. W. (2002). The elusive concept of cultural competence. Children’s Services, 5, 231–243. doi:10.1207/S15326918CS0503_7.CrossRefGoogle Scholar
  15. Dierker, L., Nargison, J., Wiseman, R., & Hoff, D. (2001). Factors predicting attrition within a community initiated system of care. Journal of Child and Family Studies, 10, 367–383. doi:10.1023/A:1012581027044.CrossRefGoogle Scholar
  16. Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. B. (2000). Treatment preferences among depressed primary care patients. Journal of General Internal Medicine, 15, 527–534. doi:10.1046/j.1525-1497.2000.08035.x.PubMedCrossRefGoogle Scholar
  17. 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 services across one year. Community Mental Health Journal, 35, 31–46. doi:10.1023/A:1018743908617.PubMedCrossRefGoogle Scholar
  18. Friedman, I. M., & Litt, I. F. (1987). Adolescents’ compliance with therapeutic regimens: Psychological and social aspects and intervention. Journal of Adolescent Health Care, 8, 52–67. Google Scholar
  19. Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70, 439–443. doi:10.1037/0022-006X.70.2.439.PubMedCrossRefGoogle Scholar
  20. Glisson, C. (2007). Assessing and changing organizational culture and climate for effective services. Research on Social Work Practice, 17, 736–747. doi:10.1177/1049731507301659.CrossRefGoogle Scholar
  21. Hammen, C., Rudolph, K., Weisz, J., Rao, U., & Burge, D. (1999). The context of depression in clinic-referred youth: Neglected areas in treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 64–71. doi:10.1097/00004583-199901000-00021.PubMedCrossRefGoogle Scholar
  22. Harpaz-Rotem, I., Leslie, D., & Rosenheck, R. A. (2004). Treatment retention among children entering a new episode of mental health care. Psychiatric Services (Washington, DC), 55, 1022–1028. doi:10.1176/ Scholar
  23. Huey, S., & Polo, A. (2008). Evidence-based psychosocial treatments for ethnic minority youth: A review and meta-analysis. Journal of Clinical Child and Adolescent Psychology, 37, 262–301. doi:10.1080/15374410701820174.PubMedCrossRefGoogle Scholar
  24. Kazdin, A. E. (1996). Dropping out of child psychotherapy: Issues for research and implications for practice. Clinical Child Psychology and Psychiatry, 1, 133–156. doi:10.1177/1359104596011012.CrossRefGoogle Scholar
  25. Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Clinical and Consulting Psychology, 65, 453–463. doi:10.1037/0022-006X.65.3.453.CrossRefGoogle Scholar
  26. Kazdin, A. E., & Mazurick, J. L. (1994). Dropping out of child psychotherapy: Distinguishing early and late dropouts over the course of treatment. Journal of Consulting and Clinical Psychology, 62, 1069–1074. doi:10.1037/0022-006X.62.5.1069.PubMedCrossRefGoogle Scholar
  27. Kazdin, A. E., Mazurick, J. L., & Bass, D. (1993). Risk for attrition in treatment of antisocial children and their families. Journal of Clinical Child Psychology, 22, 2–16.Google Scholar
  28. Kazdin, A. E., & Wassell, G. (1998). Treatment completion and therapeutic change among children referred for outpatient therapy. Professional Psychology, Research and Practice, 29, 332–340. doi:10.1037/0735-7028.29.4.332.CrossRefGoogle Scholar
  29. Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65, 883–888. doi:10.1037/0022-006X.65.5.883.PubMedCrossRefGoogle Scholar
  30. Klein, E. B., Stone, W. N., Hicks, M. W., & Pritchard, I. L. (2003). Understanding dropouts. Journal of Mental Health Counseling, 25, 89–100.Google Scholar
  31. LaGreca, A. M., & Bearman, K. J. (2003). Adherence to pediatric treatment regimens. In M. C. Roberts (Ed.), Handbook of pediatric psychology (3rd ed., pp. 119–140). New York: The Guilford Press.Google Scholar
  32. Lasalvia, A., Bonetto, C., Tansella, M., Stefani, B., & Ruggeri, M. (2007). Does staff-patient agreement on needs for care predict better mental outcome? A 4-year follow-up in a community service. Psychological Medicine, 38, 123–133.PubMedGoogle Scholar
  33. Lau, A. S. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295–310. doi:10.1111/j.1468-2850.2006.00042.x.CrossRefGoogle Scholar
  34. Lau, A. S., & Weisz, J. R. (2003). Reported maltreatment among clinic-referred children: Implications for presenting problems, treatment attrition, and long-term outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1327–1334. doi:10.1097/01.CHI.0000085754.71002.14.PubMedCrossRefGoogle Scholar
  35. Mak, W. W. S., Law, R. W., Alvidrez, J., & Pérez-Stable, E. J. (2007). Gender and ethnic diversity in NIMH-funded clinical trials: Review of a decade of published research. Administration and Policy in Mental Health and Mental Health Services Research, 34, 497–503. doi:10.1007/s10488-007-0133-z.PubMedCrossRefGoogle Scholar
  36. Martinez, C. R., & Eddy, J. M. (2005). Effects of culturally adapted parent management training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psychology, 73, 841–851. doi:10.1037/0022-006X.73.5.841.PubMedCrossRefGoogle Scholar
  37. Masi, M. V., Miller, R. B., & Olson, M. M. (2003). Differences in dropout rates among individual, couple, and family therapy clients. Contemporary Family Therapy, 25, 63–75.Google Scholar
  38. McClure, E. B., Connell, A. M., & Zucker, M. (2005). The Adolescent Depression Empowerment Project (ADEPT): A culturally sensitive family treatment for depressed African American girls. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 149–164). Washington, DC: American Psychological Association.Google Scholar
  39. McMahon, R. J., Wells, K. C., & Kotler, J. S. (2006). Conduct problems. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (3rd ed., pp. 137–268). New York: Guilford Press.Google Scholar
  40. McMiller, W. P., & Weisz, J. R. (1996). Help-seeking preceding mental health clinic intake among African-American, Latino, and Caucasian youths. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1086–1094. doi:10.1097/00004583-199608000-00020.PubMedCrossRefGoogle Scholar
  41. Meichenbaum, D., & Turk, D. C. (1987). Facilitating treatment adherence: A practitioner’s guidebook. New York: Plenum Press.Google Scholar
  42. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford.Google Scholar
  43. Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10, 155–180. doi:10.1023/A:1016699424731.CrossRefGoogle Scholar
  44. Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73, 872–879. doi:10.1037/0022-006X.73.5.872.PubMedCrossRefGoogle Scholar
  45. Pina, A. A., Silverman, W. K., Weems, C. F., Kurtines, W. M., & Goldman, M. L. (2003). A comparison of completers and noncompleters of exposure-based cognitive and behavioral treatment for phobic and anxiety disorders in youth. Journal of Consulting and Clinical Psychology, 71, 701–705. doi:10.1037/0022-006X.71.4.701.PubMedCrossRefGoogle Scholar
  46. Prinz, R., & Miller, G. (1994). Family-based treatment for childhood antisocial behaviour: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62, 645–650.Google Scholar
  47. 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.Google Scholar
  48. Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services (Washington, DC), 52, 1190–1197. doi:10.1176/ Scholar
  49. Siqueland, L., Crits-Cristoph, P., Gallop, R., Barber, J. P., Griffin, M. L., Thase, M. E., et al. (2002). Retention in psychosocial treatment of cocaine dependence: Predictors and impact on outcome. The American Journal on Addictions, 11, 24–40. doi:10.1080/10550490252801611.PubMedCrossRefGoogle Scholar
  50. Southam-Gerow, M. A. (2005, Summer). Using partnerships to adapt evidence-based mental health treatments for use outside labs. Report on Emotional & Behavioral Disorders in Youth, 5, 58–60, 77–79.Google Scholar
  51. Southam-Gerow, M. A., Austin, A. A., & Marder, A. M. (2008a). Transportability and dissemination of psychological treatments: Research models and methods. In D. McKay (Ed.), Handbook of research methods in abnormal and clinical psychology (pp. 203–224). Newbury Park, CA: Sage.Google Scholar
  52. Southam-Gerow, M. A., Chorpita, B. F., Miller, L. M., & Gleacher, A. A. (2008b). Are children with anxiety disorders privately-referred to a university clinic like those referred from the public mental health system? Administration and Policy in Mental Health and Mental Health Services Research, 35, 168–180. doi:10.1007/s10488-007-0154-7.PubMedCrossRefGoogle Scholar
  53. Southam-Gerow, M. A., Ringeisen, H. L., & Sherrill, J. T. (2006). Introduction to special issue: Integrating interventions and services research: Progress and prospects. Clinical Psychology: Science and Practice, 13, 1–8. doi:10.1111/j.1468-2850.2006.00001.x.CrossRefGoogle Scholar
  54. Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2003). Youth with anxiety disorders in research and service clinics: Examining client differences and similarities. Journal of Clinical Child and Adolescent Psychology, 32, 375–385. doi:10.1207/S15374424JCCP3203_06.PubMedCrossRefGoogle Scholar
  55. Sparks, W. A., Daniels, J. A., & Johnson, E. (2003). Relationship of referral source, race, and wait time on preintake attrition. Professional Psychology: Research and Practice, 5, 514–518.Google Scholar
  56. Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. The American Psychologist, 53, 440–448. doi:10.1037/0003-066X.53.4.440.PubMedCrossRefGoogle Scholar
  57. United States Public Health Service. (1999). Mental health: A report of the surgeon general. Washington, DC: United States Public Health Service.Google Scholar
  58. United States Public Health Service. (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Washington, DC: United States Public Health Service.Google Scholar
  59. Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132, 132–149. doi:10.1037/0033-2909.132.1.132.PubMedCrossRefGoogle Scholar
  60. Weisz, J. R., Southam-Gerow, M. A., Gordis, E. B., & Connor-Smith, J. K. (2003). Primary and secondary control enhancement training for youth depression: Applying the deployment-focused model of treatment development and testing. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based treatments for children and adolescents (pp. 165–183). New York: Guilford.Google Scholar
  61. Werba, B. E., Eyberg, S. M., & Boggs, S. R. (2006). Predicting outcome in parent–child interaction therapy: Success and attrition. Behavior Modification, 30, 618–646. doi:10.1177/0145445504272977.PubMedCrossRefGoogle Scholar
  62. Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology, Research and Practice, 24, 190–195. doi:10.1037/0735-7028.24.2.190.CrossRefGoogle Scholar
  63. Yeh, M., McCabe, K., Hough, R. L., Lau, A., Fakhry, F., & Garland, A. (2005). Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use. Journal of Consulting and Clinical Psychology, 73, 800–807. doi:10.1037/0022-006X.73.5.800.PubMedCrossRefGoogle Scholar
  64. Zimmerman, F. J. (2005). Social and economic determinants of disparities in professional help-seeking for child mental health problems: Evidence from a national sample. Health Services Research, 40(5 Pt 1), 1514–1533. doi:10.1111/j.1475-6773.2005.00411.x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Lauren M. Miller
    • 1
  • Michael A. Southam-Gerow
    • 1
  • Robert B. AllinJr.
    • 2
  1. 1.Department of PsychologyVirginia Commonwealth UniversityRichmond USA
  2. 2.Chesterfield County Community Mental Health Services Chesterfield USA

Personalised recommendations