Abstract
Background
Dropout from child and adolescent psychotherapy is a common phenomenon which can have negative consequences for the individual later in life. It is therefore important to gain insight on dropout risk factors.
Objective
Several potential risk factors [ethnic minority status, a lower socioeconomic status (SES), and higher problem severity] were analyzed in present study. Innovations are that these risk factors were examined for children and adolescents separately, and a distinction was made in termination status between referred patients, dropouts and completers.
Methods
For ethnic majority and minority outpatient children (age 5–11, n = 399) and adolescents (age 12–20, n = 352) problem severity, ethnic background, SES, and treatment termination status (completer, dropout, referral) were specified. Multinomial logistic regression models were used as main method of analysis.
Results
For children, a Moroccan/Turkish ethnicity and higher externalizing scores were risk factors for being referred. For adolescents, a Surinamese/Antillean ethnicity, being female, being older, and lower parental SES occupation levels were risk factors for dropout.
Conclusions
Different dropout risk profiles emerged for children versus adolescents, and for dropouts versus referrals. Also, it depended on the specific ethnic background whether ethnic minority status was a predictor for dropout, and the relationship between SES and termination status differed by whether parental SES occupation or parental SES education were used as SES indicator. Professionals should thus be aware of these potential risk factors for dropout or referral when treating children and adolescents.
Similar content being viewed by others
References
Achenbach, T. M. (1994a). Manual for the child behavior checklist/4-18. Burlington: University of Vermont, Department of Psychiatry.
Achenbach, T. M. (1994b). Manual for the youth self report. Burlington: University of Vermont, Department of Psychiatry.
Armbruster, P., & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children’s mental health clinic. American Journal of Orthopsychiatry, 64(4), 577–585. doi:10.1037/h0079571.
Armbruster, P., & Kazdin, A. E. (1994). Attrition in child therapy. In T. H. Ollendick & T. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 16, pp. 81–108). New York: Plenum.
Baruch, G., Vrouva, I., & Fearon, P. (2009). A follow-up study of characteristics of young people that dropout and continue psychotherapy: Service implications for a clinic in the community. Child and Adolescent Mental Health, 14(2), 69–75. doi:10.1111/j.1475-3588.2008.00492.x.
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 and Family Behavior Therapy, 26(4), 1–22. doi:10.1300/J019v26n04_01.
CBS. (2012). Central Bureau voor de Statistiek. Statline. [Central agency for statistics]. Voorburg: CBS.
Chen, E., Martin, A. D., & Matthews, K. A. (2006). Understanding health disparities: The role of race and socioeconomic status in children’s health. American Journal of Public Health, 96(4), 702–708. doi:10.2105/AJPH.2004.048124.
Cooper, H. (2002). Investigating socio-economic explanations for gender and ethnic inequalities in health. Social Science and Medicine, 54(5), 693–706. doi:10.1016/S0277-9536(01)00118-6.
Dadds, M. R., Hiolland, D. E., Laurens, K. R., Mullins, M., Barrett, P. M., & Spence, S. H. (1999). Early intervention and prevention of anxiety disorders in children: Results of a 2-year follow-up. Journal of Consulting and Clinical Psychology, 67(1), 145–150. doi:10.1037/0022-006X.67.1.145.
De Haan, A. M., Boon, A. E., De Jong, J. T. V. M., Hoeve, M., & Vermeiren, R. R. J. M. (2013). A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clinical Psychology Review, 33(5), 698–711. doi:10.1016/j.cpr.2013.04.005.
De Jong, J. T. V. M. (2010). Zorgfilters [care filters]. In J. T. V. M. De Jong & S. Colijn (Eds.), Handboek Culturele psychiatrie en psychotherapie [manual cultural psychiatry and psychotherapy] (pp. 179–203). Utrecht: De Tijdstroom.
Harland, P., Reijneveld, S., Brugman, E., Verloove-Vanhorick, S. P., & Verhulst, F. (2002). Family factors and life events as risk factors for behavioural and emotional problems in children. European Child and Adolescent Psychiatry, 11(4), 176–184. doi:10.1007/s00787-002-0277-z.
Hibbert, A., Campbell, A., & Lempens, W. (Eds.). (2003). Kinderrechten [children’s rights]. Leidschendam: NBD Biblion Publishers.
Hoogsteder, M., & Dias, E. B. (2011). Tests en testgebruik in een interculturele context: een verkennend overzicht [Questionnaires and the use of questionnaires in an intercultural context: an explorative overview]. In R. Borra, R. Van Dijk & R. Verboom (Eds.), Cultuur en psychodiagnostiek. Professioneel werken met psychodiagnostische instrumenten (pp. 53–71). Houten: Bohn Stafleu van Loghum.
Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression. New York: Wiley.
Janssen, M. M. M., Verhulst, F. C., Bengi-Arslan, L., Erol, N., Salter, C. J., & Crijnen, A. A. M. (2004). Comparison of self-reported emotional and behavioral problems in Turkish immigrant, Dutch and Turkish adolescents. Social Psychiatry and Psychiatric Epidemiology, 39(2), 133–140. doi:10.1007/s00127-004-0712-1.
Johnson, E., Mellor, D., & Brann, P. (2008). Differences in dropout between diagnoses in child and adolescent mental health services. Clinical Child Psychology and Psychiatry, 13(4), 515–530. doi:10.1177/1359104508096767.
Kamperman, A. M., Komproe, I. H., & De Jong, J. T. V. M. (2007). Migrant mental health: A model for indicators of mental health and health care consumption. Health Psychology, 26(1), 96–104. doi:10.1037/0278-6133.26.1.96.
Kaufman, J. S., Cooper, R. S., & McGee, D. L. (1997). Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiology, 8(6), 621–628. doi:10.1097/00001648-199710000-00002.
Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65(3), 453–463. doi:10.1037/0022-006X.65.3.453.
Leung, P. W. L., Kwong, S. L., Tang, C. P., Ho, T. P., Hung, S. F., Lee, C. C., et al. (2006). Test–retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR. Journal of Child Psychology and Psychiatry, 47(9), 970–973. doi:10.1111/j.1469-7610.2005.01570.x.
Lochman, J. E., & Salekin, R. T. (2003). Prevention and intervention with aggressive and disruptive children: Next steps in behavioral intervention research. Behavior Therapy, 34(4), 413–419. doi:10.1016/S0005-7894(03)80027-8.
Midgley, N., & Navridi, E. (2006). An exploratory study of premature termination in child analysis. Journal of Infant, Child, and Adolescent Psychotherapy, 5(4), 437–458. doi:10.1080/15289160701382360.
Miller, L. M., Southam-Gerow, M. A., & Allin, R. B, Jr. (2008). Who stays in treatment? Child and family predictors of youth client retention in a public mental health agency. Child and Youth Care Forum, 37(4), 153–170. doi:10.1007/s10566-008-9058-2.
Moffitt, T. E., Caspi, A., Harrington, H., & Milne, B. (2002). Males on the life-course persistent and adolescence-limited antisocial pathways: Follow-up at age 16. Development and Psychopathology, 14(1), 179–206. doi:10.1017/S0954579402001104.
Murad, S. D., Joung, I. M. A., van Lenthe, F. J., Bengi-Arslan, L., & Crijnen, A. A. M. (2003). Predictors of self-reported problem behaviors in Turkish immigrants and Dutch adolescents in the Netherlands. Journal of Child Psychology and Psychiatry, 44(3), 412–423. doi:10.1111/1469-7610.00131.
Reijneveld, S. A., Harland, P., Brugman, E., Verhulst, F. C., & Verloove-Vanhorick, S. P. (2005). Psychosocial problems among immigrant and non-immigrant children: Ethnicity plays a role in their occurrence and identification. European Child and Adolescent Psychiatry, 14(3), 145–152. doi:10.1007/s00787-005-0454-y.
Rescorla, L. A., Achenbach, T. M., Ivanova, M. Y., Dumenci, L., Almqvist, F., Bilenberg, N., et al. (2007). Behavioral and emotional problems reported by parents of children aged 6 to 16 in 31 societies. Journal of Emotional and Behavioral Disorders, 15(3), 130–142. doi:10.1177/10634266070150030101.
Ryan, S. R., Cunningham, P. B., Foster, S. L., Brennan, P. A., Brock, R. L., & Whitmore, E. (2013). Predictors of therapist adherence and emotional bond in multisystemic therapy: Testing ethnicity as a moderator. Journal of Child and Family Studies, 22(1), 122–136. doi:10.1007/s10826-012-9638-5.
Schoenwald, S. K., Letourneau, E. J., & Halliday-Boykins, C. (2005). Predicting therapist adherence to a transported family-based treatment for youth. Journal of Clinical Child and Adolescent Psychology, 34(4), 658–670. doi:10.1207/s15374424jccp3404_8.
Stevens, G. W. J. M., Pels, T., Bengi-Arslan, L., Verhulst, F. C., Vollebergh, W. A. M., & Crijnen, A. A. (2003). Parent, teacher and self-reported problem behavior in The Netherlands: Comparing Moroccan immigrant with Dutch and with Turkish immigrant children and adolescents. Social Psychiatry Psychiatric Epidemiology., 38(10), 576–585. doi:10.1007/s00127-003-0677-5.
Stronks, K., & Kunst, A. E. (2009). The complex interrelationship between ethnic and socio-economic inequalities in health. Journal of Public Health, 31(3), 324–325. doi:10.1093/pubmed/fdp070.
Stronks, K., Ravelli, A. C. J., & Reijneveld, S. (2001). Immigrants in the Netherlands: Equal access for equal needs? Journal of Epidemiology and Community Health, 55(10), 701–707. doi:10.1136/jech.55.10.701.
Verboom, R. (2002). Psychodiagnostisch testonderzoek bij migranten [Psychodiagnostic testing with migrants]. In E. Van Meekeren, A. Limburg-Okken, & R. May (Eds.), Culturen binnen psychiatriemuren; geestelijke gezondheidszorg in een multiculturele samenleving (pp. 94–105). Amsterdam: Boom.
Verhulst, F. C., Achenbach, T. M., van der Ende, J., Erol, N., Lambert, M. C., Leung, P. W. L., et al. (2003). Comparisons of problems reported by youth from seven countries. American Journal of Psychiatry, 160(8), 1479–1485. doi:10.1176/appi.ajp.160.8.1479.
Verhulst, F. C., Van der Ende, J., & Koot, H. (1996). Handleiding voor de CBCL/4-18 [Manual for the CBCL/4-18]. Rotterdam: Department of Child and Adolescent Psychiatry, Erasmus Medical Centre/Sophia.
Verhulst, F. C., Van der Ende, J., & Koot, H. (1997). Handleiding voor de Youth Self-Report (YSR) [Manual for the Youth Self-Report]. Rotterdam: Department of Child and Adolescent Psychiatry, Erasmus Medical Centre/Sophia.
Warnick, E. M., Gonzalez, A., Weersing, V. R., Scahill, L. D., & Woolston, J. L. (2012). Defining dropout from youth psychotherapy: How definitions shape the prevalence and predictors of attrition. Child and Adolescent Mental Health, 17(2), 76–85. doi:10.1111/j.1475-3588.2011.00606.x.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology Research and Practice, 94(2), 190–195. doi:10.1037/0735-7028.24.2.190.
Williams, D. R. (2002). Racial/ethnic variations in women’s health: The social embeddedness of health. American Journal of Public Health, 92(4), 588–597. doi:10.2105/AJPH.92.4.588.
Winkleby, M. A., Jatulis, D. E., Frank, E., & Fortmann, S. P. (1992). Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease. American Journal of Public Health, 82(6), 816–820. doi:10.2105/AJPH.82.6.816.
Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40(9), 1086–1093. doi:10.1097/00004583-200109000-00018.
Yeh, M., Eastman, K., & Cheung, M. K. (1994). Children and adolescents in community health care centers: Does the ethnicity or the language of the therapist matter? Journal of Community Psychology, 22, 153–163. doi:10.1002/1520-6629(199404.
Zwaanswijk, M. (2005). Pathways to care. Help-seeking for child and adolescent mental health problems. Utrecht: NIVEL.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
de Haan, A.M., Boon, A.E., Vermeiren, R.R.J.M. et al. Ethnic Background, Socioeconomic Status, and Problem Severity as Dropout Risk Factors in Psychotherapy with Youth. Child Youth Care Forum 44, 1–16 (2015). https://doi.org/10.1007/s10566-014-9266-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-014-9266-x