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

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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.
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Child Psychiatry & Human Development (2020) 51:13–26
https://doi.org/10.1007/s10578-019-00906-4
ORIGINAL ARTICLE
Predicting Dropout fromChildrens Mental Health Services: Using
aNeed‑Based Denition ofDropout
KimberlyW.Dossett1 · GrahamJ.Reid1,2,3,4
Published online: 9 July 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
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 out-
come 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.
Keywords Dropout· Attrition· Mental health services· Children’s mental health· Ontario
Introduction
Treatment dropout is a significant obstacle to the delivery of
effective and economically efficient children’s mental health
services. Compared to children who complete treatment,
those who drop out are more likely to experience adverse
outcomes including: persistence of symptoms, delinquency,
substance abuse, failure to graduate high school and unem-
ployment [1]. Furthermore, dropout leads to increased staff-
ing costs and reduced treatment capacity [2]. Unfortunately,
of children who receive treatment, studies find 28–88%
dropout [1]. Numerous studies have examined character-
istics of dropout [35], however, no consistent profile has
emerged [3].
Inconsistencies inDenitions ofDropout
One explanation for the variability in predictors of dropout
is inconsistency in definitions [6]. The underlying assump-
tion is that differences exist between dropouts and those who
complete treatment. If a definition accurately categorized
individuals, distinct, replicable differences would appear
between dropouts and completers.
Dropout has been defined primarily in two ways. (1)
Dropout has been defined as ceasing treatment before a set
number of sessions or specified “dose” of treatment [7].
The number of sessions may be set arbitrarily (e.g., median
split) or defined as completion of an evidence-based treat-
ment(EBT). Thus, the number of sessions used to define
dropout varies widely across studies from 2 to 21 [1]. (2)
Dropout has also been defined as terminating treatment
against clinician judgment [6]. However, clinicians may use
different criteria for judging appropriateness of termination
(e.g., specific symptom improvement, changes in overall
Electronic supplementary material The online version of
this article (doi:https ://doi.org/10.1007/s1057 8-019-00906 -4)
contains supplementary material, which is available to authorized
users.
* Kimberly W. Dossett
kdossett@uwo.ca
1 Department ofPsychology, Western University, London,
Canada
2 Department ofFamily Medicine, Western University,
London, Canada
3 Department ofPaediatrics, Western University, London,
Canada
4 Children’s Health Research Institute, London, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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