A recent article in Clinical Psychology Review by de Haan, Boon, deJong, Hoeve, and Vermeiren, A meta-analtyic review on treatment dropout in child and adolescent outpatient mental health care, takes a comprehensive look at treatment dropout in child and adolescent outpatient mental health care using meta-analysis. As the authors point out, dropout in psychotherapy is very common. Among the studies they reviewed, there was a difference in dropout rates between efficacy and effectiveness studies with dropout in the former ranging from 16% to 50%, and dropout in effectiveness studies ranging from 17% to 72%. This may not be surprising given the more homogenous makeup of samples in efficacy trials, relative to the more ‘real-world’ context of effectiveness studies. However, one might also question whether there are differences in motivation between the therapists in efficacy vs. effectiveness studies. Do efficacy trial therapist try harder to retain study participants? There is more at stake in terms of the research. The authors also looked at predictors of dropout across the studies. Among several child factors, the only one with a medium to large effect size was having more contact with deviant peers. Among caregiver factors, four stood out with medium to large effect sizes: younger age of caregiver, homelessness, mother not knowing the child’s diagnosis, and low confidence in the child benefitting from therapy. Among therapist factors, eighteen had medium to large effect sizes which included weaker therapeutic alliance, and the therapist being directive and perceived as controlling and lacking empathy and focus. The authors discuss important implications of this work, including focusing on engagement early and throughout therapy, with particular emphasis on engaging the caregiver.
de Haan, A.M., Boon, A.E., de Jong, J.T.V.M., Hoeve, M. & Vermeiren, R.R.J.M., A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care, Clinical Psychology Review (2013), doi: 10.1016/j.cpr.2013.04.005
DISCUSSION QUESTIONS FOR YOU:
1. What have been your experiences with drop-out and what do you find works best to retain patients in treatment?
2. What are your thoughts regarding the differences between efficacy and effectiveness studies?
3. What barriers exist in terms of your ability to engage patients and to retain them in therapy?