Defining Dropout From Children’s Mental Health Services: A Novel Need-based Definition

Abstract

Dropout from children’s mental health services has negative impacts on children, families and mental health agencies. Correctly defining individuals as treatment dropouts may help efforts to reduce dropout. The development of a novel definition of dropout is described, which suggested the optimal number of sessions required should vary based on a client’s need at intake. Dropout was defined as receiving lower than the optimal number of sessions. The novel definition was compared to existing definitions in a secondary data analysis of individual’s first and second episodes of care. The sample contained children (N = 650; 61% male) aged 5–13 who attended one of five studied mental health agencies in Ontario, CA. Discriminant function analysis was used to predict individuals who met: (a) all current dropout definitions and the need-based definition, (b) any one or two definitions of dropout, or (c) no definitions of dropout. In the first and second episodes of care respectively, the prevalence of dropout was 63.5 and 69.7% using the need-based definition, 93.5 and 76.5% using the dose definition, and 53.3 and 84.4% using the clinician judgment definition. In the first episode of care, higher child internalizing and externalizing problems and greater caregiver needs differentiated dropouts from treatment completers using the need-based definition. Further, families with higher child problem severity and higher caregiver needs were more likely to be categorized as a dropout by all definitions. A need-based definition is a valuable method for categorizing treatment dropouts and mitigates disadvantages of existing definitions of dropout.