Barriers and facilitators to treatment participation by adolescents in a community mental health clinic

Oruche UM, Downs S, Holloway E, Draucker C, Aalsma M.

J Psychiatr Ment Health Nurs. 2013 May 17. doi: 10.1111/jpm.12076. [Epub ahead of print]

Department of Environments for Health, Indiana University School of Nursing.

A large number of children drop out or stop attending their mental health counseling appointments before they actually complete all the needed treatment sessions. This is a problem because the children’s behavior problems may get worse or affect their willingness to seek treatment in the future. We have not studied how the mental health clinics’ daily operations and staff’s behaviors may contribute to children, particularly teenagers, drop out from treatment. We asked 12 teenagers and their parents to tell us what about the mental health clinic helped them stay or leave treatment. Having long waits at counseling appointments, frequent changes in staff, and negative staff attitudes led to drop out from treatment. However, having staff who showed respect, involved teenagers and their parents in the counseling sessions, and communicated timely helped to decrease dropout. The parents suggested that provision of automated appointment reminders, transportation to clinics, and provision of education and support groups for caregivers will improve attendance to counseling sessions. ABSTRACT: An estimated 40-60% of children in mental health treatment drop out before completing their treatment plans, resulting in increased risk for ongoing clinical symptoms and functional impairment, lower satisfaction with treatment, and other poor outcomes. Research has focused predominately on child, caregiver, and family factors that affect treatment participation in this population and relatively less on organizational factors. Findings are limited by focus on children between 3 and 14 years of age and included only caregivers’ and/or therapists’ perspectives. The purpose of this descriptive qualitative study was to identify organizational factors that influenced participation in treatment, with special attention to factors that contributed to dropout in adolescents. The sample included 12 adolescent-caregiver dyads drawn from two groups in a large public mental health provider database. Analysis of focus group interview data revealed several perceived facilitators and barriers to adolescent participation in treatment and provided several practical suggestions for improving treatment participation. Implications of the findings for psychiatric mental health nurses and other clinicians who provide services to families of adolescents with mental health concerns are discussed.