There is a dynamic influence of culture on many aspects of family lifestyle across three generations. To achieve successful intervention design, childhood obesity researchers need to collaborate with diverse groups and communities. Considering the role and influence of extended family, a multigenerational, whole-of-community approach beyond that of parent and child populations ought to be considered.
Introduction
‘Teenage suicides double as the future crumbles’ with collapse of the economy in Argentina (Arie 2002). Schizophrenia ‘linked to racism’, a study reveals among ethnic minorities in London (Boydell et al. 2001).
The promotion of emotional well‐being focuses on improving environments (social, physical, economic) that affect emotional well‐being and enhancing the ‘coping’ capacity of communities as well as individuals (Wood & Wise 1997). What improvements in the ‘environment’ are required, and how does one ‘enhance coping’ in order to promote emotional well‐being? What is the role of those working in community child health in promoting mental health and emotional well‐being?
Most of the research on the determinants of the health and well‐being of populations have focused on physical health problems, particularly mortality and life expectancy (Marmot & Wilkinson 1999). There is less research on the ‘upstream’ (socioeconomic) determinants of mental health problems, and even less on emotional well‐being and enhancing ‘coping’ or promoting resilience. Examples of upstream determinants of mental health problems include good evidence linking the prevalence of mental health problems of children and young people to income, educational status and family structure (Sawyer et al. 2001). Male youth suicide has been linked to such upstream determinants as relative unemployment rates. Suicide has increased with increasing ratio of youth to overall unemployment rates (Morrell et al. 2001). A significantly higher risk of suicide in Australia over the past century was shown to be associated with conservative governments compared with social democratic government tenures (Page et al. 2002).
Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base.
Key learning aims
(1)
To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature.
(2)
To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services.
(3)
To understand the potential impact of staff assumptions of factors that affect drop-out on client retention.
(4)
To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.
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