Enhancing the utilization of outpatient mental health services

Abstract

This article describes two sets of field studies undertaken by the program evaluation unit of a community mental health center. These studies analyzed clients' utilization of service and assessed service impact in the process of testing procedural variations in service delivery. In the first set of studies, a procedure for ensuring verbal client-therapist contact prior to the first appointment was developed and tested. This procedure reduced the no-show rate for initial appointments from 22 to 12%. In the second set of studies, a brief pretherapy orientation nearly eliminated dropout during the first month of therapy. Orientation had both short- and long-range impact on the amount of services used by clients as well as on their outcomes. Therapist's global ratings of client functioning reflected more change for oriented clients, who reported greater short-term symptom reduction as well. Non-oriented clients were more likely to drop out early and to impress their therapists less favorably. The results of these studies suggest that a combination of pretherapy orientation and verbal client-therapist contact prior to the initial appointment might greatly reduce the failure to complete treatment.

An Examination of Treatment Completers and Non-Completers at a Child and Adolescent Community Mental Health Clinic

“…Attrition, dropout, and retention rates are a complex issue and confound researchers, clinical providers and organizational administrators alike (Larsen et al 1983;Kazdin et al 1995). Inconsistent findings in the literature are in part due to how the term dropout is defined and at what stage in the clinical process attrition occurs.…”

An investigation of psychoeducational interventions about therapy

“…Deane et al (1992) found that a brief preparational videotape improved client knowledge about therapy and reduced anxiety but showed no improvements on therapeutic outcomes. However, others have found that prepared clients reported greater symptom reduction and lower rates of attrition than a group without the intervention (Larsen, Nguyen, Green, & Attkisson, 1983), a greater decrease in selfreported symptoms (Zwick & Attkisson, 1985), significantly more accurate expectations, and decreased state and trait anxiety (Douglas, Noble, & Newman, 1999).…”

Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review

“…Specifically, attrition decreases the validity of the inferences that can be drawn about treatment efficacy, as it can alter random composition of groups, reduce statistical power, limit the generality of findings, and introduce sampling bias (Armbruster & Kazdin, 1994). Second, premature treatment termination has a negative financial impact on the mental health service system by decreasing cost-effectiveness, as missed and cancelled appointments decrease staff productivity and cause an increase in unit cost for services (Garfield, 1994;Larsen, Nguyen, Green, & Attkisson, 1983;Pekarik, 1985). These problems have led some to identify poor treatment attendance as the most important issue facing psychotherapy researchers (e.g., Phillips, 1985).…”