Nonattenders and Attrition from a Forensic Psychology Outpatient Service

Abstract

The authors examined 219 referrals to a forensic psychology outpatient service between 1989 and 1996. Factors including age of client, whether it was first or subsequent referral, number of agencies previously involved, and type of problem were examined to determine their relationship to the outcomes of nonattendance, early dropout, or completion of assessment/therapy. Type of problem for which the referral was made was found to be significant, with referrals for anger control carrying a poor prognosis for successful completion of therapy. Recommendations for the more effective functioning of the service were made.

No-Show at a Forensic Psychiatric Outpatient Clinic

“…One study by Hambridge (1990), conducted at an outpatient forensic psychology service in the northwest of England, found that males younger than age 30 years were less likely to attend an appointment. This finding was not confirmed by Dalton et al (1998), who studied clients at a Forensic Mental Health Service in East London. Hambridge (1990), and to some extent Dalton et al (1998), suggested that clients who had aggression problems were worse attendees than clients referred by courts/solicitors or clients who had child sex problems.…”

“…This finding was not confirmed by Dalton et al (1998), who studied clients at a Forensic Mental Health Service in East London. Hambridge (1990), and to some extent Dalton et al (1998), suggested that clients who had aggression problems were worse attendees than clients referred by courts/solicitors or clients who had child sex problems. Both studies also revealed that time spent on the waiting list or geographical proximity did not affect nonattendance.…”

“…Clients were contacted within 24 hr after their no-show, which made it more likely that clients still knew the reason for their nonattendance, that is, avoiding recall bias. Moreover, in contrast with many other studies, this study assessed and compared nonattendance for initial as well as consecutive appointments at once (Dalton et al, 1998;Hambridge, 1990;Kruse & Rohland, 2002). In addition, this study adhered to the theoretical framework of the theory of planned behaviour for selecting and analysing risk factors for no-show.…”

Referrals for anger management groups: identifying suitability

“…For some others the anger is instrumental, and even though the expression of anger may bring problems at times, it is nonetheless of value to the client and may be an intrinsic part of their selfworth. The research on anger as a feature of sub-cultural norms in the UK is limited, although Dalton et al (1998) reports that certain clients stated that living in a particular area of London necessitated acceptance of a violent lifestyle. For some clients, the idea of 'controlling' or 'managing' anger may therefore be associated with feelings of powerlessness, and drop-out of therapy may therefore become more likely.…”

“…While 'aggression' is not defined in his study, and more recent commentators have distinguished between anger, aggression and hostility, it appears that the term covers those referred for angerrelated problems. A study of 219 referrals to a forensic psychology outpatient service established that referrals of clients for anger control carried a poor prognosis, only 20% completing therapy (Dalton, Major and Sharkey, 1998). Hird, Williams, and Markham (1998) carried out a survey of attendance at a community-based anger control group treatment programme and found a completion rate of only 18% for patients referred.…”