Examining Outpatient Treatment Dropout in Adolescents: A Literature Review
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Examining Outpatient Treatment Dropout in Adolescents: A Literature Review Azadeh Masalehdan Block • Catherine G. Greeno
Published online: 13 May 2011 Springer Science+Business Media, LLC 2011
Abstract This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out. Keywords Dropout Mental health Adolescent Therapeutic alliance Engagement
Introduction Research suggests that of 31–78% of children and adolescents with a psychiatric diagnosis will never have contact with a provider or will drop out of treatment prematurely (Burns et al. 1995; Flisher et al. 1997; Kazdin et al. 1993; Leaf et al. 1996). However, the literature on treatment dropout and failure to obtain treatment lacks a strong empirical research base for adolescents. Most treatment dropout A. M. Block (&) Department of Public Health and Social Work, Slippery Rock University, 118 Strain Behavioral Science Building, 1 Morrow Way, Slippery Rock, PA 16057, USA e-mail: [email protected] C. G. Greeno School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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research has focused on adult populations, with some authors suggesting that only 1–2% of dropout studies focus on children or adolescents (Kazdin 1996; Pekarik and Stephenson 1988). This article comprises four objectives: (1) identify what is known about the incidence and long term implications of adolescent mental health issues; (2) explain how theory can help us to better understand adolescent treatment drop out; (3) explore and translate what is known about treatment dropout in adult and child populations; and (4) examine factors affecting treatment dropout for adolescents, including the influence that parents have on treatment.
Method A thorough search of the appropriate databases was conducted to gather the literature relevant to the research base and theory pertinent to adolescent treatment drop out. Different combinations of the words: adolescent, treatment, therapy, mental health, mental illness, engagement, drop out, development, therapeutic alliance, working alliance, parent and barriers were used in the following databases: PsycInfo, SCOPUS and Social Work Abstracts (EBSCO). Date constraints were not utilized because we aimed to identify any and all research that was relevant to the topic of adoles
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