Keeping the door open or keeping the door shut? How and why adolescents terminate from mental health treatment.
Item
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Title
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Keeping the door open or keeping the door shut? How and why adolescents terminate from mental health treatment.
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Identifier
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AAI9969712
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identifier
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9969712
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Creator
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Mirabito, Diane Margaret.
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Contributor
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Adviser: Irwin Epstein
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Date
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2000
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Language
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English
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Publisher
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City University of New York.
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Subject
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Social Work
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Abstract
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This study examines patterns of termination from mental health treatment among primarily low-income, minority adolescents at an outpatient, mental health center in New York City. The research design combines quantitative and qualitative methods, utilizing existing information from 100 closed client records and original data from interviews with 14 adolescents who terminated treatment. The analysis focuses on how and why adolescents with "acknowledged" and "unacknowledged" terminations discontinue treatment and the similarities and differences between these terminations. Quantitative findings report clinical and non-clinical correlates of acknowledged and unacknowledged terminations. Qualitative findings present an analysis of adolescents' experience of treatment, reasons for termination, and their retrospective assessment of treatment.;"Unacknowledged" terminations occurred almost twice as frequently (66%) as "acknowledged" terminations (34%). Among the "acknowledged" cases, termination was "addressed" by a clinical process (1--5 sessions), in only 19% of the cases. "Acknowledged" terminations occurred more frequently among Caucasian and Asian adolescents, self and school referred; diagnosed with depression, school, and conduct problems; who received more treatment sessions with multiple modalities over a longer period of time. "Unacknowledged" terminations occurred more frequently among Hispanic, African-American, and Biracial adolescents, referred by parents; diagnosed with family problems; who acknowledged a problem at intake; and were motivated for treatment. Statistically significant relationships were found between acknowledged terminations and adolescents'/parents' desire to terminate; clinician/placement initiated terminations; participation in group and psychiatric services; and clinical disengagement at termination.;Contrary to conventional theory concerning treatment termination, adolescents who terminated without a "clinical process", reported considerably more engagement in and satisfaction with treatment than those who had clinically addressed terminations. In "unacknowledged/unaddressed" cases, reasons for termination included positive progress toward developmental tasks, resolution of problems, and "natural" interruptions of treatment. In "acknowledged/addressed" cases, termination was frequently initiated by the clinician because adolescents were disengaged from and/or dissatisfied with treatment.;Recommendations for practice include: reconceptualization of termination from a developmental perspective utilizing an "open-door" approach to treatment; diverse and flexible treatment approaches and collaborative treatment planning to engage adolescents in treatment; and implementation of "exit interviews" to structure termination and provide therapeutic closure.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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D.S.W.
