Mental Health: A Report by the Surgeon General

Among children and adolescents who begin treatment, the dropout rate is high, although estimates vary considerably. According to Kazdin and colleagues (1997), 40 to 60 percent of families who begin treatment terminate it prematurely. Armbruster and Fallon (1994) found that the great majority of children who enter outpatient treatment attend for only one or two sessions. One of the explanations for the high dropout rate and for failure to keep the first appointment is that referrals are often made not by children and adolescents or their families, but by schools, courts, or other agencies. Most of the research on dropping out has focused exclusively on examining demographic or diagnostic correlates of dropping out, and few researchers have directly asked the children or their parents about their reasons for discontinuing treatment.

There are a number of effective interventions to reduce dropout from treatment and to increase enrollment and retention (Szapocznik et al., 1988; McKay et al., 1996; Santisteban et al., l996). Offering services in the schools improves treatment access (Catron & Weiss, 1994). A variety of case management approaches can also improve engagement of low-income families in the treatment of their children (Burns et al., 1996; Koroloff et al., 1996a; Lambert & Guthrie, 1996).

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