Shawna M. Green, PhD & Roger Boothroyd, PhD, University of South Florida
Less than half of individuals living with behavioral health illnesses access care, and for those who do, premature discontinuation is common. This study examined the measurement and operationalization of dropout from behavioral health care. A systematic review of the literature from 2014-2019 was conducted, including seven databases: Cinahl, the Cochrane Central Registry of Controlled Trials, Embase, Google Scholar, PsycINFO, Scopus, and Web of Science.
Across the 28 studies reviewed, the differing terminology, data sources, determiners, diverse samples and diagnoses, and varied modalities and settings, contributed to inconsistent definitions and operationalizations. Not surprisingly, dropout rates ranged widely from of a low 21% to a high as 60%. Operational definitions consisted of duration-based measures, dosage thresholds, clinician determination of behavior change, substance abuse treatment program guidelines, and client self-report. Operationalizations of these definitions consisted of various quantitative threshold measures for number of sessions or time to follow-up, clinician judgement of client progress and compliance with rules, and even client-reported progress.
Researchers, practitioners, and clients are not on the same page in terms of measuring this concept, which presents difficulties, even when conducting meaningful evaluations. Research would benefit from developing basic standard indicators for assessing dropout. Consistency could provide more accurate information to develop a profile of individuals who are most likely to drop out of care. This could assist in the development of engagement strategies for clients who initially seek care and may ultimately result in decreased rates of dropout.