Exploring the effect of therapists' treatment practices on client attendance in community-based care for children

Sustained treatment attendance has been reported to be poor in publicly funded community-based clinic settings serving children and families. Several child and family characteristics have been shown to predict attendance in community-based care, but virtually no research has been conducted to examine how experiences in care, including psychotherapists' within-session practices, influence client attendance. The goal of this exploratory study was to examine how observed practice within sessions, in particular the extent to which therapists delivered elements consistent with evidence-based practices, impacts total number of sessions attended, while accounting for an array of other potential predictors. Participants include 181 children ages 4-13 and their parents entering a new episode of care for disruptive behavior problems in publicly funded clinics. Data sources include administrative billing records on treatment attendance; coded videotaped treatment sessions; and self-reports from children, parents, and therapists. Results indicate that parent education, service funding source, parent alliance with therapist, and therapist experience predicted number of sessions attended; intensity of evidence-based treatment techniques delivered to children was marginally associated with attendance (p = .059). Implications for improving engagement in community-based care are discussed.