Service- and practitioner-level variation in non-consensual dropout from child mental health services

Area of Science:

• Child and Adolescent Mental Health
• Healthcare Services Research
• Health Services Management

Background:

• Non-attendance at mental health appointments is a significant international issue, costing the UK over £45 million annually in child services.
• Understanding the sources of variation in non-attendance is crucial for improving treatment adherence and outcomes.

Purpose of the Study:

• To investigate service-level and practitioner-level variations in non-consensual dropout rates within child mental health services.
• To identify factors contributing to patient dropout beyond demographic and socioeconomic characteristics.

Main Methods:

• Analysis of routinely collected data from 39 child mental health services.
• Inclusion of 3,622 children (mean age 12.70 years, 57% female) and 896 practitioners.
• Statistical examination of service- and practitioner-level variance in non-consensual dropout.

Main Results:

• Service-level variation accounted for 35% of the differences in non-consensual dropout.
• Practitioner-level variation explained 15% of the dropout variance.
• Children were nearly four times more likely to drop out based on their service and 2.5 times more likely based on their practitioner.

Conclusions:

• Significant variations in non-consensual dropout exist at both service and practitioner levels in child mental health care.
• These variations persist independently of area deprivation or patient demographics.
• Findings suggest a need to address systemic and individual practitioner factors influencing treatment adherence in pediatric mental health services.