One in five children and adolescents meet the criteria for psychiatric disorders each year. Of those who meet the criteria and are referred for treatment, forty to sixty percent will terminate prematurely (Nock and Kazdin, 2001). While some researchers studying this phenomenon have focused on how a client progresses through treatment and others look at dropout risk factors, no one has explored the relationship between the two.
The specific purpose of this study is to provide information to the existing pool of research focusing on treatment effectiveness and completion to help provide better services to the mentally ill adolescent population already being seriously underserved in this country. A client's readiness to change a behavior in treatment, as studied by James Prochaska (1993), and barriers one faces throughout treatment, as researched by Alan Kazdin (1997) are two variables that have been developed for the purpose of understanding the dynamics of change in the therapeutic setting.
Specifically, Prochaska has developed the Transtheoretical Model of Change including five stages (Precontemplation, Contemplation, Preparation, Action and Maintenance) through which one progresses while in treatment, from a lack of intention to change, to the recognition of a problem but an unwillingness to do anything about it, to a decision and commitment to change. Prochaska believes that change must occur for individual development and that his Transtheoretical Model provides a balance of empiricism and theory for utility among various populations (Petrocelli, 2002).
Kazdin (1997) has found that child and adolescent dropouts in treatment showed higher levels of barriers than did completers based on parent and therapist total barriers scores. His term “barriers to participation in treatment” explore factors that might impact a client's ability to successfully complete a treatment program, including socioeconomic disadvantage, family stress and life events.
Data for this study were gathered at a community mental health agency with 153 participants among the 14-17 year old population. Measurements used included the Stage of Change Assessment (SoC; McConnaughy, Prochaska and Velicer, 1983; McConnaughy, DiClemente, Prochaska and Velicer, 1989), the Barriers to Treatment Participation Scale (BTPS; Kazdin, Holland, Crowley and Breton, 1997)) and the Child Behavior Checklist (CBCL; Achenbach, 1991). Participants also received a demographic data sheet which included the number of sessions attended and length of time in treatment.
The hypotheses examined the relationship between Stage of Change (Precontemplation, Contemplation, Action and Maintenance), Barriers to Treatment (Treatment Demands and Issues and Perceived Relevance of Treatment), the CBCL (Total Problems Scale) and attendance in treatment (number of sessions attended and length of time in treatment). Data analysis revealed a significant positive relationship between Contemplation stage scores and CBCL total problem scores, a significant negative relationship between Action stage scores and CBCL total problem scores, a significant positive relationship between Maintenance stage scores and CBCL total problem scores, and a significant positive relationship between time in treatment and CBCL total problem scores.