Revisiting unplanned termination: Clinicians' perceptions of termination from adolescent mental health treatment

This qualitative study explored clinicians' perceptions about unplanned terminations from outpatient mental health treatment among economically disadvantaged, inner-city adolescents. Findings revealed that most terminations were unplanned, unannounced, and unilaterally initiated by adolescents. Planned terminations occurred only when short-term treatment and situational factors for clients or clinicians dictated termination. Client, clinician, and clinic factors that contributed to unplanned terminations, or treatment dropout, included normative adolescent development, the ways clinicians conducted treatment, and the agency context. Although clinicians believed that the process of termination and closure was important, they rarely initiated it. Implications for practice include reconceptualizing termination; developing collaborative, consistent goals between adolescents and clinicians; use of problem-focused, intermittent, time-limited interventions; and development of organizational and clinical structures to guide case review and closure.