Psychological treatment dropout among pathological gamblers

Premature dropout from treatments for pathological gambling is potentially of significant importance, if it occurs before substantial progress has been made in addressing the problem. A systematic review of current research on dropout from psychological treatments for pathological gambling identified 12 studies from five countries. Dropout ranged from 14% to 50%, with a median of dropout 26%. Overall, 31% of the participants dropped out of treatment. Few studies distinguish between dropouts at different stages of participation. The evidence on specific variables that predict dropout is limited or inconsistent, and is characterised by a lack of a coherent, gambling-specific model and by methodological problems. Two studies that attempted to apply motivational and compliance-enhancing techniques were found. Both showed promising effects on reduction of dropout and improvement of short-term impact of treatment, but inconsistent results on longer-term outcomes were obtained. The review highlighted a need for more rigorous investigation of the extent of dropout and of variables associated with dropout from pathological gambling treatment programs. Further research on interventions to enhance retention and reduce dropout from psychological treatment is also required.

Dropout from internet-based treatment for psychological disorders

Purpose: The purpose of this review was to present an in-depth analysis of literature identifying the extent of dropout from Internet-based treatment programmes for psychological disorders, and literature exploring the variables associated with dropout from such programmes. ----- ----- Methods: A comprehensive literature search was conducted on PSYCHINFO and PUBMED with the keywords: dropouts, drop out, dropout, dropping out, attrition, premature termination, termination, non-compliance, treatment, intervention, and program, each in combination with the key words Internet and web. A total of 19 studies published between 1990 and April 2009 and focusing on dropout from Internet-based treatment programmes involving minimal therapist contact were identified and included in the review. ----- ----- Results: Dropout ranged from 2 to 83% and a weighted average of 31% of the participants dropped out of treatment. A range of variables have been examined for their association with dropout from Internet-based treatment programmes for psychological disorders. Despite the numerous variables explored, evidence on any specific variables that may make an individual more likely to drop out of Internet-based treatment is currently limited. ----- ----- Conclusions: This review highlights the need for more rigorous and theoretically guided research exploring the variables associated with dropping out of Internet-based treatment for psychological disorders.

Trainee-therapists are not all equal: Examination of therapeutic efficiency, effectiveness and early client dropout after 12 months of clinical training

Objective Contemporary research demonstrates the feasibility of assessing therapeutic performance of trainee-therapists through the use of objective measures of client treatment outcome. Further, significant variation between individual therapists based on their client treatment outcomes has been demonstrated. This study sets out to determine whether a reliable composite measure of therapeutic efficiency, effectiveness and early dropout can be developed and used to objectively compare trainee-therapists against each other. Design and methods Treatment outcomes of 611 clients receiving treatment from 58 trainee-therapists enrolled in a professional training programme were tracked with the OQ-45.2 over a 6-year period to assess therapeutic efficiency, therapeutic effectiveness and early client dropout. Results Significant variation between trainee-therapists was observed for each index. Findings of a moderately strong correlation between therapeutic efficiency and effectiveness enabled the ranking of trainee-therapists based upon a composite measure of these indexes. A non-significant correlation was found between early client dropout and measures of therapeutic effectiveness and efficiency. Conclusions The findings stress the importance of utilizing objective measures to track the treatment outcomes. Despite all trainee-therapists being enrolled in the same training programme, significant variation between trainee-therapists' therapeutic efficiency and effectiveness was found to exist. Practitioner points Developing of potential benchmarking tools that enable trainee-therapists, supervisors and educational institutions to quickly assess therapeutic performance can become part of a holistic assessment of a trainee-therapist's clinical development. Despite an inherent optimistic belief that therapists do not cause harm, there appears to be a small and significant proportion of trainee-therapists who consistently evidence little therapeutic change. Considerable variability in trainee-therapists' therapeutic efficiency and effectiveness can exist in the one training programme. Early client dropout may not be associated with therapists' therapeutic effectiveness and efficiency.

A Data Dropout Compensation Algorithm Based on the Iterative Learning Control Methodology for Discrete-Time Systems

This paper deals with the convergence of a remote iterative learning control system subject to data dropouts. The system is composed by a set of discrete-time multiple input-multiple output linear models, each one with its corresponding actuator device and its sensor. Each actuator applies the input signals vector to its corresponding model at the sampling instants and the sensor measures the output signals vector. The iterative learning law is processed in a controller located far away of the models so the control signals vector has to be transmitted from the controller to the actuators through transmission channels. Such a law uses the measurements of each model to generate the input vector to be applied to its subsequent model so the measurements of the models have to be transmitted from the sensors to the controller. All transmissions are subject to failures which are described as a binary sequence taking value 1 or 0. A compensation dropout technique is used to replace the lost data in the transmission processes. The convergence to zero of the errors between the output signals vector and a reference one is achieved as the number of models tends to infinity.

Teacher-Student Rapport: Investigating its Impact on the Dropout Rate in Physical and Health Education

This study was an investigation into whether strong teacher-student rapport relates to the drop-out rates of students in grade 9 and 10 health and physical education (HPE). In the study, One hundred and thirty-six grade 9 students from five high schools in Ontario participated in this study. Findings of whether or not rapport related to students’ decision to take an additional HPE credit beyond grade 9 did not prove conclusive. A significant multivariate interaction effect was not found; however, tests of between-subject effects on sex and grade 10 dropouts showed some interesting trends. More research is needed to further illuminate the link between teacher-student rapport and students’ enrollment in optional HPE classes.

Stressors and turning points in high school and dropout : a stress process, life course framework

High school dropout is commonly seen as the result of a long-term process of failure and disengagement. As useful as it is, this view has obscured the heterogeneity of pathways leading to dropout. Research suggests, for instance, that some students leave school not as a result of protracted difficulties but in response to situations that emerge late in their schooling careers, such as health problems or severe peer victimization. Conversely, others with a history of early difficulties persevere when their circumstances improve during high school. Thus, an adequate understanding of why and when students drop out requires a consideration of both long-term vulnerabilities and proximal disruptive events and contingencies. The goal of this review is to integrate long-term and immediate determinants of dropout by proposing a stress process, life course model of dropout. This model is also helpful for understanding how the determinants of dropout vary across socioeconomic conditions and geographical and historical contexts.

Bindung und Dropout im Nachwuchsleistungssport

Jede sportliche Karriere ist durch eine Vielzahl von Entscheidungen geprägt. Während sich ein Teil dieser Entscheidungsprozesse nur geringfügig auf den Karriereverlauf auswirkt, können andere diesen massiv beeinflussen. In den meisten Fällen begründet sich ein vorzeitiger Ausstieg nicht auf der Grundlage eines akuten Ereignisses, sondern lässt sich aus langfristigen Bilanzierungsprozessen, in denen Kosten und Nutzen des leistungssportlichen Engagements gegenüber gestellt werden, ableiten. Welche der Gründe eine solche Entscheidung maßgeblich beeinflussen, kann jedoch nicht mit aller Sicherheit gesagt werden. Diese Tatsache begründet sich vor Allem über die in diesem Forschungsfeld bisher meist sportartspezifisch ausgerichteten Untersuchungen. Neben den Begründungen, die zum Karriereabbruch führen, interessieren zudem die Athleten, die langfristig im Fördersystem aktiv sind. Wie unterscheiden sie sich von den Aussteigern und welche Strategien verfolgen sie, um den Anforderungen aus den unterschiedlichen Lebensbereichen gerecht werden zu können? Die Studie versucht die Frage nach karrierebeeinflussenden Merkmalen auf der Grundlage eines theoretisch abgeleiteten Analysemodells aus der Sicht der Athleten sportartübergreifend zu bearbeiten und legt hierbei den Fokus vor allem auf die Rahmen- und Umweltbedingungen der leistungssportlich trainierenden Athleten. Ausgangspunkt des entwickelten Untersuchungsmodells sind die Überlegungen von Mayntz und Scharpf zum akteurzentrierten Institutionalismus. Demnach muss eine umfassende Betrachtung von Entscheidungen im Karriereverlauf junger Nachwuchsathleten neben systemischen Fragen vor allem über die Interaktionen der am Förderprozess beteiligten Personengruppen geführt werden. Das längsschnittlich angelegte Untersuchungsdesign soll einerseits ermöglichen, den vorzeitigen Karriereabbruch aufgrund der Veränderungen in der Bewertung der Einflussfaktoren im Karriereverlauf zu erklären, andererseits soll über die retrospektive Betrachtung der Antworten zum ersten Messzeitpunkt überprüft werden, ob sich die Aussteiger und Fortsetzer bereits im Vorfeld anhand zentraler Variablen unterscheiden lassen. Hinsichtlich der Untersuchungsgruppen zeigte sich, dass zwischen den Aussteigern und den Fortsetzern eine Reihe von signifikanten Unterschieden festgestellt werden konnte. Vor allem dem Erwerb von Strategien zur Bewältigung der Anforderungen aus der Verbindung von Leistungssport mit den weiteren Lebensbereichen der Athleten ist in der Gruppe der Fortsetzer deutlich höher ausgeprägt, wenngleich diese Athleten auch angeben, mit höheren Belastungen umgehen zu müssen. Es ist anzunehmen, dass diese in der Auseinandersetzung erworbenen Kompetenzen im Sinne des Transfers auf sportliche Situationen übertragen werden können und zu einer für die Athleten zufriedenstellenderen Bewältigung beitragen.

Youth sport dropout from the achievement goal theory. 'El abandono del deporte en j??venes desde la Teor??a de las metas de logro'

Resumen tomado de la publicaci??n. Resumen tambi??n en ingl??s

The differential effect on dropout of increasing grades' supply by integrating or expanding schools: evidence from a quasi-experiment in Bogotá

En el año 2002, la Secretaría de Educación de Bogotá estipuló la Resolución 2101 que tenía por objeto asegurar el ciclo de la educación completo en los colegios públicos. El propósito de este trabajo es evaluar el impacto de los mecanismos seguidos a la aplicación de esta política sobre la tasa de deserción escolar. Las escuelas tenían tres mecanismos diferentes para alcanzar el objetivo de la presente resolución: expandir los grados escolares ofertados, integrarse con otros colegios de la zona, o ambos. Para ello, utilizo variables instrumentales para resolver el sesgo causado por el hecho de que los colegios que siguen determinada estrategia eran los que tenían altas tasas de deserción inicialmente. Usando datos sobre las características institucionales y las características socio-demográficas de la población cerca del colegio, evalúo el impacto de estos tres mecanismos sobre las tasas de deserción escolar. Los resultados sugieren que las instituciones que aumentaron los grados experimentan un aumento en el número de estudiantes que abandonan el colegio en 12.1 puntos porcentuales, mientras que las instituciones que complementaron este mecanismo con la integración de un colegio próximo pre existente mostraron una reducción en la tasa de deserción escolar de 9.8 puntos porcentuales.

Reconciling the electron counterstreaming and dropout occurrence rates with the heliospheric flux budget

Counterstreaming electrons (CSEs) are treated as signatures of closed magnetic flux, i.e., loops connected to the Sun at both ends. However, CSEs at 1 AU likely fade as the apex of a closed loop passes beyond some distance R, owing to scattering of the sunward beam along its continually increasing path length. The remaining antisunward beam at 1 AU would then give a false signature of open flux. Subsequent opening of a loop at the Sun by interchange reconnection with an open field line would produce an electron dropout (ED) at 1 AU, as if two open field lines were reconnecting to completely disconnect from the Sun. Thus EDs can be signatures of interchange reconnection as well as the commonly attributed disconnection. We incorporate CSE fadeout into a model that matches time-varying closed flux from interplanetary coronal mass ejections (ICMEs) to the solar cycle variation in heliospheric flux. Using the observed occurrence rate of CSEs at solar maximum, the model estimates R ∼ 8–10 AU. Hence we demonstrate that EDs should be much rarer than CSEs at 1 AU, as EDs can only be detected when the juncture points of reconnected field lines lie sunward of the detector, whereas CSEs continue to be detected in the legs of all loops that have expanded beyond the detector, out to R. We also demonstrate that if closed flux added to the heliosphere by ICMEs is instead balanced by disconnection elsewhere, then ED occurrence at 1 AU would still be rare, contrary to earlier expectations.

A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community

Background: The paper reports the findings from a follow-up study of the factors that contribute to whether young people dropout or continue once-weekly psychotherapy at a voluntary sector psychotherapy service for young people aged 12 to 21 years. Method: The study uses data from an ongoing audit of the psychotherapy service that started in 1993; 882 young people were included in the study. Premature termination of treatment was defined as dropping out before the 21st session. Continuation in treatment was defined as remaining in therapy after 20 sessions. Measures and areas of interest used in the study include diagnostic measures, the Youth Self Report Form and Young Adult Self Report Form, demographic characteristics and treatment related information. Results: Young people who continued in treatment were more likely to be older, have anxieties about sexual and relationship issues and have higher scores on self-reported anxiety-depression. Young people who dropped out of treatment were more likely to be younger, have higher self-reported delinquency scores, have a diagnosis of hyperactivity-conduct disorder and be homeless. Conclusions: The study of treatment termination has demonstrated the value of service audit and has led to a significant change in clinical practice.

Dropout: MOOC participants’perspective

Massive Open Online Courses (MOOCs) open up learning opportunities to a large number of people. A small percentage (around 10%) of the large numbers of participants enrolling in MOOCs manage to finish the course by completing all parts. The term ‘dropout’ is commonly used to refer to ‘all who failed to complete’ a course, and is used in relation to MOOCs. Due to the nature of MOOCs, with students not paying enrolment and tuition fees, there is no direct financial cost incurred by a student. Therefore it is debatable whether the traditional definition of dropout in higher education could be directly applied to MOOCs. This paper reports ongoing exploratory work on MOOC participants’ perspectives based on six qualitative interviews. The findings show that MOOC participants are challenging the widely held view of dropout, suggesting that it is more about failing to achieve their personal aims.

Children with persistent conduct problems who dropout of treatment

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also  significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.

Factors associated with dropout and diagnosis in child and adolescent mental health services

Objective: Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors.

Method: A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories.

Results: Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses.

Conclusion: There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.