JMIR Publications

ABSTRACT

Background:

Many adolescents and young adults (28-75%) drop out of treatment early, putting them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, it has not been studied in intensive or telehealth settings.

Objective:

The purpose of this quality improvement study is to assess whether family therapy participation is associated with treatment dropout, attendance, and length of stay for youth and young adults in a remote intensive outpatient program (IOP).

Methods:

Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youth and young adult, nationally. Data includes 1,487 patients who completed both surveys and either completed or disengaged from treatment between December 2020 and September 2022. Engagement outcome variables included treatment completion/disengagement, length of stay (in weeks), and IOP group therapy session attendance. Chi-square tests explored differences between patients who had any family therapy sessions and patients who had none, and further chi-square tests, binary logistic, and Mann Whitney U tests examined differences in engagement outcome variables, including by age subgroups (adolescents and young adults).

Results:

Patients who identified as heterosexual [509/1487] were more likely to engage in family therapy; older age and identifying as binary were associated with decreased odds of engaging in family therapy. Across all three metrics of engagement, and across age groups, clients who attended family therapy were more engaged. Youth and young adults with one or more family therapy sessions were significantly more likely to stay in treatment an average of 2 weeks longer (median = 11 weeks versus 9 weeks) and to attend a higher percentage of IOP sessions (median = 84.38% vs. 75.00%), and to complete treatment. With each additional family therapy session attended, patients had 35% more likely to complete treatment. These differences were significant and consistent across each of the youth and young adult subgroup analyses.

Conclusions:

Findings suggest that youth and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote, IOP program. The differences by family therapy participation held when accounting for age, suggesting that beyond the expected importance of family engagement in therapy for adolescents, family engagement continues to be important into young adulthood. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and increased engagement and retention in remote treatment for youth and young adult patients in intensive outpatient programming. These findings suggest remote treatment programs can include and promote family therapy as an integral part of services, consistent with the literature on family engagement in in-person services. Clinical Trial: N/A