Therapist turnover and client non-attendance

Shaili Babbar*, Danielle R. Adams, Emily M. Becker-Haimes, Laura C. Skriner, Hilary E. Kratz, Lauren Cliggitt, Patty Inacker, Rinad S. Beidas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives: Although turnover, defined as when a therapist leaves his/her organization, occurs frequently in public mental health organizations, its impact on clients is understudied. This study examined the effects of turnover on client engagement among youth receiving services in one public mental health agency. Methods: Data were abstracted through a retrospective chart review of 76 clients who initiated outpatient trauma-focused treatment with 30 therapists between June 2013 and January 2016 at one agency in Philadelphia. Client demographic information, client session attendance, and therapist for each session was abstracted from each chart. The dependent variable (i.e., client engagement) was operationalized as client attendance to scheduled sessions. Mixed-effects regression analyses were used. Results: Youth who experienced therapist turnover were 86% more likely to miss a future scheduled therapy session. When exploring this effect by diagnosis, youth without a Post-Traumatic Stress Disorder (PTSD) diagnosis were more likely to miss a scheduled session following therapist turnover than those with a PTSD diagnosis (p <.05). Conclusions: Therapist turnover is a strong predictor of client engagement among youth receiving trauma-focused treatment, and a PTSD diagnosis may be a protective factor against missing sessions. Implications for treatment planning in the face of therapist turnover are discussed.

Original languageEnglish (US)
Pages (from-to)12-16
Number of pages5
JournalChildren and Youth Services Review
StatePublished - Oct 2018


  • Client engagement
  • Community mental health
  • Therapist turnover
  • Trauma
  • Youth

ASJC Scopus subject areas

  • Education
  • Developmental and Educational Psychology
  • Sociology and Political Science


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