Social care programme attrition - what looks like failure could mean success

Gill Churchill explains why programme attrition can indicate social care success

graphProgramme attrition is a significant problem across social care interventions. 

Defined in this post as premature departure from a programme, it can significantly reduce a programme's efficacy and cost-effectiveness. 

However, through my involvement in an evaluation of SafeCare, a parenting programme for neglect, I've found that programme attrition is a complex concept that can reflect programme success as well as failure. 

Challenges presented by programme attrition

There is an almost universally negative view of attrition.

Missed and cancelled appointments can impact on staff productivity and prevent others in need from gaining access to services, limiting the number of people a programme can serve.

Attrition can also have an adverse impact on the morale of professionals who may experience a sense of failure and frustration.

High rates of attrition in research studies can lead to inadequate sample sizes and significantly compromise the generalisability of findings.

And, most significantly, it is widely accepted that children and families who leave programmes prematurely are less likely to benefit from the intervention and are likely to experience poorer outcomes. 

Understanding the causes

Understanding why attrition occurs is critical if we want to improve our ability to identify, engage and retain families in service.

Many studies simply quote attrition rates with little or limited consideration of the cause.

Where studies have looked at the cause of attrition, it has usually been limited to an exploration of participant characteristics and, or programme characteristics. Other important ecological influences on programme retention have been ignored. 

Looking at things from a different perspective

magnifying glassAs part of the NSPCC’s evaluation of the SafeCare parenting programme, I examined 12 case records for families who left the programme prior to completion.

I wanted to gain an insight into the reasons attrition occurred.

I was surprised to find that in over half of the cases I reviewed, parents’ success in accessing appropriate long-term sources of support to meet their family’s needs featured in the decision to leave the programme early - an area that has largely been overlooked in studies of attrition.

This included support from child and adult mental health services, paediatrics, education, Home Start and multiagency support from an Early Help Family Support Team.

For others, the support that had been accessed was more informal – receiving help from extended family members, for example.

When early exit from a programme signals success

Despite leaving the programme prior to completion, there was a range of positive outcomes which practitioners felt had been facilitated by the families' engagement with the programme. 

These included:

  • safer home environment
  • improved responsiveness to a child's needs
  • more effective behaviour management
  • better family relationships
  • improvements relating to structured play activities
  • increased knowledge of appropriate care when a child's sick or injured

In these cases, the decision to leave the programme didn't represent the failure of the programme, the provider or the parent(s).

On the contrary, the needs of these parents has been satisfied by the programme. They had made progress and, or, been able to access sufficient support to enable them to manage their needs, and those of their family, appropriately in the future. 

They had made what could be considered a healthy, informed and appropriate decision to exit the programme early, prior to completion.

Attrition has been recognised as a significant problem facing social care programmes for many years.

Despite growing interest in the rates and causes of attrition, I believe we may have been missing a vital component in our discussions. The recognition that not all attrition is negative.

As we strive for a more in-depth understanding into the reasons for engagement and early programme departure, the challenge for future studies will be how to define and differentiate positive from negative attrition.

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