title: An investigation into whether clients and/or their respective clinicians are aware of pending service exit in the first two months of treatment admission.
abstract: OBJECTIVE
  When a client exits an alcohol and other drug (AOD) treatment service against clinical advice, they and their service may incur significant disadvantage. The extent of awareness by both clients and clinicians that treatment would not continue has not been examined. Accordingly, this paper presents findings from a study that sought to identify whether clients and/or their respective clinicians were aware of pending service exit that occurred within the first 2 months of treatment admission.
  
  
  METHODS
  The study was set in an outpatient AOD treatment service located in Auckland, New Zealand. Data were obtained by structured questionnaire and were reported for a group of clients (n = 49), clinicians (n = 46) and matched client/clinician pairs (n = 36).
  
  
  RESULTS
  Overall, clients and clinicians were no more likely to accurately identify pending service exit at a rate greater than would be expected by chance alone. However, clinicians were significantly more likely to identify pending service exit as compared with their respective clients (47% vs. 25%), although a large proportion of both groups expected treatment to continue beyond what proved to be the final treatment appointment (44% and 52%, respectively).
  
  
  CONCLUSIONS
  These findings suggest that service exit that occurs within the first 2 months of treatment admission may be largely unpredictable and that, as a result of this unpredictability, the opportunities for a targeted response may be limited.
authors.affiliation: Clinical Research and Resource Centre, Waitemata District Health Board, Auckland, New Zealand. justin.pulford@aut.ac.nz
authors.forename: Justin
authors.initials: J
authors.lastname: Pulford
authors.forename: Peter
authors.initials: P
authors.lastname: Adams
authors.forename: Janie
authors.initials: J
authors.lastname: Sheridan
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010343:Patient Admission / Q000639:trends; D010349:Patient Compliance / Q000523:psychology; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology / Q000639:trends; D016320:Substance Abuse Treatment Centers / Q000379:methods / Q000639:trends; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult