title: Treatment planning: A key milestone to prevent treatment dropout in adolescents with borderline personality disorder.
abstract: OBJECTIVE
  The aim of this study was to gain a broader appreciation of processes involved in treatment dropout in adolescents with borderline personality disorder (BPD).
  
  
  METHODS
  A constructivist grounded theory was chosen using a multiple-case research design with three embedded levels of analysis (adolescent, parent, and care setting).
  
  
  METHODS
  Theoretical sampling and the different stages of analysis specific to grounded theory were performed according to the iterative process of constant comparative analysis. Twelve cases were examined (nine dropouts among adolescents with BPD and for the purpose of falsification, one dropout of suicidal adolescent without BPD and two completed treatments among adolescents with BPD). To document the cases, three groups of informants were recruited (adolescents, parents, and therapists involved in the treatment) and 34 interviews were conducted.
  
  
  RESULTS
  Psychological characteristics, perception of mental illness and mental health care, and help-seeking context were the specific treatment dropout vulnerabilities identified in adolescents with BPD and in their parents. However, their disengagement became an issue only when care-setting response--including mitigation of accessibility problems, adaptation of services to needs of adolescents with BPD, preparation for treatment, and concern for clinicians' disposition to treat--was ill-suited to these treatment dropout vulnerabilities. Treatment planning proves to be a key milestone to properly engage adolescents with BPD and their parent.
  
  
  CONCLUSIONS
  Systematic assessment of treatment dropout vulnerabilities before the intervention plan is laid out could foster better-suited responses of the care setting thus decreasing the incidence of treatment discontinuation in adolescents with BPD.
  
  
  CONCLUSIONS
  Treatment dropout vulnerabilities specific to adolescents with BPD and their parents can be detected before the beginning of treatment. Premature treatment termination may be prevented if the care setting considers these vulnerabilities at treatment planning. Fears and negative reaction to treatment can be attenuated if the reasons behind the therapeutic orientation are explained and if the adolescent understand how the treatment will affect his condition. Concerns for autonomy of the adolescent, parental help-seeking context as well as ensuring that the clinician has the skills, interest, and motivation to work with the family may have a positive effect on families' commitment to treatment.
authors: Occupational Therapy Program, School of Rehabilitation, Medical Faculty, University of Montréal, Québec, Canada.|Research Center of the Montréal Mental Health University Institute, Montréal, Québec, Canada.|Mood Disorders Clinic, Child and Adolescent Psychiatry Program, Rivière-des-Prairies Hospital, Montréal, Québec, Canada.
authors: Lyne
authors: L
authors: Desrosiers
authors: Occupational Therapy Program, School of Rehabilitation, Medical Faculty, University of Montréal, Québec, Canada.
authors: Micheline
authors: M
authors: Saint-Jean
authors: Occupational Therapy Program, School of Rehabilitation, Medical Faculty, University of Montréal, Québec, Canada.|Research Center of the Montréal Mental Health University Institute, Montréal, Québec, Canada.
authors: Jean-Jacques
authors: JJ
authors: Breton
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D010347:Patient Care Planning; D010352:Patient Dropouts / Q000523:psychology*; D011582:Psychological Theory; D036301:Qualitative Research
keywords: Adolescent; Borderline personality disorder; Disengagement; Engagement; Treatment dropout; Treatment planning