Dropouts and refusers: clinicians’ insights and initiatives into reducing treatment attrition amongst young people who sexually offend

Sexual offending by young people causes significant harm to victims, families and communities. Treatment engagement and completion are therefore important for reducing future harm; however, young people who drop out of, or refuse to engage in, treatment present a unique challenge for clinicians and justice systems. Drawing on Bronfenbrenner’s (1979) ecological systems theory, this study explored clinicians’ perspectives on the barriers to treatment engagement and completion for young people who have sexually offended in the Australian context. Semi-structured interviews were conducted with clinicians who provided or facilitated treatment for young people who had sexually offended (N = 22). Two major themes were identified: family factors and program factors. Family factors included caregiver shame, minimisation, stigma, competing household demands, limited family support and instability in out-of-home care. Program factors included barriers to accessing treatment, the limitations of office-based service delivery, regional and remote access issues and the need for programs to continue working through the young person’s broader ecology when direct engagement is limited. The findings suggest that attrition should not be understood solely as individual non-compliance, but as a product of the interaction between the young person and their family and their interaction with community services and policy systems. The paper provides practice and policy recommendations for strengthening ecological approaches to treatment engagement and reducing attrition.