6 - (IOP 39) SSCP Submission: Development and Preliminary Findings of PREP-UP, a Pre-treatment Engagement Program in a Training Clinic

Premature termination, defined as unilateral client-initiated dropout, remains a significant challenge, with university-affiliated training clinics reporting 70–75% dropout rates compared to 20% in other settings (Al-Jabari et al., 2019; Callahan et al., 2014; Swift & Greenberg, 2012, 2015). This disrupts treatment outcomes and strains clinic resources. Long wait times exacerbate disengagement, eroding treatment motivation and increasing dropout risk (Barrett et al., 2008; Swift et al., 2012). Training clinics, which provide low-cost mental health care, often have long waitlists and high dropout rates, disproportionately affecting underserved populations and contributing to mental health disparities (Biringer et al., 2015). Research suggests bundled attendance-improvement strategies outperform individual interventions (Gandy et al., 2019; Lefforge et al., 2007), yet no study has identified an optimized combination of engagement practices. Additionally, engagement interventions have largely overlooked waitlisted clients, despite their heightened risk of disengagement (Krendl et al., 2022; Peipert et al., 2022).

To address this, the Pre-treatment Engagement Program with Unified Protocol (PREP-UP) was developed as a bundled, single-session pre-intake intervention to enhance motivation and reduce premature termination. PREP-UP integrates role induction strategies (Swift & Greenberg, 2015) with motivation-building techniques from the Unified Protocol (Barlow et al., 2017), including goal setting and decisional balance exercises. It targets three key determinants of treatment motivation: problem recognition, perceived costs of treatment, and outcome expectancy (Drieschner et al., 2004).

This quasi-experimental, mixed-methods study examines PREP-UP’s reach, acceptability, and appropriateness in a university-based training clinic. All adult clients (n=35) coming off the waitlist for individual therapy were offered PREP-UP (wait time: M=620.5 days, SD=250.74). A significant majority (80%) opted in (χ² = 12.6, p < .001). Among 28 interested clients, 8 were lost to follow-up, with 20 completing the intervention. Intake clinicians (n=8), supervisors (n=6), and clinic leadership (n=2) assessed PREP-UP’s acceptability and appropriateness. Quantitative ratings showed high acceptability (M=4.6/5, SD=0.58) and appropriateness (M=4.6/5, SD=0.62) across stakeholders. Qualitative themes highlighted enhanced readiness, increased motivation, and greater trust in therapy. Clinicians and supervisors valued PREP-UP for streamlining intake, aiding case conceptualization, and improving engagement, with minimal burden on providers.

By bundling multiple evidence-based engagement strategies, PREP-UP offers a scalable, targeted approach to improving engagement and retention. Its implementation in a training clinic underscores its potential for broader dissemination in resource-limited settings. Findings support pre-treatment interventions to optimize service delivery and improve mental health access. This study has significant implications for expanding reach and effectiveness of cognitive and behavioral therapies and mitigating structural barriers in mental healthcare.