*2.3.4.3 Unplanned endings*

For the third quarter, the focus shifted to exploring the nature of unplanned endings. An analysis was undertaken to explore the potential associations between unplanned endings and the rate of non-attendance during therapy. This analysis found that, across all services, there was a link between session absence and ultimate attrition, especially regarding DNAs. For all TSOs, the DNA rate for clients with an unplanned (13%) versus planned (2%) ending was around 6½ times difference, ranging from 2 to 18 times across providers (**Figure 5**). By the end of the third quarter, those with planned endings attended almost 3 times more sessions (11) than those with unplanned endings (4) and were more likely to report reliable improvement for planned (62%, n = 226) versus unplanned (36%, n = 70) endings.

To assess how the pattern of non-attendance varied during therapy per ending type, session numbers and total appointments recorded were banded across all services (**Figure 6**). This analysis found that again, non-attendance was indicative of an unplanned ending, with higher rates of cancellations and DNAs. For those with an unplanned ending, it also revealed that while DNAs as a proportion were reduced in the lower session number bandings (2–4; 5%), they remained consistent at around 17–21%, excluding the 14–16 banding which reported a rate of 30%. Similar to the overall patterns of attendance, cancellations as a proportion of all appointments tended to increase the longer therapy progressed but again, this could be explained by a decrease in appointments recorded during these later subgroup stages.

#### **Figure 4.**

*The rate of appointment non-attendance per session number showing a higher proportion of DNAs earlier and cancellations later in therapy, across all SILC TSOs.*

### *Evaluating the Efficiency of a Collaborative Learning Network in Supporting Third Sector… DOI: http://dx.doi.org/10.5772/intechopen.84294*

#### **Figure 5.**

*A comparison of session non-attendance reporting a higher rate for unplanned versus planned endings across all SILC TSOs.*

#### **Figure 6.**

*A comparison of session non-attendance bandings showing a steady DNA rate and increasing cancellations for unplanned versus planned endings, across all SILC TSOs.*

#### *2.3.4.4 Clinical outcomes*

In the final quarter, the project focused on clinical outcomes and understanding therapist variation and trajectories of change. To identify a possible dose-effect, an analysis was undertaken to assess the rates of change across individual domains of the CORE-OM (wellbeing, problems, functioning, and risk) within the one service using the full 34-item measure, as opposed to the shorter CORE-10 which does not record all domains [17]. A pattern of average scores were mapped relative to individual session numbers up to the 10th session (for clients having 10+ appointments each) for those who reported reliable improvement (n = 130; 891 sessions) versus those who reported no reliable change (n = 39 clients; 243 sessions) or reliable deterioration (n = 7 clients; 53 sessions) (**Figure 7**). Based on this analysis, most of the score changes tended to occur early in treatment for those reporting reliable improvement, with an average decrease in scores of −6.1 across the first four sessions, remaining steady between sessions four to seven (−0.5), and then

#### **Figure 7.**

*A pattern-of-change comparison across the CORE-OM per session number illustrating early improvements for clients reporting reliable improvement compared with no reliable change or reliable deterioration.*

decreasing steadily from sessions seven to 10 (−2.3). For those reporting no reliable change or reliable deterioration, scores generally remained steady, with average changes ranging from 0.2 to 1.7. This suggests the first four sessions were important for identifying clients who were likely to improve or not. This triggered the integration of a flag feature to remind practitioners to review progress early in therapy to identify those at-risk of showing no change to provide additional support.
