Slipping Through the Cracks: Identifying Families At-Risk of Not Engaging with Mental Health Care Within a Specialty Anxiety Clinic.

Most youth in need of specialty anxiety treatment services do not receive it. Many families are lost between the time of initial outreach and attending a first therapy appointment. A retrospective administrative database review identified characteristics of families at risk of failing to connect with anxiety specialty services. Data included 563 records (2019-2023) from a specialty pediatric anxiety program embedded within a large community mental health setting. Variables of interest included client characteristics (age, gender, previous mental health diagnosis/history); household characteristics (insurance, parent/caregiver custody, distance from clinic); and a symptom screener. Descriptive statistics characterized documented non-response to appointment offers and failure to attend an initial scheduled appointment. The highest drop off occurred after families expressed initial interest in services; 113 (21%) families were non-responsive to outreach. Logistic regression analyses indicated that having insurance covered services (vs. self-pay) and living closer to the clinic (vs. farther) predicted increased odds of intake appointment scheduling (ps < .01). Clients with insurance covered services (vs. self-pay) also had higher odds of successful appointment attendance (ps < .01). Findings indicate that many families seeking specialty anxiety services for youth "fall off" after initial outreach (e.g., leaving a voicemail or completing an online inquiry form to learn about services). The results suggest the potential importance of streamlining initial contacts to make it easier for families to engage and suggest the potential for future work to examine whether strategies like direct intake booking can improve initial engagement rates.