Non-attendance of treatment groups is a common phenomenon in mental health care settings, and it can have negative consequences for both the individuals served and the service provider. According to some studies, non-attendance can lead to financial costs for the program, worsened outcomes for the individuals, and disrupted group processes for the therapists and other participants.  According to the Joint Commission, failure to provide alternative treatment and update the plan for care, treatment and services is one of the top non-compliance findings for Joint Commission Accredited Hospitals and Behavioral Health Care organizations.  

Potential Barriers to Group Therapy

While predicting group therapy non-attendance is complex, several factors merit consideration:

1. Sociodemographic Factors

   • Younger individuals 
   • Male participants
   • Ethnicity and cultural beliefs
   • Family and social support
   • Stigma surrounding mental health and substance abuse

2. Diagnostic Profiles

   • Social Anxiety Disorder
   • Severe Depression
   • Substance Use Disorders
   • Severe Psychotic Disorders
   • Borderline Personality Disorder
   • Post Traumatic Stress Disorder
   • Attention-Deficit/Hyperactivity Disorder
   • Autism Spectrum Disorders
   • Personality Disorders (avoidant or dependent)
   • Co-Occurring Disorders
   • Lack of Insight

3. Group Format, Environment, Interest, and Enjoyment

   • Group Size
   • Duration and frequency of sessions
   • Group composition
   • Leadership style
   • Ensuring safety and confidentiality
   • Relevance of content
   • Engagement within the group
   • Concerns related to stigmatization
   • Lack of choice in treatment options
   • Flexibility and adaptability of the program

4. Perceived Lack of Benefits

   • Concerns regarding treatment effectiveness
   • Lack of personalization in group therapy
   • Privacy apprehensions
   • Fear of judgement
   • Negative group dynamics
   • Hesitance to share personal experiences 
   • Social anxiety and discomfort
   • Skepticism regarding peer support
   • Low motivation for change

Strategies to Enhance Group Therapy Attendance

To mitigate these barriers and improve attendance, consider the following strategies:

1. Assessment and Individualized Care:
   • Conduct comprehensive assessments to understand reluctance toward group therapy.
   • Collaboratively develop treatment plans tailored to address unique concerns.
2. Patient-Centered Approach:
   • Continuously address specific barriers and concerns during orientation and throughout the treatment process.
3. Cultural Sensitivity:
   • Implement culturally sensitive and inclusive approaches to therapy.
4. Flexible Group Dynamics:
   • Adjust group size, frequency, and composition to align with participants’ preferences.
5. Stigma Reduction:
   • Initiate efforts to reduce stigma and create a safe, supportive group environment.
6. Effective Communication:
   • Consistently communicate the potential advantages of group therapy during orientation and treatment.
7. Confidentiality Assurance:
   • Provide assurances of confidentiality and privacy protection.
8. Clear Expectations:
   • Establish and communicate clear goals and expectations for participants.
9. Adaptability:
   • Remain flexible, open to adjustments in format, content, and scheduling based on participant feedback.
10. Positive Reinforcement:
    • Showcase success stories and positive outcomes from group therapy.
11. Scheduling Options:
    • Offer flexible scheduling to accommodate individual needs.
12. Peer Support Promotion:
    • Emphasize the value of peer support and shared experiences within the group.

Alternative Treatment Options

When group therapy isn’t suitable, consider alternative treatments such as:

1. Individual therapy
2. Family therapy
3. Peer-led support groups
4. Behavioral interventions (CBT, DBT, mindfulness)
5. Art, music, or expressive therapies
6. Motivational enhancement

Meeting Accreditation and Regulatory Requirements

To ensure compliance with accreditation and regulatory requirements:

1. Update problem lists
2. Document short-term and long-term goals
3. Detail planned multidisciplinary interventions, including alternatives to group therapy
4. Record enactment of planned interventions
5. Document multidisciplinary progress toward goals
6. Record achievement or non-achievement of goals
7. Update care plans if expected progress is not being met

Initiating and Maintaining Patient-Centered Care Plans

Incorporate the following key methods to foster a patient-centered plan for group attendance:

1. Client Assessment: Include criteria for identifying clients at risk for non-attendance at group sessions.
2. Individualized Care Plan: Develop patient-centered care plans addressing specific needs, such as group size, duration, frequency, and goals.
3. Collaborative Decision-Making: Work closely with clients to determine treatment alternatives if group attendance is not possible.

Improving Staff Training and Documentation for Enhanced Compliance

In the realm of healthcare compliance, setting your staff up for success is paramount. Whether your organization utilizes an electronic clinical record (EHR) or relies on traditional documentation methods, there are key steps you can take to ensure that staff members are well-prepared to meet regulatory requirements.

1. Utilize EHRs for Automated Documentation:

• • If your organization employs EHRs, consider implementing automated documentation links that connect assessment findings, problems, interventions/objectives, short-term (ST) goals, long-term (LT) goals, and progress tracking. This streamlines the documentation process, enhancing efficiency and accuracy.

2. Implement Hard Stops and Cues:

• • To enforce thorough documentation practices, introduce hard stops at each documentation step in your EHR system. These stops prompt staff members to complete each stage before proceeding, reducing the risk of oversight. For non-EHR users, incorporate cues at the end of each documentation form, serving as reminders to move forward systematically.

3. Leverage Effective Treatment Team Meetings:

• • Effective treatment team meetings play a pivotal role in achieving compliance goals. Monitor each client’s attendance at group sessions and ensure that any instances of non-attendance are documented promptly. Initiate or update the plan of care to address this issue comprehensively.

4. Utilize Automated Tracking Systems:

• • Implement automated tracking systems to monitor individual group attendance against established treatment plan goals. This approach offers real-time insights into compliance, allowing for proactive adjustments and interventions.

5. Document Alternative Treatment Initiatives:

• • Maintain thorough documentation regarding alternative treatments initiated in response to missed group meetings. This documentation should clearly outline the strategies employed to address non-attendance.

6. Evaluate Progress and Adjust Strategies:

• • Collaborate with the treatment team to regularly assess progress toward established goals. Evaluate the effectiveness of current interventions/objectives, and be prepared to retire ineffective strategies while initiating new ones.

7. Foster a Surveyor Mindset:

• • Encourage staff to adopt a surveyor’s perspective when it comes to documentation. Emphasize the importance of following the documentation trail to provide evidence of compliance with accreditation and regulatory requirements.

8. Involve Frontline Clinicians:

• • Engage frontline clinicians in the chart audit process, leveraging their expertise to identify areas for improvement.

9. Provide Tools and Training:

• • Equip your staff with tools outlining each step of the documentation process. Offer training to ensure that all team members are well-versed in compliance requirements.

10. Periodic Tracer Activities:

• • Reinforce the survey process and cultivate a surveyor’s mindset by involving staff in periodic tracer activities. These activities provide hands-on experience in evaluating compliance requirements.

By implementing these strategies and addressing the challenges associated with group therapy attendance, healthcare organizations can enhance the quality of care and outcomes for individuals seeking treatment.

Barrins & Associates Consultation

We have expert Clinical Consultants available to assist your organization in developing and implementing a robust program for alternative treatment when individuals do not attend group therapy.  We can provide a focused consulting engagement, or incorporate education regarding improving group attendance and implementing alternative treatment for individuals who do not attend group therapy, into a Mock Survey or Continuous Readiness Consultation. We continue to be your partner in achieving and sustaining Joint Commission Accreditation and regulatory compliance.