Assessing stability between treatment plans and reported practices in a system of care

Ph.D. University of Hawaii at Manoa 2011.Includes bibliographical references.The system of care approach is the leading model of service delivery in children's mental health. The coordination of services is a central tenet of this model, yet little research exists addressing this principle. The present study examined whether treatment planning meaningfully informed service provision in an established system of care. Specifically, treatment targets and practices identified in mental health treatment plans were compared with those reported in actual care during the following 12 months. The present study also identified factors, including the passage of time and number of treatment episodes received per youth, which appeared to affect stability rates. Finally, treatment targets and practices were examined individually to identify differential patterns in utilization. Results indicated that approximately two-thirds of treatment targets and threequarters of practice elements identified in treatment plans were reported as retained by providers over the following 12 months of treatment. On the other hand, a notable proportion of targets and practices that were not identified in the plan were subsequently added to the treatment profile over the year. When considering the passage of time, results suggested that treatment plans have the strongest relationship with reported practices during the first 3 months of treatment. Finally, youth with multiple episodes of treatment had significantly higher rates of code utilization overall than youth with a single episode. An examination of individual codes indicated that many of the most frequently retained treatment targets and practices were consistent with the diagnostic profile of the sample and evidence-based services for such diagnoses. On the other hand, some targets consistent with the diagnostic profile of the sample were either underrepresented in treatment plans or exhibited relatively low rates of retention. Finally, there was some evidence to suggest that providers have a tendency to utilize specific treatment targets and practices, regardless of those identified in the treatment plan and/or the evidence base. Overall, results from the present investigation suggest there is considerable room for growth in understanding and improving the coordination of services from planning to practice. Interpretation and limitations of these data are discussed, as well as potential areas for future research