Youth outcomes on therapist-identified treatment targets in a system of care

M.A. University of Hawaii at Manoa 2010.Includes bibliographical references.The present study contributes to the knowledge base regarding the diversity and composition of youth problems in usual care treatment across a system of care, and provides outcome data for a broad range of treatment targets. Archival data for 790 youth between the ages of 7 and 18 (M = 14.08 years, SD = 2.87) who received intensive-in-home services through the Hawaiʻi Child and Adolescent Mental Health Division (CAMHD), a comprehensive state-funded mental health system, were examined. Two measures of treatment outcome were examined: highest level of progress made on the target, referred to as "level," and number of months from first appearance of target to time of highest level, referred to as "rate." All 48 pre-set individual therapist-identified treatment targets appearing on the Monthly Treatment Progress Summary (MTPS), a therapist-report measure designed to track service format, utilization, and practice variables were examined. Expert raters then used a coding procedure to reliably map (k = .67 to .90) a subsample of targets onto the four major diagnostic categories in this system of care (i.e., disruptive behavior, attentional, mood, and anxiety disorders), and treatment progress measures were compared within and across these categories. Omnibus multivariate results were significant for all comparisons, as were all subsequent univariate ANOVAs on the two dependent measures of "level" and "rate," with the exception of the comparison of symptom targets within the ADHD group (inattention, hyperactivity). Results of the between-group comparisons indicated that, on average, disruptive behavior and mood disorder targets reached higher levels of improvement than ADHD targets (p < .01), with the targets associated with anxiety falling between these groups. The anxiety-related targets improved at a significantly faster "rate" than the disruptive behaviors group (p <.05). For the within-diagnostic category comparisons, targets related to disruptive behavior, mood, and anxiety disorders showed significant variability in their responsiveness to treatment. For example, targets within the ADHD group did not significantly differ from one another on either "level" or "rate," while differences between targets associated with disruptive behavior disorders emerged only on the "rate" measure. In the other two groups, significant differences were observed on both measures of treatment response. Notably, the phobias target demonstrated a significantly higher "level" of improvement than all other anxiety-related targets, and a significantly faster "rate" than the target of anxiety. Findings support the need to consider treatment outcomes at the level of individual symptoms or behavioral targets (instead of/in addition to disorder remission), as well as across diagnostic groups, in order to best understand how disorders respond to treatment. Given the high levels of comorbidity among youth receiving mental health services, such a problem-or target-based approach shows promise in furthering understanding of treatment as usual and youth treatment outcomes more generally