Category: Treatment - Other
Public mental health systems for youth often provide multiple levels of care, depending on client needs, impairment, and treatment goals. As mental health systems develop policies, it is beneficial to understand the timeline within which youth typically progress in the context of these various levels of care and to then adjust accordingly. Research has shown that limited early treatment progress predicts poorer outcomes in outpatient services; however, there is no prior research on such prediction in youth in public mental health nor across various levels of care. Such knowledge can help identify youth who might require changes in service to reduce the likelihood of treatment failure. The present study examined markers of treatment progress over time and their association with successful/unsuccessful discharge for youth receiving services across multiple levels of care in a public mental health system.
Clinical data were collected from 933 youth who received services via Hawai‘i's Child and Adolescent Mental Health Division and were discharged from episodes of care between July 1, 2011 and June 30, 2016. Clinical progress ratings (scored from 0-6 with higher numbers indicative of greater progress), level of care information, and discharge status (successful or unsuccessful) were collected using the Monthly Treatment and Progress Summary (MTPS), a mandatory monthly therapist-report form. To determine early indicators of treatment response, average monthly MTPS progress ratings for youth in eight different levels of care were calculated. Treatment progress trajectories were then compared across successfully and unsuccessfully discharged groups of youth, with the first month in which progress ratings differed significantly serving as a potential “month of divergence.” Logistic regression analyses were used to examine whether mean MTPS progress scores at these months of divergences predicted risk of unsuccessful discharge.
Across six of the eight levels of services examined, low early progress significantly predicted an unsuccessful discharge (at or greater than 50% rate). For example, successful discharge for youth receiving Multisystemic Therapy (an evidence-based treatment for youth with serious anti-social behavior) was predicted as early as the third month of treatment, whereas successful discharge from hospital-based services could be predicted as early as the second month. Overall, limited early progress can be used to inform mental health care by identifying critical times to analyze treatment progress and make treatment adjustments to reduce the likelihood of treatment failure. Findings strongly support the need to routinely measure progress for youth in public mental health services.
Austen Taylor Matro– University of Hawai at Manoa
Matt Milette-Winfree– University of Hawai at Manoa, Honolulu, Hawaii
Daniel Wilkie– Graduate Student, University of Hawaii at Manoa, Honolulu, Hawaii
David Jackson– State of Hawaii Child and Adolescent Mental Health Division
Tristan Maesaka– Psychology student, University of Hawai at Manoa
Charles Mueller– University of Hawaii at Manoa