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Frequency, Level, and Rate of Improvement for Treatment Targets in a Children’s Mental Health Community-Based Intensive In-Home Therapeutic Setting

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Abstract

Frequency, level, and rate of improvement on 48 therapist-identified treatment targets were examined for 790 youth in usual care receiving intensive in-home services. Targets related to disruptive behavior, depressive mood, and functional impairment were most common. Overall, targets attained moderate levels of improvement and reached maximum gains in approximately three months. Targets associated with disruptive behavior and depressive mood disorders showed significantly greater improvement than those associated with ADHD. Anxiety-related targets improved quickest and significantly faster than disruptive behavior targets. Outcomes for targets within the same diagnostic group also varied substantially. Practice and implementation implications are discussed.

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References

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. text rev.). Washington DC: Author.

  • Baker-Ericzén, M. J., Hurlburt, M. S., Brookman-Frazee, L., Jenkins, M. M., & Hough, R. L. (2010). Comparing child, parent, and family characteristics in usual care and empirically supported treatment research samples for children with disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 18(2), 82–99. doi:10.1177/1063426609336956.

    Article  Google Scholar 

  • Barkley, R. A. (2002). Attention-deficit/hyperactivity disorder. In E. J. Mash & R. A. Barkley (Eds.), Child Psychopathology (2nd ed., pp. 75–143). New York, NY: Guilford Press.

    Google Scholar 

  • Barrett, P. M., & Ollendick, T. H. (2004). Handbook of interventions that work with children and adolescents: Prevention and treatment. West Sussex: Wiley.

    Book  Google Scholar 

  • Becker, K. D., Chorpita, B. F., & Daleiden, E. L. (2011). Improvement in symptoms versus functioning: How do our best treatments measure up? Administration and Policy in Mental Health and Mental Health Services Research, 38(6), 440–458. doi:10.1007/s10488-010-0332-x.

    Article  PubMed  Google Scholar 

  • Bickman, L. (2000). The most dangerous and difficult question in mental health services research. Mental Health Services Research, 2(2), 71–72. doi:10.1023/A:1010100119789.

    Article  Google Scholar 

  • Borkovec, T. D., Abel, J. L., & Newman, H. (1995). Effects of psychotherapy on comorbid conditions in generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 63(3), 479–483. doi:10.1037/0022-006X.63.3.479.

    Article  CAS  PubMed  Google Scholar 

  • Brookman-Frazee, L., Haine, R. A., Baker-Ericzén, M., Zoffness, R., & Garland, A. (2010). Factors associated with use of evidence-based practices in usual care youth psychotherapy. Administration and Policy in Mental Health and Mental Health Services Research, 37, 254–269. doi:10.1007/s10488-009-0244-9.

    Article  PubMed Central  PubMed  Google Scholar 

  • Brown, T. A., & Barlow, D. H. (2005). Dimensional versus categorical classification of mental disorders in the fifth edition of the diagnostic and statistical manual of mental disorders and beyond: Comment on the special section. Journal of Abnormal Psychology, 114(4), 551–556. doi:10.1037/0021-843X.114.4.551.

    Article  PubMed  Google Scholar 

  • Child and Adolescent Mental Health Division (2003). Instructions and codebook for provider monthly summaries. Honolulu, HI: Hawaii Department of Health Child and Adolescent Mental Health Division.

  • Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77(3), 566–579. doi:10.1037/a0014565.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20. doi:10.1007/s11020-005-1962-6.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., & Donkervoet, C. (2004). Implementation of the Felix Consent Decree in Hawaii: The impact of policy and practice development efforts on service delivery. In R. G. Steele & M. C. Roberts (Eds.), Handbook of Mental Health Services for Children, Adolescents, and Families (pp. 317–332). New York: Kluwer.

    Google Scholar 

  • Chorpita, B. F., Yim, L. M., Donkervoet, J. C., Arensdorf, A., Amundsen, M. J., McGee, C., et al. (2002). Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii Empirical Basis to Services Task Force. Clinical Psychology: Science and Practice, 9, 165–190.

    Google Scholar 

  • Clark, L. A., Watson, D., & Reynolds, S. (1995). Diagnosis and classification of psychopathology: Challenges to the current system and future directions. Annual Review of Psychology, 46, 121–153. doi:10.1146/annurev.ps.46.020195.001005.

    Article  CAS  PubMed  Google Scholar 

  • Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46. doi:10.1177/00131644600200010.

    Article  Google Scholar 

  • Daleiden, E. L., & Chorpita, B. F. (2005). From data to wisdom: Quality improvement strategies supporting large-scale implementation of evidence-based services. Child and Adolescent Psychiatric Clinics of North America, 14(2), 329–349. doi:10.1016/j.chc.2004.11.002.

    Article  PubMed  Google Scholar 

  • Daleiden, E. L., Chorpita, B. F., Donkervoet, C., Arensdorf, A. M., Brogan, M., & Hamilton, J. D. (2006). Getting better at getting them better: Health outcomes and evidence-based practice within a system of care. Journal of the American Academy of Child and Adolescent Psychiatry, 45(6), 749–756. doi:10.1097/01.chi.0000215154.07142.63.

    Article  PubMed  Google Scholar 

  • Daleiden, E. L., Lee, J., & Tolman, R. (2004). Annual Evaluation Report: Fiscal Year 2004. Honolulu, HI: Hawaii Department of Health Child and Adolescent Mental Health Division. Retrieved from http://hawaii.gov/health/mental-health/camhd/library/pdf/rpteval/ge/ge011.pdf. Accessed 21 Aug 2012.

  • Ehrenreich-May, J., Southam-Gerow, M. A., Hourigan, S. E., Wright, L. R., Pincus, D. B., & Weisz, J. R. (2011). Characteristics of anxious and depressed youth seen in two different clinical contexts. Administration and Policy in Mental Health and Mental Health Services Research, 38, 398–411. doi:10.1007/s10488-010-0328-6.

    Article  PubMed  Google Scholar 

  • Fleiss, J. L. (1981). Balanced incomplete block designs for inter-rater reliability studies. Applied Psychological Measurement, 5(1), 105–112. doi:10.1177/014662168100500115.

    Article  Google Scholar 

  • Garland, A. F., Bickman, L., & Chorpita, B. F. (2010a). Change what? Identifying quality improvement targets by investigating usual mental health care. Administration and Policy in Mental Health and Mental Health Services Research, 37(1–2), 15–26. doi:10.1007/s10488-010-0279-y.

    Article  PubMed Central  PubMed  Google Scholar 

  • Garland, A. F., Hurlburt, M. S., Brookman-Frazee, L., Taylor, R. M., & Accurso, E. C. (2010b). Methodological challenges of characterizing usual care psychotherapeutic practice. Administration and Policy in Mental Health and Mental Health Services Research, 37(3), 208–220. doi:10.1007/s10488-009-0237-8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Helzer, J. E., Kraemer, H. C., & Krueger, R. F. (2006). The feasibility and need for dimensional psychiatric diagnoses. Psychological Medicine, 36(12), 1671–1680. doi:10.1017/S003329170600821X.

    Article  PubMed  Google Scholar 

  • Higa-McMillan, C., Daleidan, E., & Kimhan, C. K. (2008). Annual Evaluation Report: Fiscal Year 2008. Honolulu, HI: Hawaii Department of Health Child and Adolescent Mental Health Division. Retrieved from http://hawaii.gov/health/mental-health/camhd/library/pdf/rpteval/ge/ge/ge026.pdf. Accessed 21 Aug 2012.

  • Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52(9), 1179–1189. doi:10.1176/appi.ps.52.9.1179.

    Article  CAS  PubMed  Google Scholar 

  • Hoagwood, K., & Kolko, D. J. (2009). Introduction to the special section on practice contexts: A glimpse into the nether world of public mental health services for children and families. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 35–36. doi:10.1007/s10488-008-0201-z.

    Article  PubMed  Google Scholar 

  • Hodges, K. (1998). Child and Adolescent Functional Assessment Scale (CAFAS). Ann Arbor, MI: Functional Assessment Systems.

    Google Scholar 

  • Hurlburt, M. S., Garland, A. F., Nguyen, K., & Brookman-Frazee, L. (2010). Child and family therapy process: Concordance of therapist and observational perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 37(3), 230–244. doi:10.1007/s10488-009-0251-x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Jackson, D. S., Keir, S. S., Ku, J. G. K., & Mueller, C. W. (2011). An examination of length of stay and outcomes in Hawai’i youth residential treatment programs. Washington, DC: Poster presentation at the National Data Infrastructure Grant Annual Meeting.

    Google Scholar 

  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–709. doi:10.1001/archpsyc.62.6.617.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kolko, D. J. (2006). Studying usual care in child and adolescent therapy: It’s anything but routine. Clinical Psychology: Science and Practice, 13(1), 47–52. doi:10.1111/j.1468-2850.2006.00005.x.

    Google Scholar 

  • Landsverk, J., Brown, C. H., Reutz, J. R., Palinkas, L., & Horwitz, S. M. (2011). Design elements in implementation research: A structured review of child welfare and child mental health studies. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 54–63. doi:10.1007/s10488-010-0315-y.

    Article  PubMed Central  PubMed  Google Scholar 

  • Manteuffel, B., Stephens, R. L., & Santiago, R. (2002). Overview of the national evaluation of the comprehensive community mental health services for children and their families program and summary of current findings. Children’s Services: Social Policy, Research, and Practice, 5(1), 3–20. doi:10.1207/S15326918CS0501_2.

    Article  Google Scholar 

  • McKay, M. M., Hibbert, R., Hoagwood, K., Rodriguez, J., Murray, L., Legerski, J., et al. (2004). Integrating evidence-based engagement interventions into “real world” child mental health settings. Brief Treatment and Crisis Intervention, 4, 177–186. doi:10.1093/brief-treatment/mhh014.

    Article  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Miranda, J., Azocar, F., & Burnam, M. A. (2010). Assessment of evidence-based psychotherapy practices in usual care: Challenges, promising approaches, and future directions. Administration and Policy in Mental Health and Mental Health Services Research, 37(3), 205–207. doi:10.1007/s10488-009-0246-7.

    Article  PubMed Central  PubMed  Google Scholar 

  • Mueller, C. W., Tolman, R. T., Higa-McMillan, C. K., & Daleiden, E. L. (2010). Longitudinal predictors of youth functional improvement in a public mental health system. The Journal of Behavioral Health Services & Research, 37(3), 350–362. doi:10.1007/s11414-009-9172-4.

    Article  Google Scholar 

  • Nakamura, B. J., Daleiden, E. L., & Mueller, C. W. (2007). Validity of treatment target progress ratings as indicators of youth improvement. Journal of Child and Family Studies, 16(5), 729–741. doi:10.1007/s10826-006-9119-9.

    Article  Google Scholar 

  • Nezu, A. M., & Nezu, C. M. (1993). Identifying and selecting target problems for clinical interventions: A problem-solving model. Psychological Assessment, 5(3), 254–263. doi:10.1037/1040-3590.5.3.254.

    Article  Google Scholar 

  • Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73, 872–879. doi:10.1037/0022-006X.73.5.872.

    Article  PubMed  Google Scholar 

  • Orimoto, T. E., Higa-McMillan, C. K., Mueller, C. W., & Daleiden, E. L. (2012). Assessment of therapy practices in community treatment for children and adolescents. Psychiatric Services, 63(4), 343–350. doi:10.1176/appi.ps.201100129.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Hinshaw, S. P. (2008). The second special issue on evidence-based psychosocial treatments for children and adolescents: A 10-year update. Journal of Clinical Child and Adolescent Psychology, 37(1), 1–7. doi:10.1080/15374410701817725.

    Article  Google Scholar 

  • State of Hawaii. Education. Office of Curriculum, Instruction and Student Support. Student Services Support Branch. Health. Child & Adolescent Mental Health Division. Clinical Services Office and Performance Manage Office (2006, July 1). Interagency performance standards and practice guidelines. Retrieved from http://hawaii.gov/health/mental-health/camhd/library/pdf/ipspg/purplebook.pdf. Accessed 4 Jan 2013.

  • Weersing, V. R., Iyengar, S., Kolko, D. J., Birmaher, B., & Brent, D. A. (2006). Effectiveness of Cognitive-Behavioral Therapy for adolescent depression: A benchmarking investigation. Behavior Therapy, 37(1), 36–48. doi:10.1016/j.beth.2005.03.003.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63(5), 688–701. doi:10.1037/0022-006X.63.5.688.

    Article  CAS  PubMed  Google Scholar 

  • Weisz, J. R., & Gray, J. S. (2008). Evidence-Based Psychotherapy for children and adolescents: Data from the present and a model for the future. Child and Adolescent Mental Health, 13(2), 54–65. doi:10.1111/j.1475-3588.2007.00475.x.

    Article  Google Scholar 

  • Weisz, J. R., & Kazdin, A. E. (Eds.). (2010). Evidence-based psychotherapies for children and adolescents. New York, NY: Guilford Press.

    Google Scholar 

  • Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130(4), 631–663. doi:10.1037/0033-2909.130.4.631.

    Article  PubMed  Google Scholar 

  • Widiger, T. A., & Douglas, S. B. (2005). Diagnostic categories or dimensions? A question for the diagnostic and statistical manual of mental disorders—fifth edition. Journal of Abnormal Psychology, 114(4), 494–504. doi:10.1037/0021-843X.114.4.494.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported in part from a research and evaluation contract awarded to the second author from the State of Hawaii Department of Health, Child and Adolescent Mental Health Division.

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Authors and Affiliations

  1. Department of Psychology, University of Hawai‘i at Mānoa, 2430 Campus Road, Honolulu, HI, 96822, USA

    Allison R. Love, Charles W. Mueller, Ryan T. Tolman & A. Ka Powell

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  1. Allison R. Love
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  2. Charles W. Mueller
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  3. Ryan T. Tolman
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  4. A. Ka Powell
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Correspondence to Charles W. Mueller.

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Love, A.R., Mueller, C.W., Tolman, R.T. et al. Frequency, Level, and Rate of Improvement for Treatment Targets in a Children’s Mental Health Community-Based Intensive In-Home Therapeutic Setting. Adm Policy Ment Health 41, 421–433 (2014). https://doi.org/10.1007/s10488-013-0480-x

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  • DOI: https://doi.org/10.1007/s10488-013-0480-x

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