Skip to main content

Advertisement

SpringerLink
Log in

Longitudinal Predictors of Youth Functional Improvement in a Public Mental Health System

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

The present study examined youth characteristics that predict level of impairment at entry into a system of care and rate of improvement over the course of service provision. Youth characteristics studied included gender, age, specific diagnostic categories, and comorbidity. A total of 2,171 youth served in a state-wide public mental health system were included in the study. Hierarchical linear modeling was used to analyze longitudinal data derived from quarterly ratings of functional status. Gender had no relationship to initial level of impairment or rate of improvement. Older youth, those with disruptive behavior disorders, and those with more than one DSM diagnosis were more impaired at system entry. Those with attentional disorders began services less impaired. Older youth improved at faster rates. Youth with a disruptive behavior disorder diagnosis improved at slower rates. Neither comorbidity nor the presence of a mood or attentional disorder affected the rate of improvement. Both researchers and systems of care developers should consider these patterns in their future work.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Weiss B, Weisz JR. Relative effectiveness of behavioral and nonbehavioral child psychotherapy. Journal of Consulting and Clinical Psychology. 1995;63:317–320.

    Article  CAS  PubMed  Google Scholar 

  2. Weisz JR, Doss AJ, Hawley KM. Youth psychotherapy outcome research: a review and critique of the evidence base. Annual Review of Psychology. 2005;56:337–363.

    Article  PubMed  Google Scholar 

  3. Bruns EJ, Hoagwood KE. State implementation of evidence-based practice for youths, part I: responses to the state of the evidence. Journal of the American Academy of Child and Adolescent Psychiatry. 2008;47:369–373.

    Article  PubMed  Google Scholar 

  4. Chambers DA. Introduction: advancing implementation research in mental health. Administration and Policy in Mental Health and Mental Health Services Research. 2008;35:1–2.

    Article  Google Scholar 

  5. Chambers DA, Ringeisen H, Hickman EE. Federal, state, and foundation initiatives around evidence-based practices child and adolescent mental health. Child and Adolescent Psychiatric Clinics of North America. 2005;14:307–327.

    Article  PubMed  Google Scholar 

  6. National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment. Blueprint for Change: Research on Child and Adolescent Mental Health. Washington, DC: National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment; 2001.

    Google Scholar 

  7. New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. (SMA)03-3832. Rockville, MD: Department of Health and Human Services; 2003.

    Google Scholar 

  8. Walrath CM, Mandell DS, Leaf PJ. Responses of children with different intake profiles to mental health treatment. Psychiatric Services. 2001;52:196–201.

    Article  CAS  PubMed  Google Scholar 

  9. James S, Leslie LK, Hurlburt MS, et al. Children in out-of-home care: entry into intensive or restrictive mental health and residential care placements. Journal of Emotional and Behavioral Disorders. 2006;14:196–208.

    Article  Google Scholar 

  10. McCauley E, Myers K, Mitchell J, et al. Depression in young people: initial presentation and clinical course. Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32:714–722.

    Article  CAS  PubMed  Google Scholar 

  11. Walrath CM, Ybarra ML, Holden EW. Understanding the pre-referral factors associated with differential 6-month outcomes among children receiving system-of-care services. Psychological Services. 2006;3:35–50.

    Article  Google Scholar 

  12. Pfeiffer SI, Strzelecki SC. Inpatient psychiatric treatment of children and adolescents: a review of outcome studies. Journal of the American Academy of Child and Adolescent Psychiatry. 1990;29:847–853.

    Article  CAS  PubMed  Google Scholar 

  13. Emslie GJ, Rush AJ, Weinberg WA, et al. Recurrence of major depressive disorder in hospitalized children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36:785–792.

    Article  CAS  PubMed  Google Scholar 

  14. Jayson D, Wood A, Kroll L, et al. Which depressed patients respond to cognitive-behavioral treatment? Journal of the American Academy of Child and Adolescent Psychiatry. 1998;37:35–39.

    Article  CAS  PubMed  Google Scholar 

  15. Sanford M, Szatmari P, Spinner M, et al. Predicting the one-year course of adolescent major depression. Journal of the American Academy of Child and Adolescent Psychiatry. 1995;34:1618–1628.

    Article  CAS  PubMed  Google Scholar 

  16. Brown SA, Myers MG, Mott MA. Correlates of success following treatment for adolescent substance abuse. Applied and Preventive Psychology. 1994;3:61–73.

    Article  Google Scholar 

  17. Friedman AS, Terras A, Kreisher C. Family and client characteristics as predictors of outpatient treatment outcome for adolescent drug abusers. Journal of Substance Abuse. 1995;7:345–356.

    Article  CAS  PubMed  Google Scholar 

  18. Ralph N, McMenamy C. Treatment outcomes in an adolescent chemical dependency program. Adolescence. 1996;31:91–107.

    CAS  PubMed  Google Scholar 

  19. Goodyer IM, Herbert J, Tamplin A, et al. Short-term outcome of major depression: II. Life events, family dysfunction, and friendship difficulties as predictors of persistent disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36:474–480.

    Article  CAS  PubMed  Google Scholar 

  20. King CA, Hovey JD, Brand E, et al. Prediction of positive outcomes for adolescent psychiatric inpatients. Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36:1434–1442.

    Article  CAS  PubMed  Google Scholar 

  21. Rey JM, Denshire E, Wever C, et al. Three-year outcome of disruptive adolescents treated in a day program. European Child and Adolescent Psychiatry. 1998;7:42–48.

    Article  CAS  PubMed  Google Scholar 

  22. Doss AJ, Weisz JR. Syndrome co-occurrence and treatment outcomes in youth mental health clinics. Journal of Consulting and Clinical Psychology. 2006;74:416–425.

    Article  PubMed  Google Scholar 

  23. Singer JD, Willett JB. Applied Longitudinal Data Analysis: Modeling Change And Event Occurrence. New York: Oxford; 2003.

    Google Scholar 

  24. U.S. Census Bureau. State and County Quickfacts. 2007. Available at http://quickfacts.census.gov/qfd/states/15/15001.html. Accessed December 31, 2007.

  25. Evidence Based Services Committee. 2007 Biennial Report: Effective Psychosocial Interventions for Youth with Behavioral and Emotional Needs. Honolulu, HI: Evidence Based Services Committee; 2007.

    Google Scholar 

  26. Hawaii Departments of Education and Health. Interagency Performance Standards and Practice Guidelines. Honolulu, HI: Hawaii Department of Health Child and Adolescent Mental Health Division; 2006. Available at http://www.hawaii.gov/health/mental-health/camhd/library/pdf/ipspg/purplebook.pdf. Accessed April 9, 2008.

  27. Diagnostic and Statistical Manual of Mental Disorders DSM-IV Fourth Edition, Washington, DC, American Psychiatric Association; 1994.

  28. Tolman RT, Mueller CW, Daleiden EL, et al. Outcomes from Multisystemic Therapy in a statewide system of care. Journal of Child and Family Studies. 2008;17:894–908.

    Article  Google Scholar 

  29. Daleiden E, Higa-McMillan C. Child and Adolescent Mental Health Division: 2007 Annual Report. Honolulu, HI: Child and Adolescent Mental Health Division; 2008.

    Google Scholar 

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

    Google Scholar 

  31. Hodges K, Wong MM. Psychometric characteristics of a multidimensional measure to assess impairment: the Child and Adolescent Functional Assessment Scale (CAFAS). Journal of Child and Family Studies. 1996;5:445–467.

    Article  Google Scholar 

  32. Hodges K, Doucette-Gates A, Liao Q. The relationship between the Child and Adolescent Functional Assessment Scale (CAFAS) and indicators of functioning. Journal of Child and Family Studies. 1999;8:109–122.

    Article  Google Scholar 

  33. Hodges K, Doucette-Gates A, Kim CS. Predicting service utilization with the Child and Adolescent Functional Assessment Scale in a sample of youths with serious emotional disturbance served by Center for Mental Health Services-funded demonstrations. The Journal of Behavioral Health Services and Research. 2000;27:47–59.

    Article  CAS  Google Scholar 

  34. Hodges K, Kim CS. Psychometric study of the child and adolescent functional assessment scale: prediction of contact with the law and poor school attendance. Journal of Abnormal Child Psychology. 2000;28:287–297.

    Article  CAS  PubMed  Google Scholar 

  35. Manteuffel B, Stephens R, Santiago R. 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. 2002;5:3–20.

    Google Scholar 

  36. Nakamura BJ, Daleiden EL, Mueller CW. Validity of treatment target progress ratings as indicators of youth improvement. Journal of Child and Family Studies. 2007;16:729–741.

    Article  Google Scholar 

  37. Roberts D, Pang D, Kim SP, et al. Intensive home and community services: status of twelve-month follow-up. In Daleiden E, Mueller CW (Co-chairs); Rosenblatt A (Discussant). Multi-Level Systems Evaluation: Selected Projects from Hawaii. Symposium presented at the 19th Annual Research Conference of the Research and Training Center for Children’s Mental Health, Tampa, FL, February, 2006.

  38. Yeh M, Takeuchi DT, Sue S. Asian-American children treated in the mental health system: a comparison of parallel and mainstream outpatient service centers. Journal of Clinical Child Psychology. 1994;23:5–12.

    Article  Google Scholar 

  39. Leong FTL. Asian Americans’ differential patterns of utilization of inpatient and outpatient public mental health services in Hawaii. Journal of Community Psychology. 1994;22:82–96.

    Article  Google Scholar 

  40. Matsuoka JK, Breaux C, Ryujin DH. National utilization of mental health services by Asian Americans/Pacific islanders. Journal of Community Psychology. 1997;25:141–145.

    Article  Google Scholar 

  41. Hodges K, Xue Y, Wotring J. Use of the CAFAS to evaluate outcome for youths with severe emotional disturbance served by public mental health. Journal of Child and Family Studies. 2004;13:325–339.

    Article  Google Scholar 

  42. Cohen J. Statistical Power Analysis For the Behavioral Sciences. 2nd edn. Hillsdale, NJ: Erlbaum; 1988.

    Google Scholar 

  43. Daleiden EL, Chorpita BF. From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services. Child and Adolescent Psychiatric Clinics of North America. 2005;14:329–349.

    Article  PubMed  Google Scholar 

  44. Daleiden EL, Chorpita BF, Donkervoet C, et al. 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. 2006;45:749–756.

    Article  PubMed  Google Scholar 

  45. Fixsen DL, Naoom SF, Blasé KA, et al. Implementation Research: A synthesis of the literature. FMHI Pub. No. 231. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network; 2005.

    Google Scholar 

  46. Garland AE, Hurlburt MS, Hawley KM. Examining psychotherapy processes in a services research context. Clinical Psychology: Science and Practice. 2006;13:30–46.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported in part by a research and evaluation contract (05-017) awarded to the first author from the State of Hawaii Department of Health, Child and Adolescent Mental Health Division.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Hawaii at Manoa, 2430 Campus Road, Honolulu, HI, 96822, USA

    Charles W. Mueller PhD, Ryan Tolman MA & Charmaine K. Higa-McMillan PhD

  2. Kismetrics, LLC, 285 Wilson Avenue, Satellite Beach, FL, 32937, USA

    Eric L. Daleiden PhD

Authors
  1. Charles W. Mueller PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Tolman MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charmaine K. Higa-McMillan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric L. Daleiden PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles W. Mueller PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mueller, C.W., Tolman, R., Higa-McMillan, C.K. et al. Longitudinal Predictors of Youth Functional Improvement in a Public Mental Health System. J Behav Health Serv Res 37, 350–362 (2010). https://doi.org/10.1007/s11414-009-9172-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-009-9172-4

Keywords

Search

Navigation