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Dose Response in Child and Adolescent Mental Health Services

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Mental Health Services Research

Abstract

This study examines the dose–response relationship, the correlation between the amount of mental health treatment a child receives (dose) and the outcome (response) in a community setting. Participants were 125 children treated in the Stark County Child and Adolescent Mental Health System. Study methods include multiple outcomes, multiple-dose definitions, longitudinal hierarchical analysis of repeated measures, and instrumental variable estimation to control for possible confounding between outcome and treatment dose. Results show no statistically significant dose response. The results do not support the existence of a dose response for children and adolescents consistent enough to guide clinicians, administrators, or policymakers.

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REFERENCES

  • Achenbach, T. M. (1991). Manual for the Child Behavior Checklist: 4-18 and 1991 profile. Burlington, MA: University ofVermont, Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M. (1994). Child Behavior Checklist and related instruments. In M. Edward (Ed.), The use of psychological testing for treatment planning and outcome assessment (pp. 517-549). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization. Millbank Memorial Fund Quarterly, 51, 95-124.

    Google Scholar 

  • Andrade, A., Lambert, E. W., & Bickman, L. (2000). Dose effect in child psychotherapy: Outcomes associated with negligible treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 39(2), 161-168.

    Google Scholar 

  • Angold, A., Costello, J., Burns, B. J., Erkanli, A., & Farmer, E.M.Z. (2000). Effectiveness of nonresidential specialty mental health services for children and adolescents in the “real world.” Journal of American Academy of Child and Adolescent Psychiatry, 39(2), 154-160.

    Google Scholar 

  • Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society B, 57, 289-300.

    Google Scholar 

  • Bickman, L., Lambert, E. W., Karver, M., & Andrade, A. (1998). Two low-cost measures of child and adolescent functioning for services research. Evaluation and Program Planning, 21, 263-275.

    Google Scholar 

  • Bickman, L., Noser, K., & Summerfelt, W. T. (1999). Long-term effects of a system of care on children and adolescents. Journal of Behavioral Health Services and Research, 26(2), 185-202.

    Google Scholar 

  • Bickman, L., Summerfelt, W. T., Firth, J. M., & Douglas, S. M. (1997). The Stark County Evaluation Project: Baseline results of a randomized experiment. In C. T. Nixon & D. A. Northrup (Eds.), Evaluating mental health services: How do programs for children 'work' in the real world? Children's mental health services (Vol. 3, pp. 231-258). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Bickman, L., Summerfelt, W. T., & Noser, K. (1997). Comparative outcomes of emotionally disturbed children and adolescents in a system of services and usual care. Psychiatric Services, 48(12): 1543-1548.

    Google Scholar 

  • Casey, R. J., & Berman, J. S. (1985). The outcome of psychotherapy with children. Psychological Bulletin, 98, 388-400.

    Google Scholar 

  • Catron, T., Harris, V. S., & Weiss, B. (1998). Posttreatment results after 2 years of services in the Vanderbilt School-Based Counseling project. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices (Vol. 18, p. 738). Austin, TX: Prod-Ed.

    Google Scholar 

  • Diggle, P., Liang, K. Y., & Zeger, S. L. (1994). Analysis of longitudinal data. Oxford, England: Oxford University Press.

    Google Scholar 

  • Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9(2), 171-180.

    Google Scholar 

  • Fonagy, P., & Target, M. (1994). The efficacy of psychoanalysis for children with disruptive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 33(1), 45-55.

    Google Scholar 

  • Foster, E. M. (2000). Is more better than less? Children's mental health services. Health Services Research, 35(5), 1135-1158.

    Google Scholar 

  • Foster, E. M., & Bickman, L. (1996). An evaluator's guide to detecting attrition problems. Evaluation Review, 20, 695-723.

    Google Scholar 

  • Gibbons, R. D., Hedeker, D., & Davis, J. M. (1987). Regression toward the mean: More on the price of beer and the salaries of priests. Psychoneuroendocrinology, 12(3), 185-192.

    Google Scholar 

  • Gibbons, R. D., Hedeker, D., Elkin, I., Waternaux, C., Kraemer, H. C., Greenhouse, J. B., et al. (1993). Some conceptual and statistical issues in analysis of longitudinal data: Application to the NIMH Treatment of Depression Collaborative Research Program dataset. Archives of General Psychiatry, 50, 739-750.

    Google Scholar 

  • Heckman, J. J. (1997). Instrumental variables: A study of implicit behavioral assumptions used in making program evaluations. Journal of Human Resources, 33, 441-462.

    Google Scholar 

  • Heyse, J., & Rom, D. (1988). Adjusting for multiplicity of statistical tests in the analysis of carcinogenicity studies. Biometrica Journal, 30, 883-896.

    Google Scholar 

  • Hoagwood, K., Hibbs, E., Brent, D., & Jensen, P. (1995). Introduction to the Special Section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63(5), 683-687.

    Google Scholar 

  • Hochberg, Y. (1988). A sharper Bonferroni procedure for multiple significance testing. Biometrika, 75, 800-803.

    Google Scholar 

  • Hodges, K. (1993). Structured interviews for assessing children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 34(1), 49-68.

    Google Scholar 

  • Hodges, K., Gordon, Y., & Lennon, M. P. (1990). Parent-child agreement on symptoms assessed via a clinical research interview for children: The Child Assessment Schedule (CAS). Journal of Child Psychology and Psychiatry and Allied Disciplines, 31(3), 427-436.

    Google Scholar 

  • Hodges, K., Kline, J., Stern, L., Cytryn, L., & McKnew, D. (1982). The development of a child assessment interview for research and clinical use. Journal of Abnormal Child Psychology, 10, 173-189.

    Google Scholar 

  • Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy [Special issue]. American Psychologist, 41(2), 159-164.

    Google Scholar 

  • Kopta, S. M., Howard, K. I., Lowry, J. L., & Beutler, L. E. (1994). Patterns of symptomatic recovery in psychotherapy. Journal of Consulting and Clinical Psychology, 62(5), 1009-1016.

    Google Scholar 

  • Kraemer, H. C., & Thiemann, S. (1987). How many subjects?: Statistical power analysis in research. Newbury Park, CA: Sage.

    Google Scholar 

  • Lambert, E. W., & Guthrie, P. (1996). Clinical outcomes of a children's mental health managed care demonstration. Journal of the Mental Health Administration, 23, 51-68.

    Google Scholar 

  • Lambert, E. W., Wahler, R. G., Andrade, A. R., & Bickman, L. (2001). Looking for the disorder in conduct disorder. Journal of Abnormal Psychology, 110(1), 110-123.

    Google Scholar 

  • Littell, R. C., Milliken, G. A., Stroup, W. W., & Wolfinger, R. D. (1996). SAS system for mixed models. Cary, NC: SAS Institute.

    Google Scholar 

  • MACRO International. (1996). The national comprehensive community mental health for child and families program evaluation. (Report from Year One, Stark County, OH). Atlanta, Georgia: Author.

    Google Scholar 

  • Miller, I. (1996). Managed care is harmful to outpatient mental health services: A call for accountability. Professional Psychology: Research and Practice, 27, 349-363.

    Google Scholar 

  • Miller, R.C., & Berman, J. S. (1983). The efficacy of cognitive behavior therapies: A quantitative review of the research evidence. Psychological Bulletin, 94, 39-53.

    Google Scholar 

  • Miller, I. W., Epstein, N. B., Bishop, D. S., & Keitner, G. I. (1985). The McMaster Family Assessment Device: Reliability and validity. Journal of Marital and Family Therapy, 11(4), 345-356.

    Google Scholar 

  • Newhouse, J.P., & McClellan, M. (1998). Econometrics in outcomes research: The use of instrumental variables. Annual Review of Public Health, 19, 17-34.

    Google Scholar 

  • Robinson, L., Berman, J., & Neimeyer, R. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30-49.

    Google Scholar 

  • Salzer, M. S., Bickman, L., & Lambert, E. W. (1999). Dose-effect relationship in children's psychotherapy services. Journal of Clinical and Consulting Psychology, 66(2), 270-279.

    Google Scholar 

  • Schneider, B. H., & Byrne, B. M. (1985). Children's social skills training: A meta-analysis. In K. B. H. Schneider, K. R. Rubin, & J. E. Ledingham (Eds.), Children's peer relations: Issues in assessment and intervention (pp. 175-192). New York: Springer.

    Google Scholar 

  • Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50(12), 965-974.

    Google Scholar 

  • Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore: John Hopkins University Press.

    Google Scholar 

  • Stern, S. (1993). Managed care, brief therapy, and therapeutic integrity. Psychotherapy, 30, 162-175.

    Google Scholar 

  • Stroul, B., & Friedman, R. (1986). A system of care for severely emotionally disturbed youth. Washington, DC: CASSP Technical Assistance Center.

    Google Scholar 

  • Sturm, R. (1996). Instrumental variables for effectiveness research. International Journal of Methods in Psychiatric Research, 7(1), 17-26.

    Google Scholar 

  • Tukey, J. W. (1962). The future of data analysis. Annals of Mathematical Statistics, 33, 22.

    Google Scholar 

  • Verbeek, M., & Nijman, T. (1992). Testing for selectivity bias in panel data models. International Economic Review, 33(3), 681-703.

    Google Scholar 

  • Weiss, B., Catron, T., Harris, V., & Phung, T. M. (1999). The effectiveness of traditional child psychotherapy. Journal of Consulting and Clinical Psychology, 67(1), 82-94.

    Google Scholar 

  • Weiss, B., & Weisz, J. R. (1995). Effectiveness of psychotherapy. Journal of the American Academy of Child and Adolescent Psychiatry, 34(8), 971-972.

    Google Scholar 

  • Weisz, J. R., & Weiss, B. (1989). Assessing the effects of clinic-based psychotherapy with children and adolescents. Journal of Consulting and Clinical Psychology, 57(6), 741-746.

    Google Scholar 

  • Weisz, J. R., & Weiss, B. (1993). Effects of psychotherapy with children and adolescents. Newbury Park, CA: Sage.

    Google Scholar 

  • Weisz, J. R., Weiss, B., Alicke, M. D., & Klotz, M. L. (1987). Effectiveness of psychotherapy with children and adolescents: A meta-analysis for clinicians. Journal of Consulting and Clinical Psychology, 55(4), 542-549.

    Google Scholar 

  • Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. American Psychologist, 47(12), 1578-1585.

    Google Scholar 

  • Weisz, J. R., Weiss, B., Han, S. S., Granger, D. A., & Morton, T. (1995). Effects of psychotherapy with children and adolescents revisited: A meta-analysis of treatment outcome studies. Psychological Bulletin, 117(3), 450-468.

    Google Scholar 

  • Westfall, P. H., & Young, S. S. (1989). P-value adjustments for multiple tests in multivariate binomial models. Journal of the American Statistical Association, 84, 780-786.

    Google Scholar 

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Authors and Affiliations

  1. Center for Mental Health Policy, Vanderbilt University, Nashville, Tennessee

    Leonard Bickman, Ana Regina Andrade & E. Warren Lambert

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  1. Leonard Bickman
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  2. Ana Regina Andrade
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  3. E. Warren Lambert
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Correspondence to Leonard Bickman.

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Bickman, L., Andrade, A.R. & Lambert, E.W. Dose Response in Child and Adolescent Mental Health Services. Ment Health Serv Res 4, 57–70 (2002). https://doi.org/10.1023/A:1015210332175

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