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Dose Effect in Child Psychotherapy: Outcomes Associated With Negligible Treatment

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ABSTRACT

Objective

To compare the outcomes of children who received negligible amounts of outpatient treatment to children receiving more treatment.

Method

A random regression longitudinal model was used to analyze outcomes of children (aged 5-17 years) from the Fort Bragg Evaluation Project.

Results

In examining several outcomes, the results show no statistically significant dose effect.

Conclusions

Children receiving substantial amounts of treatment showed no better mental health outcomes than those receiving negligible amounts of treatment. The results do not support the existence of a dose effect consistent enough to guide clinicians, administrators, or policymakers.

Section snippets

Data

This study uses data from the FBEP (Bickman et al., 1995). The FBEP total sample includes 984 treated military-dependent children, aged 5 to 17 years. In the FBEP, 58% (N = 574) of cases were treated at the demonstration site, a comprehensive continuum of care at Fort Bragg, North Carolina, and 410 cases at the comparison sites, traditional mental health care at Fort Campbell, Kentucky, and Fort Stewart, Georgia. The FBEP continuum was part of a $94 million project which asked whether a

Client Characteristics

Table 2 shows client characteristics for cases with negligible and more-than-negligible treatment based on Howard's 8-session criterion. Children with negligible treatment showed less average disturbance on the CBCL, YSR, and CAFAS, although such differences were generally not significant (see adjusted p values).

Next we compared 1-year improvement (12-month difference scores) for CBCL, YSR, CAFAS, and GLOF to test the hypothesis that children receiving substantial treatment had better outcomes.

Summary of Results

This study compared children receiving negligible versus substantial amounts of outpatient psychotherapy on 4 outcomes (2 problem checklists and 2 ratings of functioning). A GLOF rating showed a univariate significant dose effect for 2 of 4 definitions of negligible treatment, as did a parent-reported problem score (CBCL) in 1 of 4 analyses, but these results did not meet the significance criteria for multiple tests. After properly controlling for multiple testing, the longitudinal analysis of

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    This research was supported by NIMH grant R01MH-46136 to Dr. Bickman.

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