Are Children Improving? Results from Outcome Measurement in a Large Mental Health System

Abstract

Standardized outcome assessment was implemented in a large county mental health system. This study examines changes in children's emotional and behavioral problems after 6 months of treatment and identifies factors associated with treatment improvement. Results from 3,215 youth indicated that externalizing and internalizing problems significantly decreased from intake to 6 months and that ethnicity, gender, and age were associated with caregiver-reported changes in symptomatology. While there was improvement associated with entry into treatment, the magnitude of symptom reduction was small to medium and not associated with amount of care, providing only limited support for the impact of routine out-patient care.

Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action

“…Several studies have reported aggregate decreases in children’s behavioral and emotional problems after entering care in community-based service systems, reflecting overall improvement in symptoms (Hawley and Weisz 2005; Manteuffel et al 2002; Trask and Garland 2011), but like all uncontrolled studies, the extent to which these observed changes can be attributed to treatment received is unknown. Results from a number of studies demonstrating no “dose–effect” relationship (i.e., no link between amount of treatment received—usually measured as number of sessions attended—and outcome variability) reinforce skepticism about attributing observed symptom change to treatment (Andrade et al 2000; Garland et al Under Review; Lindhiem and Kolko 2011; Trask and Garland 2011; Warren et al 2009).…”

“…Results from a number of studies demonstrating no “dose–effect” relationship (i.e., no link between amount of treatment received—usually measured as number of sessions attended—and outcome variability) reinforce skepticism about attributing observed symptom change to treatment (Andrade et al 2000; Garland et al Under Review; Lindhiem and Kolko 2011; Trask and Garland 2011; Warren et al 2009). Lambert and Bickman (2004) proposed that observed decreases in symptom severity and/ or improvements in functioning after service entry should not necessarily be attributed to service effectiveness because such changes likely reflect predictable variation, including expected “regression to the mean.” Longitudinal modeling of expected variations in symptom severity and the assumption that children generally enter care when symptoms are most severe support this point.…”

Resources, Exposure to Trauma, and the Behavioral Health of Youth Receiving Public System Services

“…Other clinical literature has found that initial behavioral health needs are often significant predictors of behavioral health needs at multiple follow-up points (e.g. Trask and Garland 2012). This may be related to the very small overall mean change in behavioral health needs score from initial assessment to 6 month assessment (see Table 1; youth in this sample experienced a .6 point reduction in behavioral health needs and had a .nine point gain in resources over 6 months of treatment).…”

Clinical Decision-Making in Community Children’s Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment

“…Given discouraging data regarding the limited effectiveness of routine mental health care for children (Trask & Garland, 2012; Weisz & Jensen, 2001; Weisz, 2004), there have been numerous national calls for improved dissemination and implementation of evidence-based treatments (EBTs) (Hogan, 2003). At present, efforts to implement EBTs largely rely on training clinicians in individual empirically-supported treatment manuals or protocols.…”