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

Mueller, Charles W.; Tolman, Ryan; Higa-McMillan, Charmaine K.; Daleiden, Eric L.

doi:10.1007/s11414-009-9172-4

Cited by 32 publications

(11 citation statements)

References 34 publications

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“…Change over time was small to moderate and statistically significant for all three outcomes (i.e., child symptom severity, inconsistent parent disciplinary practices, and general family functioning), as well as clinically significant for one of the three outcomes (i.e., child symptom severity). The effect size for child symptom severity was similar to that reported for child functional impairment in a large, diverse sample of children and youth from a different public mental health system (e.g., Cohen’s d of .72, compared to .71 in Mueller, Tolman, Higa-McMillan, & Daleiden, 2010). Change was greater during the first four months compared to the second four months across all outcomes.…”

Section: Discussionsupporting

confidence: 76%

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Garland

Accurso

Haine‐Schlagel

et al. 2014

Journal of Clinical Child & Adolescent Psychology

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Objective Most of the knowledge generated to bridge the research - practice gap has been derived from experimental studies implementing specific treatment models. Alternatively, this study uses observational methods to generate knowledge about community-based treatment processes and outcomes. Aims are to (1) describe outcome trajectories for children with disruptive behavior problems (DBPs), and (2) test how observed delivery of a benchmark set of practice elements common in evidence-based (EB) treatments may be associated with outcome change, while accounting for potential confounding variables. Method Participants included 190 children ages 4–13 with DBPs and their caregivers, plus 85 psychotherapists, recruited from six clinics. All treatment sessions were video-taped and a random sample of four sessions in the first four months of treatment was reliably coded for intensity on 27 practice elements (benchmark set and others). Three outcomes (child symptom severity, parent discipline, and family functioning) were assessed by parent report at intake, four, and eight months. Data were collected on several potential covariates including child, parent, therapist, and service use characteristics. Multi-level modeling was used to assess relationships between observed practice and outcome slopes, while accounting for covariates. Results Children and families demonstrated improvements in all three outcomes, but few significant associations between treatment processes and outcome change were identified. Families receiving greater intensity on the benchmark practice elements did demonstrate greater improvement in the parental discipline outcome. Conclusion Observed changes in outcomes for families in community care were generally not strongly associated with the type or amount of treatment received.

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Section: Discussionsupporting

confidence: 76%

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Garland

Accurso

Haine‐Schlagel

et al. 2014

Journal of Clinical Child & Adolescent Psychology

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“…While there is no widely accepted definition of change (Roussos, 2013), researchers have utilised quantitative process-outcome designs, microanalytic/sequential process methodologies, as well as studies of significant events and helpful factors (Elliott, 2010). These different research designs have utilised; pre-post outcome measures, criteria for clinical significance, reliable change, effect sizes, qualitative accounts, and measures of subjective well-being or functioning to describe change (Jacobson & Truax, 1991;Kazdin, 2008;Mueller, Tolman, Higa-McMillan, & Daleiden, 2010). From a phenomenological perspective, therapeutic change has been categorised as occurring either gradually, suddenly or a combination of both (Fosha, 2006;Gianakis & Carey, 2011).…”

Section: What Is Known About Therapeutic Changementioning

confidence: 99%

Therapeutic change in young people—A qualitative investigation of client and therapist perspectives

Donald

Carey

Rickwood

2018

Couns and Psychother Res

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Background Young people's vulnerability to developing mental illness makes it important to understand therapeutic change, integrating the views of both young people and their therapists, to improve treatment effectiveness. To date, qualitative research aiming to triangulate experiences of therapeutic change in young people has not clearly differentiated the unique perspectives of clients and therapists. Instead both groups’ perspectives have been analysed together, which may be phenomenologically problematic considering clients are the site of change, while therapists observe it. Aims This study explored experiences of therapeutic change from the perspectives of young people and their therapists. Three clients aged 17–19 years, and their two therapists, participated in semi‐structured interviews post‐therapy. Methods Six themes were identified for clients: facing problems alone; how the therapeutic space was used; change characteristics; partial changes; the role of context in change; and growing into the new self. Four themes were identified for therapists: problematic experiences; change processes; therapist‐related change process; and change qualities. Results Six themes were identified for clients: facing problems alone; how the therapeutic space was used; change characteristics; partial changes; the role of context in change; and growing into the new self. Four themes were identified for therapists: problematic experiences; change processes; therapist‐related change process; and change qualities. Conclusions Congruent with adult research, common and specific factors was important to change. Contextual and relational factors were particularly important for young people, who described that isolation caused by their problems caused distress beyond the impact of symptoms. Therapeutic change was facilitated through responsive therapy practices that led to developmentally normal levels of activity and changes in selfhood. Participants accepted a good‐enough level of recovery which was anticipated to continue post‐therapy.

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“…Although there are no studies that provide directly comparable data, three studies report service use over longer time periods. Mueller et al [82] analyzed data from children with severe mental and behavioral disorders treated within the publicly-funded system in Hawaii. After excluding all cases seen for fewer than 90 days, the average duration of a “service episode” was about one and a half years (560.2 days; SD = 372.2).…”

Section: Discussionmentioning

confidence: 99%

Predicting patterns of service utilization within children’s mental health agencies

Reid

Stewart

Barwick

et al. 2019

BMC Health Serv Res

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BackgroundSome children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns.MethodsLatent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit.ResultsFive patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children’s pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits.ConclusionsOptimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.

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

Cited by 32 publications

References 34 publications

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Searching for Elements of Evidence-Based Practices in Children's Usual Care and Examining Their Impact

Therapeutic change in young people—A qualitative investigation of client and therapist perspectives

Predicting patterns of service utilization within children’s mental health agencies

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