Quality Indicators of Children's Mental Health Services: Do They Predict Improved Client Outcomes?

Abstract

Demonstrations of high-quality services have surpassed cost control as the primary task of health care. In this study we evaluated the relationship between several traditionally accepted standards of quality of children's mental health care and client mental health outcomes. Three customary performance guidelines (therapeutic relationship, satisfaction, and parent involvement) that are believed to be indicators of quality care were tested for their ability to account for improvement of mental health outcomes among adolescent clients. In addition, we examined service utilization to determine whether it represents an intermediate outcome of the treatment process.The results showed statistically significant, yet weak and inconsistent, relationships between these commonly accepted measures of quality and client outcomes among adolescents receiving outpatient treatment. We did not find service utilization to be a mediator.Limitations of the study and implications of the results are discussed.

Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review.

“…When converted to Z scores, the unweighted effect size was .25 and the weighted effect size was .21. The sample in the study by Noser and Bickman (2000) was almost equal to the total sample of the other 22 studies combined, thereby resulting in undue influence. Removing this study from the calculation resulted in an unweighted effect size of .26.…”

“…The mean sample size was 82.22 clients (SD ϭ 146.66). However, this mean sample size was inflated because of one study (Noser & Bickman, 2000) that had a sample size of 731. A more accurate representation of the typical sample size was the median of 47.…”

Working Alliance in Adolescent Outpatient Therapy: Youth, Parent and Therapist Reports and Associations with Therapy Outcomes

“…First, in a sample of adolescents receiving outpatient therapy as usual, Noser and Bickman (2000) examined youth-therapist alliance and found significant associations between alliance and therapist and interviewer reports of improved youth functioning, and between alliance and parent reports of improved youth symptom severity (youth-therapist alliance was unrelated to youth report of symptom severity; parent-therapist alliance was not assessed). More recently, Hawley and Weisz (2005) examined outcome associations with both parent-therapist and youth-therapist alliances in a sample of children and adolescents receiving outpatient therapy as usual; they found significant associations between parent-therapist alliance and attendance and persistence in therapy, and between youth-therapist alliance and symptom improvement (youth-therapist alliance was unrelated to attendance and persistence; parent-therapist alliance was unrelated to symptoms).…”

The Service Provider and Medication Usage Grids: A New Method to Measure “Treatment as Usual” (TAU)

“…The framework for development of the Grids was that by assessing the basic details of treatment in addition to the families' qualitative experience with the services and medication, the Grids would collect process and outcome information that could be used to understand the overall quality of services received by families (Noser and Bickman 2000). It was also hoped that the collection of both process and outcome treatment information would make this instrument applicable in both research and clinical settings.…”