Differential effectiveness of group, individual, and conjoint treatments: An archival analysis of OQ-45 change trajectories.

OBJECTIVE: While empirically-supported treatment (EST) choices are continually expanding, choices regarding formats for delivery (individual only, group only, or conjoint [simultaneous individual & group]) are often determined by agency resources or clinician preference. Studies comparing individual and group formats have produced mixed results, while recent meta-analytic reviews support format equivalence. METHOD: We employed a multilevel model to test for outcome differences using the OQ-45 on an outpatient archival data set of clients receiving individual-only (n = 11,764), group-only (n = 152) or conjoint (n = 1557). RESULTS: Individual and group outcomes were equivalent with some analyses showing conjoint trailing. Moderators of change included initial distress, treatment duration, intra-group dependency, and format. CONCLUSIONS: Results support meta-analytic findings of format equivalence in a naturalistic setting for group and individual. Referral practices and future results are discussed.

Youth psychotherapy change trajectories and early warning system accuracy in a managed care setting.

OBJECTIVES: To examine change trajectories in routine outpatient mental health services for children and adolescents in a managed care setting, and to use these trajectories to test the accuracy of two variations of an early warning system designed to identify cases at risk for deterioration. METHOD: Multilevel modeling procedures were used to examine longitudinal Youth Outcome Questionnaire (YOQ) data for 16,091 youth aged 4-17 years (39% female, mean age 10.5) referred for treatment in a managed care system. RESULTS: Clients with more frequent YOQ administrations had slightly lower baselines and faster rates of change. Both the traditional and simplified versions of the early warning system demonstrated good accuracy in identifying clients who deteriorated, with a sensitivity of .63, specificity of .83, and hit rate of .81. CONCLUSIONS: Results provide further evidence that patient-focused early warning systems can accurately identify most youth who are at risk for negative outcomes in routine mental health services.

Predicting patient deterioration in youth mental health services: community mental health vs. managed care settings.

OBJECTIVE: To examine differences across a community mental health system and a private managed care system in the accuracy of a warning system designed to identify youth at risk for deterioration in mental health services. DESIGN: Longitudinal outcome data from the Youth Outcome Questionnaire (Y-OQ) were examined using multilevel modeling for 2,310 youth ages 4-17 who received outpatient treatment. RESULTS: The warning system correctly identified 69% of cases that ultimately ended in deterioration in the community mental health setting, compared to 61% in the managed care setting. The overall hit rate (overall accuracy in classifying cases as deteriorators/non-deteriorators) was the same in the two settings (75%). CONCLUSIONS: Results are consistent with previous research demonstrating that patient-focused warning systems can be reasonably accurate in identifying youth cases at risk for treatment failure.

Parenting self-efficacy as a predictor of child psychotherapy outcomes in usual care: a multi-dimensional approach.

Three theorized dimensions of perceived parenting self-efficacy (Parental Connection, Psychological Autonomy, and Behavioral Influence) were used to predict psychotherapy outcomes in 271 youth (age = 4-17 years, mean age = 10.4, 42% girls) receiving routine outpatient services in a community mental health setting. We used individual growth curve modeling to examine patterns of change in self-efficacy domains and corresponding changes in parent-reported child symptoms. Parenting self-efficacy scores at pre-treatment did not predict treatment outcomes. Parenting self-efficacy scores for Parental Connection and Psychological Autonomy increased over the course of therapy, and increases in parenting self-efficacy dimensions (particularly Psychological Autonomy) were significantly associated with improvements in child symptoms over the course of treatment. Parenting self-efficacy appears to merit further study as a candidate mechanism of therapeutic change in child mental health treatment.

Change trajectories for the Youth Outcome Questionnaire self-report: identifying youth at risk for treatment failure.

This study used longitudinal youth outcome data in routine mental health services to test a system for identifying cases at risk for treatment failure. Participants were 2,715 youth (M age = 14) served in outpatient managed care and community mental health settings. Change trajectories were developed using multilevel modeling of archival data. Expected change trajectories served as the basis for a warning system designed to identify cases at risk for treatment failure. Tests of the predictive accuracy of the warning system yielded moderately high sensitivity rates for both youth self-report and parent-report measures. Incorporating data from multiple sources (youth, parents, and others) yielded the highest sensitivity in identifying at-risk cases. Results emphasize the importance of using empirically derived methods for identifying youth at risk for negative outcomes in usual care.

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

OBJECTIVE: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. METHOD: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4-17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. RESULTS: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. CONCLUSIONS: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes.