Identifying Youth Problem Profiles and Predicting Remission Following Mental Health Treatment.

This study utilized latent profile analysis to categorize youth served by a public mental health setting into homogenous classes. Then, associations between class membership and meeting clinical criteria by the latest assessment were examined. Caregiver responses to the Ohio Scales, Short Form, Problem Severity Scale for 1090 youth completed at entry into this public mental health system were subjected to latent profile analysis. This method classifies youth into categories based on mental health problem profiles, in order to determine the degree to which these groupings are related to later mental health outcomes. The classification of youth cases that emerged was then used to predict clinical remission at or nearest end of treatment, including final Ohio Scales Problem Severity scores and a measure of day-to-day functioning, the Child and Adolescent Functional Assessment Scale (CAFAS). A four-class model was identified as best representing the data, reflecting a relatively low-risk class (63.3% of the sample), an internalizing class (23.2%), a delinquency class (8.8%), and a high-risk class (4.7%). Individuals in the internalizing and high-risk classes had lower likelihoods of achieving problem remission than those in the low-risk and delinquency classes at the time of their last completed Ohio Scales. Additionally, youth assigned to the delinquency and high-risk classes had lower likelihoods of reaching functional impairment remission than those in the internalizing and low-risk classes. Youth membership in a class based on initial problem scores can be utilized to predict clinical remission over the course of treatment in public mental health care. Such class-based predictions support other methods of predicting outcomes and can be used by clinicians to develop more informed treatment plans and to adjust treatment based on such classifications.

A History of Child and Adolescent Treatment Through a Distillation Lens: Looking Back to Move Forward.

Youth psychosocial treatments have proliferated over many decades and the time is ripe to examine the unique contribution of these treatments. Six hundred eighty-nine randomized clinical trials were examined from the PracticeWise Evidence-Based Services Database, an ongoing data source of youth psychosocial literature. A number of studies, treatment protocols, and practice elements across 11 youth problem areas (e.g., anxiety) from 1966 to 2016 are provided. Using distillation methodology, we compared the relationship between new treatment protocols and the identification of new practice elements within each problem area over time. Anxiety, disruptive behavior, attention/hyperactivity, and depression were the most studied problem areas, whereas suicide, eating disorders, and mania were least studied. While identification of new practice elements leveled off, studies continued to increase over time. For some problem areas, unique practice elements have not been identified for over a decade. Future studies examining treatment innovation and implications for behavioral health are discussed.

Insights in Public Health: The Help Your Keiki Website: Increasing Youth and Caregiver Awareness of Youth Psychosocial Mental Health Treatment.

Increasing evidence-based practice (EBP) use in community mental health is a national priority, especially given that one in five youth will suffer from mental health concerns before adulthood. Implementation science offers a unique lens for understanding EBP use that identifies barriers and facilitators of successful adoption. Consumer engagement is often overlooked as an EBP implementation strategy. In this article, we describe the State of Hawai'i Child and Adolescent Mental Health Division's innovative effort to target consumer EBP demand via the Help Your Keiki Website. Feedback from community stakeholders and website analytics converge to suggest that the most helpful content is related to finding help, normalizing concerns, and questions to ask therapists. Future outreach efforts as well as ongoing improvement and enhancement of the website are discussed.

Factor Analysis of Therapist-Identified Treatment Targets in Community-Based Children's Mental Health.

The present study used exploratory and confirmatory factor analyses to identify underlying latent factors affecting variation in community therapists' endorsement of treatment targets. As part of a statewide practice management program, therapist completed monthly reports of treatment targets (up to 10 per month) for a sample of youth (n = 790) receiving intensive in-home therapy. Nearly 75 % of youth were diagnosed with multiple co-occurring disorders. Five factors emerged: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Using logistic regression, primary diagnosis predicted therapist selection of Disinhibition and Emotional Distress targets. Client age predicted endorsement of Societal Rules Evasion targets. Practice-to-research implications are discussed.

A Meta-Analysis of Personalized Treatment Goals in Psychotherapy: A Preliminary Report and Call for More Studies.

The aim of this study was to explore the hypothesis that psychotherapy has larger effect sizes for personalized treatment goals than for symptom checklists. We conducted a meta-analysis of clinical trials that measured treatment success both in terms of symptom checklists and personalized treatment goals. Our search of the literature yielded 12 studies that met our inclusion criteria. Effect sizes were substantially larger for personalized treatment goals (ES = .86, p < .0001) than for symptom checklists (ES = .32, p = .003). The magnitude of this difference was significant (p < .05). Our results suggest that psychotherapy is perhaps more effective in helping patients with individual goals than reducing scores on broad measures of symptoms. Estimates of the effectiveness of psychotherapy that are based on symptom checklists perhaps underestimate the true benefit of psychotherapy. We discuss the implications for research and clinical practice.

Validity of Clinician's Self-Reported Practice Elements on the Monthly Treatment and Progress Summary.

An increased demand for accountability in community mental health systems has resulted in a need for valid, reliable measures of therapeutic practice. The Monthly Treatment and Progress Summary (MTPS), developed through the Hawaii Child and Adolescent Mental Health Division, is a clinician-report measure that describes therapeutic practices, treatment targets, and progress ratings for each treatment case. The current study evaluated the validity of the therapeutic strategies reported on the MTPS by comparing coder- and clinician-reported use of practices. Using 47 audio recordings from 19 youths' therapy sessions, trained observers reliably coded 12 discrete practices. Four of the 12 practices were found to be valid according to clinician-coder agreement (intraclass correlations ≥0.60). The coding system was revised, utilizing extensiveness and experiential scales, and 100 % of practices were valid according to clinician-coder agreement. Practical use of the MTPS, implications for service systems, and future directions for research on the MTPS are discussed.

Community-based treatment for youth with co- and multimorbid disruptive behavior disorders.

Little is known about the types of psychotherapeutic practices delivered to youth with comorbid and multimorbid diagnoses in community settings. The present study, based on therapists' self-reported practices with 569 youth diagnosed with a disruptive behavior disorder (ODD or CD), examined whether specific therapeutic practice applications varied as a function of the number and type of comorbid disorders. While type of comorbid disorder (AD/HD or internalizing) did not predict therapists' practices, youth with more than two diagnoses (multimorbid) received treatment characterized by a more diverse set and a higher dosage of practices.

Hawai'i's multiethnic adolescent and young adult survivors of childhood cancer: are their health behavior risks similar to state and national samples?

Due to toxicities associated with their malignancies and treatments, adolescent and young adult survivors of childhood cancer (AYASCC) are at high risk for developing chronic diseases. This can be compounded by a greater prevalence of unhealthy behaviors relative to similarly aged non-cancer peers. Disparities in health behaviors have been noted for Black and Hispanic AYASCC, but data on Asian American (AA) or Native Hawaiian and Other Pacific Islander (NHOPI) minorities are lacking. The purpose of this study was to help bridge these information gaps by gathering data from Hawai'i AA and NHOPI AYSCC. Telephone surveys were used to collect health behavior data from survivors 13-24 years of age (N=64); 55% of the sample was female, 77% AA or NHOPI, 63% leukemia/lymphoma survivors, and 32% overweight/obese. These were compared to state/national survey data for similarly aged individuals (Youth Risk Behavior Surveillance System data for 13-17 year olds, and Behavioral Risk Factor Surveillance System data for 18-24 year olds). While Hawai'i AYASCC had significantly lower rates of tobacco/alcohol use, a higher proportion did not eat five fruits/vegetables a day (96%) compared to state (83%) and national (78%) samples (P < .001). Although many met age-specific physical activity recommendations, 44% of <18 year olds and 29% of ≥18 year olds still failed to meet national guidelines. Low intake of fruits/vegetables and suboptimal levels of physical activity place these vulnerable, ethnic minority cancer survivors at higher risk for chronic disease. These findings underscore the need to assess and advise survivors about their diet and exercise habits as part of post-treatment care.

Assessment of therapy practices in community treatment for children and adolescents.

OBJECTIVE: The Monthly Treatment and Progress Summary (MTPS) was developed to assess treatment techniques applied in clinical practice. This study examined the factor structure of the reported therapeutic practice elements on the MTPS and explored patterns in technique use based on client and therapist characteristics in a community mental health setting. METHODS: MTPS data from 278 lead therapists in Hawai'i's local system of care were extracted from the online state mental health information management system. Therapists' endorsements (yes-no) of each practice element were examined across 278 completed youth treatment episodes, and an exploratory factor analysis with varimax rotation was conducted on the categorical data set. RESULTS: Three factors emerged from the analyses: behavior management (behavioral interventions), coping and self-control (self-change practices), and family interventions (family supports). Treatment teams with licensed therapists reported higher use of coping and self-control practice elements, whereas teams with unlicensed therapists and paraprofessionals reported greater use of behavior management practice elements. Lead therapists reported that teams treating younger clients and those with attentional disorders were more likely to use behavior management practice elements, and teams treating youths with more severe impairment at intake utilized more behavior management and family intervention practice elements. CONCLUSIONS: Overall, the MTPS shows promise as a therapist report of practices. The finding that practice elements organized into theoretical patterns and were applied in expected ways suggests a thoughtful approach to usual care techniques. With the increased focus on health care reform and managed care, the MTPS can inform system monitoring, feedback, and improvement.