Introducing a Measurement Feedback System for Youth Mental Health: Predictors and Impact of Implementation in a Communit
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ORIGINAL ARTICLE
Introducing a Measurement Feedback System for Youth Mental Health: Predictors and Impact of Implementation in a Community Agency Rafaella Sale1 · Sarah Kate Bearman1 · Rebecca Woo1 · Nichole Baker1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Measurement feedback systems (MFSs) that routinely collect and report client progress to mental health therapists have demonstrated beneficial impact on outcomes in numerous studies, with evidence that there is a dose–response relationship related to the implementation of the MFS. The current study examined the impact of MFS implementation (Implementation Index) on youth symptom outcomes separately by caregiver and youth self-report. Additionally, we tested the extent to which Implementation Index rates varied by individual therapists and clients, and whether therapist and client characteristics predicted MFS implementation. Methods: Administrative data (client charts, youth- and caregiver-reported Youth Outcome Questionnaires) for 229 youth (52.83% Latinx, 42.79% girls, M age = 10.33) treated during a 1-year period at a community mental health organization in Central Texas were analyzed using multi-level modeling. Caregiver-reported symptoms decreased faster for those with a higher MFS Implementation Index. Between-group differences among therapists accounted for a significant proportion of variance in the Implementation Index for caregiver report, whereas client differences accounted for most of the variance in the Implementation Index for youth self-report. Therapist trainee status predicted a significant increase in the Implementation Index for caregiver-report data. Youth symptom improvement as reported by caregivers varied with the extent of MFS implementation fidelity, and MFS implementation fidelity was higher for clients treated by trainees relative to staff therapists for caregiver report of symptoms. Keywords Measurement feedback system · Routine outcome monitoring · Youth mental health services · Implementation rate Approximately 26–37% of children meet criteria for one or more psychological disorders by adulthood, and 25% of children meet criteria for two psychological disorders at any given time (Costello et al. 2003, 2014; Merikangas et al. 2010). Psychotherapy is often recommended as the first line of treatment; however, approximately half of youth treated in community mental health settings do not improve and 15–24% worsen while in treatment (Cooper et al. 2013; Smith and Jensen-Doss 2017; Warren et al. 2010). Clinical judgment for detecting client worsening may be faulty, as therapists typically underestimate their clients’ clinical worsening and overestimate their improvement (Hatfield et al. 2010; Walfish et al. 2012). In contrast, actuarial methods * Rafaella Sale [email protected] 1
Department of Educational Psychology, The University of Texas At Austin, 504 SZB, 1 University Station, D5800, Austin, TX 78712‑0383, USA
such as those embedded within measurement feedback systems (MFSs) (Edbrooke-Chi
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