Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-05-2018 | Original Article

Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a Community Mental Health Setting

Authors: Daniel P. Wilkie, David C. Cicero, Charles W. Mueller

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 3/2018

Abstract

Monthly disruptive behavior treatment progress for 613 youth ages 7–18 receiving intensive in-home services was examined. Multilevel modeling indicated carrying a depressive mood diagnosis predicted less disruptive behavior progress compared to youth with only externalizing diagnoses. Paradoxically, more monthly focus on disruptive behavior treatment targets predicted lower concurrent progress ratings, while greater focus on depressive mood targets predicted greater disruptive behavior progress for youth with a depressive mood diagnosis. Findings held when other predictors of disruptive behavior progress were included as covariates, including episode length, youth age, and functional impairment. Treatment and research implications are discussed.

The disruptive behavior target predictor variable included all seven targets while the outcome progress rating criterion variable was based on only three of these targets (see justification earlier). To assure this choice did not affect results, all analyses were replicated using only the subset of three disruptive behavior targets as predictors with no change in results. Data available from author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., text rev.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC: Author.CrossRef

Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87.CrossRefPubMed

Baker-Ericzén, M. J., Hurlburt, M. S., Brookman-Frazee, L., Jenkins, M. M., & Hough, R. L. (2010). Comparing child, parent, and family characteristics in usual care and empirically supported treatment research samples for children with disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 18(2), 82–99.CrossRef

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. T. (2011). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.

Beauchaine, T. P., Hinshaw, S. P., & Pang, K. L. (2010). Comorbidity of attention-deficit/hyperactivity disorder and early-onset conduct disorder: biological, environmental, and developmental mechanisms. Clinical Psychology: Science and Practice, 17(4), 327–336.

Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005). Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73(3), 371–388.CrossRefPubMed

Bickman, L. (2000). The most dangerous and difficult question in mental health services research. Mental Health Services Research, 2(2), 71–72.CrossRef

Borntrager, C. F., Chorpita, B. E., Higa-McMillan, C., & Weisz, J. R. (2009). Provider attitudes toward evidence-based practices: Are the concerns with the evidence or with the manuals. Psychiatric Service, 60, 677–681.CrossRef

Boylan, K., Vaillancourt, T., & Szatmari, P. (2012). Linking oppositional behavior trajectories to the development of depressive symptoms in childhood. Child Psychiatry & Human Development, 43, 484–497.CrossRef

Burke, J. D., Hipwell, A. E., & Loeber, R. (2010). Dimensions of oppositional defiant disorder as predictors of depression and conduct disorder in preadolescent girls. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 484–492.

Burke, J. D., Loeber, R., Lahey, B. B., & Rathouz, P. J. (2005). Developmental transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry, 46(11), 1200–1210.CrossRefPubMed

Burke, J. D., Rowe, R., & Boylan, K. (2014). Functional outcomes of child and adolescent oppositional defiant disorder symptoms in young adult men. Journal of Child Psychology and Psychiatry, 55(3), 264–272.CrossRefPubMed

Child and Adolescent Mental Health Division, Hawai’i Department of Health Child and Adolescent Mental Health Division. (2005). Service provider monthly treatment and progress summary. Honolulu, HI: Hawaii Department of Health, Child and Adolescent Mental Health Division.

Child and Adolescent Mental Health Division, Hawai’i Department of Health Child and Adolescent Mental Health Division. (2008). Instructions and codebook for provider monthly treatment and progress summary. Honolulu, HI: Hawai’i Department of Health Child and Adolescent Mental Health Division.

Child and Adolescent Mental Health Division, Hawai’i Department of Health Child and Adolescent Mental Health Division. (2012). Child and adolescent mental health performance standards. Retrieved from http://health.hawaii.gov/camhd.

Copeland, W. E., Shanahan, L., Costello, E. J., & Angold, A. (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry, 66(7), 764–772.CrossRefPubMedPubMedCentral

Daleiden, E., Lee, J., & Tolman, R. (2004). Annual evaluation report: Fiscal year 2004. Honolulu, HI: Hawaii Department of Health.

Foster, E. M., & Jones, D. E. & The Conduct Problems Prevention Research Group. (2005). The high costs of aggression: Public expenditures resulting from conduct disorder. American Journal of Public Health, 95(10), 1767–1772.CrossRefPubMedPubMedCentral

Garland, A. F., Bickman, L., & Chorpita, B. F. (2010a). Change what? Identifying quality improvement targets by investigating usual mental health care. Administration and Policy in Mental Health and Mental Health Services Research, 37(1–2), 15–26.CrossRefPubMedPubMedCentral

Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., et al. (2010b). Mental health care for children with disruptive behavior problems: A view inside therapists’ offices. Psychiatric Services, 61(8), 788–795.CrossRefPubMedPubMedCentral

Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 409–418.CrossRef

Heck, R. H., Thomas, S. L., & Tabata, L. N. (2013). Multilevel and longitudinal modeling with IBM SPSS: Quantitative methodology series (2nd edn.). New York: Routledge.

Hinshaw, S. P., & Lee, S. S. (2003). Conduct and oppositional defiant disorders. In E. J. Mash & R. A. Barkley (Eds.), Child Psychopathology (pp. 144–198). New York: The Guilford Press.

Hodges, K. (2000). Child and Adolescent Functional Assessment Scale. Ypsilanti, MI: Eastern Michigan University.

Hodges, K., & Gust, J. (1995). Measures of impairment for children and adolescents. The Journal of Behavioral Health Services and Research, 22(4), 403–413.

Hodges, K., & Wong, M. M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale. Journal of child and Family Studies, 5(4), 445–467.CrossRef

Jackson, D. S., Keir, S. S., Sender, M., & Mueller, C. W. (2017). Reliable change and outcome trajectories across levels of care in a mental health system for youth. Administration and Policy in Mental Health and Mental Health Services Research, 44(1), 141–154.CrossRefPubMed

Jarrett, M., Siddiqui, S., Lochman, J., & Qu, L. (2014). Internalizing problems as a predictor of change in externalizing problems in at-risk youth. Journal of Clinical Child & Adolescent Psychology, 43(1), 27–35.CrossRef

Kazdin, A. E. (1997). Conduct disorder across the life-span. In S. S. Luthar, J. A. Burack, D. Cicchetti & J. R. Weisz (Eds.), Developmental psychopathology: Perspectives on adjustment, risk, and disorder (pp. 248–272). Cambridge: Cambridge University Press.

Kazdin, A. E. (2015). Treatment as usual and routine care in research and clinical practice. Clinical Psychology Review, 42, 168–178.CrossRefPubMed

Loeber, R., Burke, J. D., & Pardini, D. A. (2009). Development and etiology of disruptive and delinquent behavior. Annual Review of Clinical Psychology, 5, 291–310.CrossRefPubMed

Loeber, R., & Hay, D. (1997). Key issues in the development of aggression and violence from childhood to early adulthood. Annual Review of Psychology, 48, 371–410.CrossRefPubMed

Love, A. R., Mueller, C. W., Tolman, R. T., & Powell, A. K. (2014). Frequency, level, and rate of improvement for treatment targets in a children’s mental health community-based intensive in-home therapeutic setting. Administration and Policy in Mental Health and Mental Health Services Research, 41(4), 421–433.CrossRefPubMed

Love, A. R., Okado, I., Orimoto, T. E., & Mueller, C. W. (2016). Factor analysis of therapist-identified treatment targets in community-based children’s mental health. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-016-0770-1

Matro, A. T., Milette-Winfree, M., Wilkie, D. P., Jackson, D., Maesaka, T., & Mueller, C. W. (2017, November). Limited early progress predicts unsuccessful treatment discharge in public mental health services for youth. Poster to be presented at the 51st Annual Convention of the Association for Behavioral and Cognitive Therapies. San Diego, CA

Milette-Winfree, M., & Mueller, C. (2017). Treatment-as-usual therapy targets for comorbid youth disproportionately focus on externalizing problems. Psychological Services. https://doi.org/10.1037/ser0000162 PubMed

Moffitt, T. E., Caspi, A., Harrington, H., & Milne, B. J. (2002). Males on the life-course-persistent and adolescent-limited antisocial pathways: Follow-up at age 26 years. Development and Psychopathology, 14, 179–207.CrossRefPubMed

Mueller, C., Tolman, R., Higa-McMillan, C. K., & Daleiden, E. (2010). Longitudinal predictors of youth functional improvement in a public mental health system. Journal of Behavioral Health Services and Research, 37, 350–362.CrossRefPubMed

Nakamura, B. J., Daleiden, E. L., & Mueller, C. W. (2007). Validity of treatment target progress ratings as indicators of youth improvement. Journal of Child and Family Studies, 16(5), 729–741.CrossRef

Newcorn, J. H., & Halperin, J. M. (2000). Attention-deficit disorders with oppositionality and aggression. In. In T. E. Brown (Ed.), Attention-deficit disorders and comorbidities in children, adolescents, and adults (pp. 171–207). Washington, DC: American Psychiatric Press, Inc.

Nezu, A. M., & Nezu, C. M. (1993). Identifying and selecting target problems for clinical interventions: A problem-solving model. Psychological Assessment, 5(3), 254–263. https://doi.org/10.1037/1040-3590.5.3.254.CrossRef

Scott, S., Knapp, M., Henderson, J., & Maughan, B. (2001). Financial cost of social exclusion: Follow up study of antisocial children into adulthood. British Medical Journal, 323, 191–194.CrossRefPubMedPubMedCentral

Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.CrossRef

Stalk, H., Love, A., & Mueller, C. (2015). Age of conduct disorder onset and comorbid anxiety and depression. Journal of Forensic Psychiatry and Psychology, 26, 337–350.CrossRef

Stringaris, A. (2011). Irritability in children and adolescents: A challenge for DSM-5. European Child & Adolescent Psychiatry, 20, 61–66.CrossRef

Weisz, J. R., Donenberg, G. R., Han, S. S., & Kauneckis, D. (1995). Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity? Journal of Abnormal Child Psychology, 23(1), 83–106.CrossRefPubMed

Wilkie, D. P., Orimoto, T. E., Miyamoto, K. D., Stalk, H. L., & Mueller, C. W. (2016). Comorbidity of psychiatric disorders. In R. Levesque (Ed.), Encyclopedia of adolescence (2nd ed.). New York: Springer.

Title: Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a Community Mental Health Setting
Authors: Daniel P. Wilkie
David C. Cicero
Charles W. Mueller
Publication date: 01-05-2018
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 3/2018
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-017-0840-z

At a glance: The STEP trials

Springer Medicine

Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a Community Mental Health Setting

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2018

Qualitative Evaluation of a Peer Navigator Program for Latinos with Serious Mental Illness

Correction to: The Effect of a Change Agent on Use of Evidence-Based Mental Health Practices

What Makes Research Useful for Public School Educators?

Individualized Progress Measures Are More Acceptable to Clinicians Than Standardized Measures: Results of a National Survey

Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort

Exploring Provider Use of a Digital Implementation Support System for School Mental Health: A Pilot Study