Methods: Merged archival administrative data from the Ohio Mental Health Consumer Outcomes System and the Multi-Agency Community Services Information System were used to study the characteristics of clients who received outpatient mental health services in Ohio. Children and adolescents who met the following criteria were included in the analyses: (1) ages 5 to 18, (2) presence of a primary diagnosis, (3) completion of the Ohio Scales at baseline and T2 to measure problem severity, functioning, quality of services, and coping mechanisms in the fiscal year 2004-2009, and (4) various service utilization frequencies between the two time points. Among the total sample of 875 clients, 340 were new to treatment and 535 were involved in treatment for one or more months at baseline. Mixed factorial analysis of variance was conducted to investigate the patterns of changes in problem severity and functioning for new or ongoing users over time. With the two groups, hierarchical multiple regression was performed separately to assess the unique and relative contributions of service quantity and quality, and coping mechanisms on the outcomes of problem severity and functioning.
Results: Participants were 58% African American; 52% male; with a mean age of 13.2 years (SD=2.1). More than half (61%) were diagnosed with an externalizing disorder (e.g., ADHD). On average, participants used 2.3 (SD=1.2) different types of services (e.g., counseling) for 17.6 (SD=22.9) visits, at 1.2 (SD=0.6) different agencies over 3 months. Mixed factorial ANOVAs revealed that there was a significant interaction between the new vs. ongoing status and the problem severity (F(1,873)=11.42, p=.001) as well as functioning (F(1,873)=3.825 , p=.05) across the times. New users showed higher problem severity at baseline than at T2, and low scores on functioning at baseline but higher at T2 as compared to ongoing users who did not show such a dramatic difference between T1 and T2. For problem severity coping is the predictor for new users while service quality and coping are predictors for ongoing users. Regarding functional outcomes, gender, diagnosis, number of providers, and coping are the predictors for the new users, and coping is the predictor for the ongoing users.
Conclusions/Implications: Findings suggest the need for employing different treatment approaches for new users versus ongoing users of mental health services. Coping mechanisms were a significant predictor in all participants' mental health outcomes. Patterns of outcomes change over time, however, and the predictor of the outcomes varied by service utilization. Considering service utilization is critical to ensure that new users and ongoing users receive proper assessment, stabilization, and treatment.