Problem Severity and Youth Functioning: How Initial Item Response Predicts Youth Outcomes at Discharge from Psychiatric Residential Treatment

Background:

Outcome research for youth admitted to psychiatric residential treatment facilities (PRTF) is limited and inconsistent, typically focusing on youth collectively or distinguishing youth by diagnosis, which limits the ability to use findings to tailor services that meet individualized need and preserves a diagnostic rather than strengths focus.  To support the goal of a good and healthy start for this particularly vulnerable population, this study seeks to capture the unique characteristics of youth in PRTF that serve as predictors for positive change by examining youth problem severity and strengths-based functioning attributes at admission.

Methods: This study uses administrative data from an outcome-based reporting system on all youth admitted to PRTF statewide.  Data was collected from youth at admission and discharge between January 2014 and April 2015 using The Ohio Youth Problem, Functioning, and Satisfaction Scales, Short Form.  Multiple regression analyses using MPlus were conducted to evaluate the predictive quality of twenty problem severity items at admission on levels of change in youth functioning at discharge (n=716) and the predictive quality of twenty youth functioning items on levels of change in problem severity (n=685). 

Results:

Analyses revealed that particular items measured at admission were effective predictors of level of change at discharge.  Among the twenty problem severity items, regression results indicate an overall model of six items (getting into fights, can’t seem to sit still, having too much energy, refusing to do things teachers or parents ask, lying, and feeling sad or depressed) that significantly predicted youth functioning change, R²= .189, p<.001.  The analysis of twenty youth functioning items yielded five items (getting along with family, completing household chores, feeling good about self, thinking clearly and making good decisions, learning skills that will be useful for future jobs) that significantly predicted change in problem severity levels, R²= .203, p<.001.

Implications:

This analysis is the first step of a larger research project intended to meet the AASWSW Grand Challenge of ensuring all youth are given a good and healthy start by identifying characteristics among individual and clusters of youth that may function as strengths to promote improved outcomes in PRTF.  Findings suggest that youth attributes at admission may contribute to positive changes in problem levels and functioning during treatment.  Although the importance of personal attributes may be intuitive, collecting this information from youth at admission is important not only in guiding treatment planning but also in evaluating whether and how services leverage child strengths to promote change.

 In addition to the unique attributes of youth that promote positive clinical change, this study identifies further clinical, programmatic, and policy concerns to be addressed by the project including: identification of risks to youth lacking particular  strengths or characteristics; how programs can best target these important characteristics; and how these characteristics can be of value in defining service programs.  As knowledge develops about who benefits most from PRTF services, the child mental health community to residential treatment continuum can be further clarified, achieving services that are more targeted and appropriate.