Youth Functioning As a Predictor for Positive Outcomes: How Item-Based Latent Class Membership Predicts Youth Outcomes at Discharge from Psychiatric Residential Treatment

Background & Purpose:

Outcome research for youth admitted to psychiatric residential treatment facilities (PRTF) is limited and typically focuses primarily on PRTF youth as a single group or by diagnostic subgroup.  This study seeks to understand who benefits most in PRTF with the broader goal of ensuring healthy development for this particularly vulnerable population.  This study examines whether latent classes based on youth functioning responses at admission exist among PRTF youth, and determine whether class membership predicts outcome achievement at discharge.

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. Analysis was conducted in three steps. First, Latent Class Analysis (LCA) was applied to define the latent class variable identifying subgroups of youth with particular patterns across baseline youth functioning characteristics (N = 877). Next, youth were classified into their most likely baseline class based on the posterior probabilities retained from the LCA model. Finally, the differential impact of class membership on total problem severity and problem severity change at discharge was estimated (N = 767). The 20-item baseline Ohio Scales Youth Functioning Subscale served as class indicators and the 20-item Ohio Scales Problem Severity subscale served as the outcome variables of interest. 

Results:

Analyses revealed a statistically supported two-class solution (BIC = 47,697.86; Entropy = .91). Final class counts and proportions for the latent classes based on the estimated model were: Class 1: N = 314.05, .36; Class 2: N = 562.95, .64. The response patterns across the Functioning items were consistent across classes, with higher response levels in one class. Conceptually these classes were characterized as High Perceived Strength (Class 1) and Low Perceived Strength (Class 2). High average posterior probabilities for both latent classes suggest low classification error. Differential outcomes were also observed between groups. Problem Severity scores at discharge were significantly higher for Class 2 (b = 4.49, p < .001), but membership in Class 2 also predicted a larger problem severity change score (b = 7.85, p < .001).

Conclusion & Implications:

This analysis aims to parse the PRTF population to determine whether it is comprised of differential classes to better understand the unique needs of youth and to inform PRTF services to promote their healthy development.  Findings suggest that these youth in PRTF are clustered in two classes that predict problem severity outcome achievement with one group having higher problems but making greater gains at discharge.  This study identifies clinical, programmatic, and policy concerns to be addressed.  Class-dependent identification of risks to youth at admission may guide individualized treatment planning and identification of unique groups of youth in PRTF can inform the development of treatment protocols to target these distinct classes to improve outcomes.  Finally, these class characteristics help us to understand the population most suited to PRTF services on the mental health service continuum.