Relationship of Use of Evidence-Based Practice and Length of Stay to Treatment Outcomes at a Large Children, Youth, and Family Services Agency

Background/purpose: Children, youth, and family services represent a significant portion of the human services landscape in the United States and elsewhere. Such agencies provide a diverse range of behavioral health care and substance use counseling, in addition to more specialized services like wraparound and family therapies. Like other health and human service agencies, children, youth, and family service agencies have faced pressures to boost outcomes and embrace research supported treatment while funding has remained flat or even decreased. The purpose of this investigation was to explore the relationship between use of research supported treatments, length of stay, and treatment outcomes.

Methods: Data were drawn from an administrative data set (n=2063) provided to our research team by a large child and adolescent services agency with offices in urban, suburban, and rural areas. De-identified data included variables such length of stay and discharge status as well as whether or not research supported treatment was used during the course of the young person’s treatment. We created a dichotomous treatment outcome variable by recoding discharges to the same or higher level of care as unsuccessful and discharges to a lower level of care as successful.

We planned two analyses: the first was determine if the use of research supported treatment had an effect on length of stay with an ANOVA. The second was to determine if the use of research supported treatments increased the odds of successful discharge while controlling for length of stay with a logistic regression.  

Results: In the first analysis, the use of research supported treatment significantly decreased the length of stay (F(1, 1384) = 14.169, p < .001). In the second analysis, the use of research supported treatment increased the odds of successful discharge while controlling for length of stay (chi-square = 9.334, df = 2, p = .009). Young people who had been exposed to research supported treatment had increased odds of successful discharge (exp(B)=1.25, p =.043).

Conclusions/implications: The finding that use of research supported treatment was related to shorter length of stay was unexpected. However, it can be explained by the fact that research supported treatment results in positive change and a quicker discharge from a program. Taken together, the results of this analysis indicate that research supported treatment in a child and adolescent service agency have the potential to both decrease length of stay and increase the likelihood of successful treatment. The effect size for increased odds of successful treatment is small, though the large sample size adds to the confidence with which this interpretation is made. Though costs related to treatment and length of stay were not available in this data set, it is reasonable to conclude that shorter length of stay would be associated with reduced costs to payers. This analysis justifies further investigation in to the potential for research supported treatment to simultaneously enhance outcomes and reduce costs by reducing length of stay. Research supported treatments hold promise in many dimensions for children, youth, and family service agencies.