Functional Improvement over Time in Behavioral Health Treatment for Children in out-of-Home Care: Sociodemographic Differences

Background and Purpose

Children in out-of-home care (OOHC) experience significant amounts of trauma with resultant behavioral health needs (e.g., Casanueva et al., 2011). The literature has called for implementation of standardized screening, assessment and decision-support processes to identify those needs, and to track progress in treatment over time (e.g., Conradi et al., 2011; He et al., 2015). This study reports on results of statewide implementation of such processes and will focus on the use of the Child and Adolescent Needs and Strengths (CANS) decision support tool (Lyons, 2009) for youth in OOHC who are referred to behavioral health providers for assessment, treatment, and the periodic re-administration of the CANS every 90 days to assess progress. The purpose of the study was to explore factors which predict the extent to which youth demonstrate improvement in functioning while in treatment.

Methods

The study included 6,104 youth in OOHC between 2016-2022 in one state. Scores for each of the six CANS domains (Risk Behaviors, Strengths, Life Functioning, Behavioral/Emotional Needs, Cultural Factors, Caregiver Needs and Resources) were assessed over one year (5 timepoints). Higher scores indicated worse functioning. we used separate latent growth curve models to examine associations between sociodemographic factors (age, binary gender, race/ethnicity, length in OOHC) and CANS domain trajectories.

Results

Across all six piece-wise trajectories, on average scores decreased between time 1 and time 3 (0-6 months). Scores stabilized between time 3 and time 5 (6-12 months) for all domains except Caregiver Needs and Resources. Those scores continued to decrease. All sociodemographic factors predicted the latent intercept (initial level) and/or slopes (rate of change between T1-T3 and T3-T5). Males, older youth, and youth with longer stays in OOHC had higher initial levels of Risk Behaviors, Strengths, Life Functioning, and Behavioral/Emotional Needs. Black youth had higher initial levels of Risk Behaviors and Cultural Factors; bi-/multi-racial youth had higher initial levels of Risk Behaviors, Life Functioning, Behavioral/Emotional Needs, and Cultural Factors. In contrast, Hispanic youth had lower initial levels compared to White youth in all domains except Cultural Factors. Males’ and older youths’ scores decreased at a faster rate between T1-T3 in Life Functioning, Behavioral/Emotional Needs, Risk Behaviors, and Strengths. Older youths’ scores on Strengths then decreased at a slower rate between T3-T5. Although generally race/ethnicity did not predict the rate of change between T1-T3, Black and Hispanic youths’ scores decreased at a faster rate than White youths’ scores between T3-T5 in Strengths, Life Functioning, Behavioral/Emotional Needs, and Caregiver Needs.

Conclusions and Implications

This study contributes to our understanding of how the trajectory of improvement in functioning for youth over the course of time in treatment varies for some children based on their sociodemographic characteristics and the status of their functioning at the time of entering treatment. This has important implications in terms of behavioral health clinician practice. Understanding these trajectories should contribute to child welfare and behavioral health provider treatment and case planning. The use of standardized measurement to track improvement is an important step to evidence-informed behavioral health treatment.