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Authors:Holmes, Kalyn L.
Contributors:Mueller, Charles W. (advisor)
Psychology (department)
Keywords:Clinical psychology
Child and adolescent mental health
Community-based mental health care
Multisystemic Therapy
Treatment focus diffusion
show 1 moreTreatment targets
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Date Issued:2020
Publisher:University of Hawai'i at Manoa
Abstract:Evidence based treatment protocols tend to describe therapies that are focused on a limited number of problem areas. Recent evidence from well-controlled efficacy studies supports this approach, with findings that diffusing treatment focus across multiple problem areas is associated with less clinical progress. In contrast, therapists in community-based public mental health care settings often focus on multiple different treatment targets, likely in an attempt to address the multiple areas of impairment often seen in youth receiving such services. Whether implemented evidence-based services are characterized by less treatment focus diffusion (the extent of focusing on multiple individual issues during the course of treatment) than less structured community care is unknown. It is also unknown whether treatment focus diffusion is associated with more or less treatment progress in community care. It was hypothesized that a more structured evidence-based treatment format implemented in a community care setting would demonstrate less treatment focus diffusion than that seen in a less structured format. It was less clear if a narrower or broader scope of treatment predicts clinical progress in community care, and if this relationship varies depending on whether community care is delivered through an implemented evidence-based service or a less structured service format.
Using routine clinical data from a statewide child and adolescent system of care, this study examined the differences in treatment focus diffusion (as defined as the average number of distinct treatment targets per month that were addressed during the first five months of treatment) between (a) Multisystemic Therapy-Hawai‘i (MST-H; n = 911 youths, 109 clinicians), an implemented evidence-based treatment, and (b) a less structured, but also intensive in-home (IIH) community care service that is more characteristic of what is often referred to as treatment as usual or usual care (n = 2362 youth, 457 clinicians). Additionally, the relationship between treatment focus diffusion and average therapeutic progress (as rated by therapists for each treatment target selected one or more times within the selected treatment episode) within and across these two service formats was examined.
As predicted, treatment focus diffusion occurred at a higher rate in the less structured service format when examined alone and while controlling for client and clinician covariates in a two-level multilevel model. When entered simultaneously into a three-level multilevel model, receiving services through the less structured service format and more diffused treatment focus predicted less clinical progress at month 5 and slower progress over the course of treatment. Significant interactions indicated different patterns across the two service formats. In separate models, higher treatment focus diffusion predicted less clinical progress between month 1 and 5 in both service formats but predicted lower average progress ratings at month 5 only in the more structured service format. Furthermore, effect sizes for treatment focus diffusion were notably larger in MST-H. Although these are correlational data, maintaining a narrower focus of treatment might be beneficial for youth receiving mental health treatment and particularly in more structured services implemented within community-based systems of care. Future research, including the use of other measures of client outcome and experimental manipulation of treatment focus level, would advance our understanding of how treatment focus diffusion relates to clinical progress and outcomes.
Pages/Duration:81 pages
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: M.A. - Psychology

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