Predicting Treatment Outcomes With Caregiver-youth Discrepancy Reporting Patterns In A Multiethnic Public Mental Health Sample

Abstract

Multi-informant reporting has long been recommended as one of several best practices for assessing youth psychopathology. In children’s mental health, this approach includes gathering information from the youth as well as others in their ecology. Gathering information from multiple perspectives yields benefits through broadening available data and examining cross-informant reporting patterns that might affect assessment findings and treatment recommendations. However, for many decades it has been acknowledged that in both clinical and research settings, informants often provide diverging perspectives when reporting about youth emotional and behavioral concerns. These diverging perspectives have been studied extensively and are commonly referred to in the literature as “informant discrepancies” (or low cross-informant rater agreement). More recently, researchers have found that such discrepancies at treatment intake have been linked to poor youth outcomes and responses to intervention. In line with this area of work, the current study examined the relation between caregiver-youth informant discrepancies at treatment intake and youth functional impairment at discharge using a multiethnic public mental health sample of 366 caregiver-youth dyads. Prior to investigating the current study’s major aim, preliminary confirmatory factor analyses involving the Ohio Scales Problem Severity domain was conducted to inform subsequent analytic strategies. These confirmatory factor analysis results suggested utilizing both the Total Scale and Subscale (i.e., Externalizing, Delinquency, Anxiety, and Depression) scores of the Problem Severity domain for my major aim, which was to examine the extent to which caregiver-youth discrepancy scores at intake into a mental health system predicted youth functional impairment at treatment discharge. Overall, while there were slightly mixed findings across Total Scale and Subscale scores, results generally supported an association between increased levels of youth functional impairment at treatment discharge with both (a) high levels of caregiver-youth agreement (i.e., high caregiver and high youth Problem Severity domain scores) and (b) higher caregiver-reports of problem severity compared to their respective youth at intake. The present findings contribute to the current literature by utilizing the latest statistical approach recommendations for research in this area, incorporating measurement schemes that include identical item content across reporter versions, and including an ethnically-diverse public mental health sample of youths and their caregivers. Implications and suggestions for future research are discussed.