Predicting Youth Improvement in Community-Based Residential Settings with Practices Derived from the Evidence-Base

Abstract

The scientific study of psychotherapy practices in treatment as usual helps to increase the understanding of which practices are associated with improvement rates. Recent researchers have begun investigating the use of practices derived from the evidence-based (PDEBs) to determine if their use predicts greater improvement. The current investigation had two aims for youth in community-based residential (CBR) settings: (a) conduct descriptive analyses on key youth and therapist variables, and (b) investigate the extent to which disruptive youth in the CBR setting improve based on therapists’ reported alignment with using PDEBs for older disruptive youth. This study included clinical data for 341 youth who were between the ages of 13 and 17 with one or more disruptive behavior treatment targets. Results from the analyses for the first aim indicated that both PDEBs and practices with minimal evidence support (PMESs) were used with youth in the CBR setting. Additionally, PDEB-use was related to youth without diagnoses of attention deficit/hyperactivity disorder or bipolar disorder and for therapists in the medical or substance abuse fields. Across the majority of these descriptive analyses, the results varied significantly across the provider agencies included in this study, suggesting different populations served by each provider agency. For the multilevel modeling analyses for the second aim of the study, results suggested that the proportionate use of PDEBs (i.e., PDEBs divided by all practice elements (PEs), averaged across the treatment episode) was not significant in predicting rate of improvement or final average progress rating. However, the average number of PDEBs and PMESs used per month were significant at p < 0.05 and p < 0.10, respectively, in predicting final average progress rating. Lower youth age at intake and longer length of treatment significantly predicted both final average progress rating and monthly rate of improvement. Finally, exploratory analyses regarding the extent to which individual PEs independently predicted improvement rates was examined, suggesting positive effects for some PEs but not others. Findings are discussed as they relate to the importance of exploring various definitions of PDEBuse, investigating the use of PMESs, and continuing the study of treatment outcomes for CBR youth.