Abstract

Patient-focused research methods have been used in adult mental health treatment to improve outcomes by tracking individual treatment response and comparing it with expected recovery patterns. One such approach has used rationally- and empirically-derived methods to analyze data from the OQ-45 and identify patients who are not responding as expected to treatment. Treatment is then adjusted, improving outcomes and lowering overall costs.

Similar but less extensive research has shown analogous methods can be used with children and adolescents. This would be particularly useful in residential treatment, which is an expensive and inadequately researched approach. This study used archival data gathered according to routine clinical procedures to compare the accuracy of a rationally-derived method (RDM) and an empirically-derived method (EDM) in predicting treatment failure on the basis of YOQ scores for 812 children and adolescents in residential treatment.

Both methods were found to predict treatment failure more accurately than would be expected by chance. Performance of the methods was roughly similar to the observations of previous OQ-45 and YOQ studies. The RDM generated more indiscriminate predictions of treatment failure, earlier in treatment, while the EDM was more selective in its predictions, which typically occurred slightly later in treatment. Overall, the EDM was most accurate, but it is recommended that joint use of the methods as a two-stage warning system be considered, as this would maximize the strengths and minimize the weaknesses of each method.

The use of data from YOQs completed by various respondents was also examined. Combined data from multiple respondents, such as parents, clinicians, and house counselors, generated outcome predictions that were just as accurate as those made using single-respondent data. For this sample, it was found that self-report YOQ data evaluated independently of other-report data also generated usefully accurate outcome predictions.

Finally, inclusion of participants with only 2 YOQs available for analysis was found to significantly inflate method accuracy. It is recommended that future studies use only participants with 3 or more YOQs. Omission of the final YOQ from the prediction pool may also be advisable, although this did not significantly alter method accuracy in the current study.

LLU Discipline

Clinical Psychology

Department

Clinical Psychology

School

Graduate Studies

First Advisor

David A. Vermeersch

Second Advisor

Adam L. Aréchiga

Third Advisor

Kendal Boyd

Fourth Advisor

John Okiishi

Fifth Advisor

Jason E. Owen

Degree Name

Doctor of Philosophy (PhD)

Year Degree Awarded

2009

Date (Title Page)

9-2009

Language

English

Library of Congress/MESH Subject Headings

Residential Treatment; Psychotherapy -- methods; Patient Participation -- psychology; Evidence-Based Practice; Treatment Failure; Data Collection; Comparative Study; Analysis of Variance; Empirical Research; Outcome and Process Assessment (Health Care)

Type

Dissertation

Page Count

xiii; 181

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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