Treatment - CBT
Macarena Kruger, B.S.
Postgraduate Associate
Yale University
New haven, Connecticut
Amber W. Childs, Ph.D.
Assistant Professor, Psychiatry
Yale University
New Haven, Connecticut
Sarah E. Barnes, Ph.D.
Assistant Professor in Psychiatry
Yale University
New Haven, Connecticut
Rates of mental health problems in youth have been exacerbated by COVID-19 and yet, treatment dropout rates are staggering for youth admitted to outpatient behavioral health services. However, few studies have examined treatment outcomes in intermediate care settings designed for more complex psychiatric presentations. This study examined patterns of treatment completion in an adolescent intensive outpatient program (IOP) to determine whether there were demographic differences in treatment outcome (i.e., insurance, documented sex, age, race/ethnicity), differences pre- and post-pandemic, and finally differences according to whether treatment occurred on telehealth or in-person. Medical records of 756 youth (Mage = 14.90, SD = 1.62) previously admitted to an adolescent psychiatric IOP between March 2016 and June 2021, were reviewed to document their treatment outcome. Most patients (n = 438, 57.9%) completed treatment. Of the remaining 42.1% (n = 318) who did not complete, 12.2% (n = 92) were psychiatrically hospitalized, 8.9% (n = 67) discharged due to excessive absences, 8.2% (n = 62) refused ongoing participation and withdrew, 6% (n = 45) were re-referred to alternate treatment, and 6.9% (n = 52) did not complete due to other reasons/barriers. Treatment completion rates were comparable across time periods, with 58.5% of patients completing treatment pre-pandemic and 56.2% completing treatment post-pandemic. Demographic predictors of treatment outcome were examined using chi-squared tests and multinomial logistic regressions. Patient’s insurance significantly predicted treatment outcome such that commercially insured youth were more likely to complete treatment as compared to any other category than Medicaid insured youth pre- and post-pandemic (χ2 (5) = 30.83, p < .001; χ2 (5) = 13.53, p = .02), and in-person services (χ2 (5) = 29.08, p < .001). On telehealth, commercially insured youth were only more likely to complete treatment than be referred for alternative treatment or drop out due to other/barriers than Medicaid insured youth (χ2 (5) = 15.31, p = .01). Race/ethnicity was only significant in the post-pandemic group, suggesting that patients identified as White, non-Hispanic were more likely than expected to drop out due to inpatient hospitalization (χ2 (25, N = 194) = 40.77, p = .02). For the whole sample, older patients were more likely to complete treatment and less likely to drop out due to hospitalizations and other/barriers compared with their younger counterparts (χ2 (5) = 11.90, p = .04). However, when the sample was analyzed pre-post pandemic and by treatment modality, age was not a significant predictor of treatment outcome. Patient’s documented sex predicted treatment outcome for the sample as a whole (χ2 (5) = 15.26, p = .01) and pre-pandemic (χ2 (5) = 15.04, p = .01) such that documented females were more likely to complete treatment and less likely to be referred to alternative treatment compared to documented males. However, documented sex did not predict treatment outcomes either for in-person or telehealth services. These results offer insight into patterns and demographic predictors of treatment outcome in a high acuity setting. Clinical implications of improving treatment completion will be discussed.