Recent calls for the expansion of evidence-based practices for youth have stressed the need to incorporate assessment data on treatment response into everyday clinical care. Receiving frequent outcome data can help clinicians understand, during treatment, whether their clients are responding, whether and when mid-course changes in treatment strategy are needed, which changes are effective, and when treatment gains have been achieved and treatment can end. Extant research increasingly supports the beneficial effects of providing clinicians ongoing feedback on their adult clients'treatment response, but less is known about youth treatment. Among the few youth studies, none (to our knowledge) has evaluated the effects of providing treatment response feedback directly to youths and their caregivers. Also, no studies have solved the problem that, even when treatment monitoring and feedback systems have been made available, they have not been accessed and used frequently, perhaps because the systems are not sufficiently responsive to the needs of participants in youth mental health care. The proposed project will address these issues in the context of youth outpatient treatment by (a) using qualitative methods to obtain feedback from stakeholders (caregivers, youths, clinicians, clinic staff, and administrators) regarding desired features of a monitoring and feedback system for youth mental health care;(b) modifying an existing monitoring and feedback system, TRAC (Treatment Response Assessment for Children), in response to stakeholder feedback, piloting it in two outpatient clinics, and revising it further based on quantitative and qualitative assessments of its use and its utility;and (c) conducting a small-sample RCT with the revised TRAC. RCT participants will be randomized to one of four treatment conditions: 1. No system: TRAC will not be used;2. No feedback: Youth clients and their caregivers will enter their progress data into TRAC, but neither they nor their clinician will have access to the data;3. Clinician feedback: Youth clients and caregivers will enter data, and their clinicians will have access to the data;and 4. Clinician and consumer feedback: Youth clients and caregivers will enter their progress data, and they as well as their clinicians will have access to the data. Analyses will evaluate the feasibility of a larger trial testing the effects (on treatment process and outcome) of providing treatment response feedback to clinicians, caregivers, and youth.
These aims are consistent with the NIMH strategic plan, which emphasizes the importance of personalizing mental health care (Strategies 3.2 and 3.4).
Providing clinicians, caregivers and youths ongoing feedback on youth treatment response is a consumer- focused approach with the potential to improve the process and outcome of youth mental health care, if these important stakeholders will access and use feedback systems. This project seeks to increase the potential public health impact of treatment response feedback by partnering with clinicians, caregivers, youths, clinic staff, and clinic administrators to identify characteristics of feedback systems that make them appealing and useful. Once the stakeholder comments have been used to revise one existing feedback system, a small- sample randomized controlled trial will be used to assess the feasibility of a larger trial evaluating the potential clinical benefits of providing weekly feedback to clinicians, caregivers, and youths.
