Much of our current research and theory on child and adolescent mental health services and their outcomes is derived from controlled experiments, in which conditions may not fully represent services in clinics. To address this limitation, the project will focus on actual clinic treatment of children and adolescents (here, """"""""children"""""""") from three socioculturally diverse clinic settings employing 60 child therapists. 900 children, aged 8-15, will be assessed at the time of intake, with a combination of established clinical measures (e.g., diagnosis, problem behavior) and recently-developed, psychometrically sound measures of adjustment, cognition, and parent-child interaction. The measures will be repeated at 6 months, 1 year, and 2 years after intake, both for children who complete a course of therapy and those who drop out at intake. The resulting longitudinal data will be used to address two primary questions of theoretical and practical import, both growing out of earlier findings by the PI and colleagues: 1. Among youngsters referred for outpatient care, who stays for treatment and who drops out? Previous findings (e.g., Weisz, Weiss, & Langmeyer, 1987, 1989) may be questioned because no research has yet distinguished between three rather different forms of """"""""dropping out."""""""" The proposed project will do so; more definitive findings may result. 2. For youngsters who stay in treatment, does clinic-based therapy have beneficial effects? Although meta-analyses of controlled outcome studies (e.g., Weisz, Weiss, Alicke, & Klotz, 1987) suggest that the answer is yes; but a recent study of clinic-based child therapy (Weisz & Weiss, in press a) showed no therapy effect. Perhaps clinic-based therapy is less than optimum in its procedures and results; or perhaps the null findings of Weisz and Weiss (in press a) resulted from methodological limitations. To find out, the project will address those limitations and assess a broadened array of outcomes. Regardless of whether these analyses reveal overall effects of therapy, secondary analyses will follow up on previous findings (e.g., Poal & Weisz, in press; Weisz, 1986a) suggesting that child, family, therapist, or therapy factors may predict improvement. An immediate objective is to test specific theoretically- and empirically-derived hypotheses about child mental health care and its effects. A broad, long-term objective (of the project and the research program of which it is a part) is to complement our field's growing base of controlled experimental evidence with rigorous information on the process and outcomes of child mental health care in practicing clinics.
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