(PS9-12) Multimorbidity in Public Mental Health Care: Longitudinal Analyses on the Timing of Addressing Youth Treatment Targets Suggest Prioritization of Non-diagnostic Issues

Research indicates that evidence-based treatments (EBTs) for mental health disorders are the gold standard of care (Chorpita et al., 2011). Despite this, the majority of EBTs were developed to treat a single diagnosis, but this is not typical among community-based mental health services (Love et al., 2013). These youth present complex, severe emotional disturbances (SED), possess higher rates of comorbidity, involvement in other service sectors (i.e., juvenile), and are more ethnically diverse than samples in EBT trials (Weisz et al., 2013). Therefore, relying on standardized EBT protocols within community-based samples may result in stagnant treatment outcomes due to a lack of clinical guidance on when, and how to address multiple areas of improvement, or treatment targets (TTs) (Bearman & Weisz, 2015). Little research explores the appropriate time sequence of addressing each TT throughout treatment among youth with multiple critical needs, particularly when non-diagnostic TTs are presented (i.e., attending to basic needs) (Wade et al., 2023). To understand the clinical patterns of TT prioritization, this study aims to explore the different time points that various TTs are addressed during treatment sessions among diverse, SED youth. 

The current sample of youth (N = 2,167) receive treatment through the Hawai‘i Department of Health, Child and Adolescent Mental Health Division (CAMHD) or through contracted providers of CAMHD between April of 2019 and July of 2023. The majority of youth identified as female (47%) and Native Hawaiian and/or Pacific Islander (57.7%) with the mean age being 13.7. TT data was collected by Direct Service Provider Notes, in an electronic health system, where therapists are asked to report the TTs used session-by-session with each client. Exploratory and descriptive analyses were utilized to analyze frequencies of specific TT use throughout treatment episodes. Specifically, all youth who had a specific TT endorsed (e.g., anxiety) at any time during a service episode were examined to determine whether there are patterns that exist in the timing of that TT within the episode. Findings indicate that life-threatening internalizing TTs, such as suicidality, and non-diagnostic TTs associated with delinquency (i.e., truancy) as well as functional skills (i.e., self-management) are addressed most frequently at the beginning of treatment. For example, for youth with School Refusal/Truancy targeted, during the first 20 weeks, an average of 34.6% of episodes targeted this every week, while an average of 14.6% of episodes targeted this during weeks 21-40, whereas for the TT of Anxiety, there was no substantial changes throughout the entire treatment course. The study highlights the critical needs of disadvantaged youth who receive treatment through various community-based settings and offers insight into the clinical decision-making process. The research may inform community-based partners in the need to implement preventative interventions that address these problem areas throughout multiple youth-serving public health service sectors (i.e., DOE). Future research should examine the differences in TT patterns by service type to further evaluate the critical needs among SED youth.