(PS9-5) Analyzing Treatment Duration: Average Time Spent on Treatment Targets in a System of Care for Youth

Improving youth mental health outcomes is a critical and longstanding national priority within the public health system. The diversity of challenges in community mental health settings necessitates flexible treatment elements beyond those outlined by traditional diagnostic frameworks like the DSM codes (Chorpita et al., 2005). However, research highlights a significant gap in our understanding of treatment duration across service settings, from complex outpatient to controlled inpatient environments, with studies reporting varied timeframes for significant improvement (e.g., 27.3 days, Swadi & Bobier, 2005; 16.6 weeks, Green et al., 2007). Even less is understood about how long therapists spend on specific treatment targets (e.g., Aggression). A deeper understanding of these dynamics could enable more strategic resource allocation, such as targeted therapist training, ultimately enhancing treatment efficacy and mental health outcomes. Therefore, we will examine the typical duration with which therapists address youth treatment targets in a public mental health system. Our first aim is to compare treatment length by problem area. Secondly, following the literature’s suggestion (e.g., Lahey et al., 2004; Milette-Winfree & Mueller, 2017) and the 2023 Child & Adolescent Mental Health Division (CAMHD) codebook, we will analyze differences in treatment target lengths across groupings of problem areas, namely internalizing, externalizing, positive behaviors, and other targets. We analyzed therapists' session notes in electronic health records, which included treatment targets for each client session-by-session. The duration of a treatment target episode begins with its first mention in therapist notes and concludes with its last mention within the treatment episode. The study used data from 2,032 youth, involving 2,976 treatment episodes, who were treated by CAMHD of Hawaii's Department of Health from April 1, 2019, to May 7, 2023. The average participant age was 13.7 years; 47% were female. Results varied significantly, ranging from the lowest amount of time (1.0 weeks) spent on targeting the issue of fire setting to the most time spent addressing Positive Family Functioning (22.9 weeks), Depressed Mood (20.7 weeks), and Anxiety (20.6 weeks). Oppositional/Non-Compliant Behavior (20.3 weeks) and Traumatic Stress (19.1 weeks) also ranged in the top five treatment targets. This study is significant for two key reasons. First, this local aggregated data enhances clinical practices, policy decisions, resource allocation and improves treatment quality for youth in Hawai’i's public health system. For example, efforts could focus on improving the time spent on treatment engagement (17.28 weeks) or amplifying support for the treatment targets that are endorsed for long periods (e.g., depressed mood). In contrast, the result may suggest allocating more time to areas that need extended focus, such as the gender identity target, which averages 2.23 weeks but often requires longer durations due to the complex nature of gender identity development in youth. Second, the most persistent treatment targets fall outside of DSM codes, aligning with calls to examine youth issues and support needs beyond the psychopathology paradigm.