(PS3-74) Informant Discrepancies in the Treatment of Youth Internalizing Disorders: Implications for Clinical Outcomes and the Effect of Measurement Based Care

The integration of evidence based assessment practices in treatment has been shown to enhance clinical outcomes for youth. However, discrepancies in the views of key stakeholders (e.g., caregivers and youth themselves) on the presence, severity, and effects of youth psychopathology often make integrating assessment into clinical decision-making complicated. Theoretical models suggest that parent and youth informants report domain-relevant information on youth’s symptoms, treatment progress, and maintaining factors of mental health concerns which, when discrepant, must be accurately interpreted and incorporated into clinical decision-making in order to provide effective care. Indeed, prior work has shown that reporting discrepancies between parents and youth predict poorer treatment outcomes. An evidence-based practice that may support this integration is the use of measurement based care (MBC), which involves the routine collection, evaluation, and sharing of informant assessment data to monitor and support treatment progress. This study seeks to further understand the link between parent-youth informant discrepancies and treatment outcomes and how this relationship is moderated by engagement in and dosage of measurement based care.

Participants include 196 parent-youth dyads, with youth ages 12 to 18, recruited as part of a larger multi-site treatment effectiveness trial. Both sets of informants completed symptom ratings of youth anxiety, depression, and psychological functioning at the outset and throughout treatment (i.e., at 8-, 16-, and 28-week timepoints) to monitor progress. Youth were assessed for clinical severity, impairment, and improvement throughout treatment (i.e., at baseline, 16, and 28 weeks) via clinical interview with an independent evaluator. Two of the three treatment conditions incorporated MBC and clinicians’ reported on their MBC practices at each session, including whether or not they provided feedback on MBC data to youth and/or parent. Standardized difference scores, hierarchal modeling and polynomial regression will be used to examine the proposed models.

Preliminary results indicate that parents and youth were significantly congruent on all symptom measures across all timepoints, as measured by bivariate Pearson and intraclass correlations (p’s ≤ .01 for all measures). However, informants differed significantly in their anxiety symptom ratings at baseline (t(190) = 2.55, p = .01) and depressive symptom ratings at the 8-week timepoint (t(149) = 2.68, p = .01). On average, parents reported greater anxiety and depressive symptoms than youth at baseline. At all assessment timepoints post-treatment initiation, youth reported more anxiety and depressive symptoms and worse psychological functioning than parents. On average, for those in the MBC conditions, clinicians provided feedback on MBC data to youth and/or parents in 28.31% of sessions attended. Subsequent analyses will explore the relationship between baseline informant discrepancies and youth treatment outcomes, as well as the moderating effects of engagement in and dosage of MBC.