Monitoring and Feedback Systems in Youth Outpatient Psychotherapy: Youth and Caregiver Use Across Two Studies

Abstract

Extant research suggests that providing mental health clinicians with routine feedback on their patients’ progress during therapy may improve therapy engagement and treatment outcomes. Monitoring and feedback systems (MFSs) have been employed as the primary mechanism for routinely collecting patient progress data and supplying clinicians with feedback. Existing studies have assessed the impact of giving therapists access to MFSs, but evidently no studies have focused on variations in patient participation in MFSs, even though the benefits may depend on level of patient participation. The current research was designed to investigate patient participation, focusing on three core research questions across two studies that differed in sample, study design, and MFS systems: (1) At what rate do youths and their caregivers participate in MFSs and what factors predict level of participation? (2) Are MFS participation rates associated with measures of treatment engagement? and (3) Are MFS participation rates associated with youth mental health treatment outcomes? In Study 1, clinically referred youths aged 8-16 and their caregivers were randomly assigned to receive usual care (UC) or a structured, modular treatment protocol (Modular Approach to Therapy for Children [MATCH]) in community mental health clinics. In Study 2, clinically referred youths aged 7-15 and their caregivers were randomly assigned to receive MATCH from clinicians who had two different levels of support for learning the protocol. Analyses were completed separately for Studies 1 and 2, and then repeated using the subsamples from Studies 1 and 2 that had been treated with MATCH. Findings indicated that youths typically showed lower levels of MFS participation than caregivers. Some evidence showed higher levels of MFS participation by families receiving MATCH than UC, by older than younger caregivers, and by families with more rather than fewer dependents, but these results were not consistent across all waves of analyses. In addition, evidence suggested that higher youth and caregiver participation rates may be associated with greater treatment satisfaction at the conclusion of treatment. Results were mixed whether youth participation rates were associated with youth-reported therapy outcomes at the conclusion of treatment. Some of the findings suggest potential benefits of MFS participation, but additional research is needed to determine which patterns are robust, and to support accurate interpretation.