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Measuring Outcomes of Care for Adolescents With Emotional and Behavioral Problems

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ABSTRACT

Objective

To validate the prototype Adolescent Treatment Outcomes Module (ATOM), examine its sensitivity to clinical change, and determine its feasibility for administration in routine clinical settings.

Method

A sample of 67 adolescents, aged 11 through 18, was selected from new patients at two inpatient and two outpatient mental health programs. Adolescents and parents completed the ATOM and validating instruments at intake, 1 week postintake, and again at 6 months.

Results

Nine self-report symptoms predicted positive diagnoses of oppositional defiant, conduct, anxiety, and depressive disorders on the basis of structured diagnoses, with sensitivities of 0.7 to 0.8. Test-retest correlations for outcome scales were largely excellent (>0.70). Scales that measured functioning at home, in school, and in the community were moderately correlated in the expected direction with global functioning. Decreases in symptom severity and functional impairment were generally associated with decreases in validating instruments. Administration time averaged 25 minutes for adolescents and 28 minutes for parents.

Conclusions

Both parents and adolescents readily completed the ATOM. Module scales demonstrated excellent reliability and good to fair concurrent validity. The ATOM was able to detect change and its absence.

Section snippets

Sample

Adolescents 11 through 18 years of age were recruited at intake from two inpatient and two outpatient mental health programs. Adolescents who were not mentally retarded (IQ > 70 as judged by the intake clinician) or psychotic were eligible to participate. Adolescents were ineligible if a parent or guardian who had regular contact with the adolescent during the prior 6 months was not available. At intake, clinicians asked parents for permission for research assistants to contact them. Each

Sample Characteristics

Of the 67 adolescents enrolled in the study, 40% were female; mean age was 13.9 (SD = 1.9). Twenty-eight percent were African American, 60% were white, 6% were Hispanic, and 6% were of other racial backgrounds. Medicaid paid for the care of 34%, 41% were covered by private insurance, 12% had no coverage, and 13% were covered under Title XX. Sixty-one percent were inpatients and 39% were outpatients. The median yearly family income for families participating in this study was $13,160, an amount

DISCUSSION

The prototype ATOM is a reasonably reliable and valid measure with modest sensitivity to change and low respondent burden. The ATOM measures multiple domains of outcomes by using complementary, brief scales that are internally consistent, stable over 7 days, and in general agreement with longer instruments. Compared with previously validated instruments, ATOM outcome measures show change in the expected direction over 6 months. In their prototype form, the parent and adolescent instruments took

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    This work was funded in part by NIMH grant R01 MH 57882 . The authors acknowledge the work of Connie Venhaus, who coordinated this study; Shelly Y. Lensing, who conducted the statistical analysis; and Emily Harris, who read an initial draft of the paper.

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