Effectiveness of nonresidential specialty mental health services for children and adolescents in the "real world"

Objective: Although many studies demonstrate the efficacy of a variety of treatments for child and adolescent psychiatric disorders, studies showing the effectiveness of such treatments in ordinary clinical settings have not been forthcoming. This report presents a study of the effectiveness of outpatient treatment in a community sample of 9- to 16-year-olds. Method: Four annual waves of data were collected from representative sample of 1,422 children and their parents in the southeastern United States. Interviews were conducted with the Child and Adolescent Psychiatric Assessment to determine clinical status and the Child and Adolescent Impact Assessment to measure the impact of psychiatric disorder on the lives of the children's families. Results: Treated individuals were more severely disturbed and showed deterioration in their clinical status, even before they received treatment. indicating that comparisons with untreated individuals required controls not only for pretreatment clinical status, but for pretreatment clinical trajectory. A significant dose-response relationship was found between the number of specialty mental health treatment sessions received and improvement in symptoms at follow-up. However, no effect of treatment on secondary psychosocial impairment or parental impact was identified. Conclusions: Child and adolescent outpatient psychiatric treatment has positive effects on psychiatric symptoms, even when conducted outside the academic units where efficacy research usually takes place. The dose of treatment required to produce such effects (more than 8 sessions) suggests that attempts to limit child psychiatric treatment to very short-term interventions may be counterproductive.