Predicting patient deterioration in youth mental health services: community mental health vs. managed care settings


  • The cases used in this study were drawn from the same archival database used in a related study: Warren, J.S., Nelson, P.L., Mondragon, S.A., Baldwin, S.A., & Burlingame, G.M. (2010). Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health Vs. Managed Care Settings. Journal of Consulting and Clinical Psychology, 78, 144–155.

    We express sincere appreciation to Catherine Carter, Dave Justice, and Mark Latkowski for their assistance in this research, particularly in providing administrative support and database management. This work would not be possible without their valued contributions.


Objective: To examine differences across a community mental health system and a private managed care system in the accuracy of a warning system designed to identify youth at risk for deterioration in mental health services. Design: Longitudinal outcome data from the Youth Outcome Questionnaire (Y-OQ) were examined using multilevel modeling for 2,310 youth ages 4–17 who received outpatient treatment. Results: The warning system correctly identified 69% of cases that ultimately ended in deterioration in the community mental health setting, compared to 61% in the managed care setting. The overall hit rate (overall accuracy in classifying cases as deteriorators/non-deteriorators) was the same in the two settings (75%). Conclusions: Results are consistent with previous research demonstrating that patient-focused warning systems can be reasonably accurate in identifying youth cases at risk for treatment failure. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–17, 2011.