Parent and Family Outcomes of Community-based Mental Health Treatment for Adolescents
Although youth mental health providers often target a broad range of youth, family, and contextual concerns, outcome measurement has typically been limited to youth symptoms and functioning. Parent and family outcomes have been assessed in several controlled child psychotherapy trials, but in few adolescent trials, particularly among adolescents receiving "real-world" community-based care. This study addresses this gap by examining parent and family outcomes in 170 families of male and female adolescents (ages 11 to 18) receiving publicly-funded outpatient mental health treatment in San Diego County. Associations between adolescent, parent, and family outcomes are examined, as well as treatment characteristics that predict outcomes. High levels of parent and family problems were observed at both youth treatment entry and 6-month follow-up. For example, 60% of parents' intake CES-D scores reflected depression symptoms in the clinical range, improving to only 51% at follow-up. Significant improvements were observed in caregiver strain and parent-reported family relationship quality, but not in parental depression, perceived social support, or adolescent-reported family relationship quality. Parent and family changes were correlated with adolescent changes, with the strongest association between reduction of adolescent externalizing problems and reductions in parental strain and depression. Therapist endorsement of family systems theoretical orientation predicted greater reduction of parental strain. Better parent-therapist alliance was associated with better parental depression, strain and family relationship outcomes. Other treatment characteristics (number of sessions, type of treatment goals, parental expectations) did not predict parent or family outcomes. These findings evidence the high level of distress among parents and families of adolescents receiving community-based mental health treatment and indicate that significant but moderate improvements in family contextual concerns occur during the course of youth treatment. Increased attention to family concerns may be critical for improving the effectiveness of "real world" youth mental health treatment, in order to create more stable family environments in which youths' therapeutic gains can be fostered and maintained.