(PS5-C62) Do Mental Health Treatment Plans Inform Youth Mental Health Treatment Sessions? Stability of Anxiety Target Focus over Time

Systems of care (SOC) are an integral part of providing public mental health services in the US. Within the context of children and their families enrolling for SOC treatment services with the State of Hawai’i, they sequentially progress through several treatment planning stages prior to therapy, including an intake assessment, resulting in treatment recommendations, and the establishment of a Mental Health Treatment Plan (MHTP) by a procured service provider. Previous research by Tsai et al. (2019) has demonstrated some continuity with regards to treatment targets and practice elements, between MHTPs and actual service delivery, suggesting that service planning can help organize care and provide structure from treatment planning to service delivery. Although their findings were important, Tsai et al. (2019) examined a wide array of treatment targets (e.g., depression, disruptive behavior, trauma, anxiety), and the current study builds upon their work by looking specifically into service continuity for the most common type of youth mental health problem, anxiety (Merikangas et al., 2010).

Clinical data was pulled from October 2018 to February 2023 for youth (N=193) ages 3 to 18 (37.82% male, 52.85% female, 6.74% transgender, 2.59% other/nondisclosed) who received services from the State of Hawai'i with at least one anxiety-based treatment target on their MHTP or first treatment session. Service continuity was examined through stability of three possible anxiety-related targets (e.g., Anxiety, Avoidance, Phobia/fears) coded as absent or present (i.e., each coded as 0 or 1, with a total possible sum of 3) on the youth’s latest MHTP and corresponding contiguous treatment session. Relative stability of treatment target identification across the MHTP and treatment session was desirable.

Four separate repeated measures ANOVAs with a Greenhouse-Geisser corrections were conducted in order to examine the extent to which anxiety-related treatment targets changed over time. ANOVA results revealed significant changes between MHTPs and treatment sessions for (a) the total number of anxiety-related treatment targets, (F(1.00, 192.00) = 67.32, p < .001), and the subordinate discrete treatment targets of (b) Anxiety (F(1.00, 192.00) = 37.81, p < .001) and (c) Avoidance (F(1.00, 192.00) = 30.64, p < .001). Endorsement rates of (d) Phobia/Fears targets did not differ significantly between MHTPs and treatment sessions (F(1.00, 192.00) = 0.00, p =1.00). Post hoc analyses with a Bonferroni adjustment revealed that (a) the total number of anxiety-related treatment targets (-.50 (95% CI, -.62 to -.43), p < .001), and subordinate (b) Anxiety targets (-.33 (95% CI, -.43 to -.22), p < .001), and (c) Avoidance targets (-.17 (95% CI, -.23 to -.11), p < .001) significantly decreased from the MHTP to the first treatment session.

Overall, these results indicate instability across treatment planning, and a decreasing focus on youth anxiety as treatment planning processes progress. Additional analyses, future research (e.g., identifying variables associated with increases or decreases in service planning stability), and clinical and service systems implications will be discussed.