Outcome Trajectories for Adolescents in Residential Treatment: A Statewide Evaluation

Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.