Assessment of therapy practices in community treatment for children and adolescents.

OBJECTIVE: The Monthly Treatment and Progress Summary (MTPS) was developed to assess treatment techniques applied in clinical practice. This study examined the factor structure of the reported therapeutic practice elements on the MTPS and explored patterns in technique use based on client and therapist characteristics in a community mental health setting.
METHODS: MTPS data from 278 lead therapists in Hawai'i's local system of care were extracted from the online state mental health information management system. Therapists' endorsements (yes-no) of each practice element were examined across 278 completed youth treatment episodes, and an exploratory factor analysis with varimax rotation was conducted on the categorical data set.
RESULTS: Three factors emerged from the analyses: behavior management (behavioral interventions), coping and self-control (self-change practices), and family interventions (family supports). Treatment teams with licensed therapists reported higher use of coping and self-control practice elements, whereas teams with unlicensed therapists and paraprofessionals reported greater use of behavior management practice elements. Lead therapists reported that teams treating younger clients and those with attentional disorders were more likely to use behavior management practice elements, and teams treating youths with more severe impairment at intake utilized more behavior management and family intervention practice elements.
CONCLUSIONS: Overall, the MTPS shows promise as a therapist report of practices. The finding that practice elements organized into theoretical patterns and were applied in expected ways suggests a thoughtful approach to usual care techniques. With the increased focus on health care reform and managed care, the MTPS can inform system monitoring, feedback, and improvement.