Psychology Ph.D. Dissertations

Who benefits from usual care? Using latent profile analysis to identify differential treatment outcomes

Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Psychology/Clinical

First Advisor

Carolyn Tompsett (Advisor)

Second Advisor

Raymond Swisher (Other)

Third Advisor

Eric Dubow (Committee Member)

Fourth Advisor

Russell Matthews (Committee Member)

Abstract

As more treatments are developed to address youth behavioral and emotional problems, an increasing number of studies seek to identify subgroups of youth for whom treatments are more effective. Previous research has shown differential treatment effects when grouping youth based on characteristics such as comorbidity, problem severity, gender, and age. However, the vast majority of this research has been conducted with evidence-based treatments (EBTs), and to date no research has directly examined differential treatment outcomes within usual care. Usual care receives minimal attention in research, and thus little is known about its effects. Additionally, the term usual care can include a variety of services including but not limited to standard outpatient, intensive outpatient, home-based services, and psychiatric services. Given the prevalence of usual care as a form of treatment, it is necessary to further explore its treatment effects. Further, the vast majority of studies exploring differential treatment outcomes use moderation as the primary method for subgroup analyses. However, moderation analyses have several limitations, and there has been a recent call for more person-centered approaches, such as latent profile analysis (LPA), as a more appropriate means of conducting subgroup analyses. The current study aims to advance the understanding of usual care by determining if some subgroups of youth, identified through LPA, are better served by specific types of usual care.

The current study utilized 953 parent-reports and 553 youth-reports of youth emotional and behavioral symptoms across multiple time points, as well as archival records of usual care services received at a local community mental health center (CMH). Symptoms and demographic data collected at intake were used in a LPA to identify subgroups of youth arriving for treatment. Subgroup differences in treatment outcomes were then explored across the array of usual care services. Results indicated that usual care services were related to a significant reduction in symptom severity across time, and that there were differences in the relation between usual care services and outcomes across subgroups. These results suggest that different subgroups of youth respond differently to certain types of usual care services. Implications for future research and clinical applications are discussed.

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