Abstract
Outcome data collection systems provide the opportunity for comparing agencies, programs, and therapists. However, the political stakes of comparisons raise important issues regarding their perceived validity. The goal of case-mix adjustment is to eliminate potential biasing factors that might render comparisons as inappropriate or irrelevant. In this paper, case-mix adjustment variables are identified using regression analysis followed by developing models of case mix adjustment using a sample of youth participants in the Ohio Mental Health Consumer Outcomes System. Results indicate that certain client level variables do predict outcomes. The total variance accounted for by variables other than baseline ratings of the outcome measure was small. When comparing agencies using adjusted and unadjusted models, some agencies did vary relative to other agencies. As with previous studies, however, the rank order of agencies was largely unchanged and the correlation between adjusted and unadjusted outcomes among agencies was significant.
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Banks, S., Pandiani, J., & Bramley, J. (2001). Approaches to risk-adjusting outcome measures applied to criminal justice involvement after community service. Journal of Behavioral Health Services & Research, 28, 235–246. doi:10.1007/BF02287241.
DeLiberty, R., Newman, F. L., & Ward, E. O. (2001). Risk adjustment in the hoosier assurance plan: Impact on providers. Journal of Behavioral Health Services & Research, 28, 301–318. doi:10.1007/BF02287246.
Dow, M., Boaz, T., & Thornton, D. (2001). Risk adjustment of Florida mental health outcomes data: Concepts, methods, and results. Journal of Behavioral Health Services & Research, 28, 258–272. doi:10.1007/BF02287243.
Elliott, M. N., Swartz, R., Adams, J., Spritzer, K. L., & Hays, R. D. (2001). Case-mix adjustment of the national CAHPS Benchmarking Data 1.0: A violation of model assumptions? Health Services Research, 36, 555–573.
Hawkins, R. P., Almeida, M. C., Fabry, B., & Reitz, A. L. (1992). A scale to measure restrictiveness of living environments for troubled children and youths. Hospital and Community Psychiatry, 43, 54–58.
Hendryx, M. S., Dyck, D. G., & Srebnik, D. (1999). Risk-adjustment outcome models for public mental health outpatient programs. Health Services Research, 34, 171–195.
Hendryx, M., Beigel, A., & Doucette, A. (2001). Introduction: Risk adjustment issues in mental health services. Journal of Behavioral Health Services & Research, 28, 225–234. doi:10.1007/BF02287240.
Iezzoni, L. I. (1994). Using risk-adjusted outcomes to assess clinical practice—An overview of issues pertaining to risk adjustment. Annals of Thoracic Surgery, 58, 1822–1826.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. doi:10.1037/0022-006X.59.1.12.
Jayson, D., Wood, A., Kroll, L., Fraser, J., & Harrington, R. (1998). Which depressed patients respond to cognitive-behavioral treatment? Journal of the American Academy of Child and Adolescent Psychiatry, 37, 35–39. doi:10.1097/00004583-199801000-00014.
Kazdin, A. E., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28, 160–172. doi:10.1207/s15374424jccp2802_4.
Kolko, D. J. (1992). Short-term follow-up of child psychiatric hospitalization: Clinical description, predictors, and correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 719–727. doi:10.1097/00004583-199207000-00021.
Kramer, T. L., Evans, R. B., Landes, R., Mancino, M., Booth, B. M., & Smith, R. G. (2001). Comparing outcomes of routine care for depression: The dilemma of case-mix adjustment. Journal of Behavioral Health Services & Research, 28, 287–300. doi:10.1007/BF02287245.
Lambert, M. J. (2001). Psychotherapy outcome and quality improvement: Introduction to the special section on patient-focused research. Journal of Consulting and Clinical Psychology, 69(2), 147–149. doi:10.1037/0022-006X.69.2.147.
Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lamber (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 139–193). New York, NY: Wiley, Inc.
Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D. A., Nielsen, S. L., & Hawkins, E. J. (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11(1), 49–68.
Ogles, B. M., Dowell, K., Hatfield, D., Melendez, G., & Carlston, D. (2004). The Ohio sc`ales. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (3rd ed.). Hillsdale, New Jersey: Lawrence Earlbaum.
Ogles, B. M., Lambert, M. J., & Masters, K. S. (1996). Assessing outcome in clinical practice. Boston: Allyn and Bacon.
Ogles, B. M., Lunnen, K. M., & Bonesteel, K. (2001a). Clinical significance: History, application, and current practice. Clinical Psychology Review, 21, 421–446.
Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (2000). The Ohio youth problems, functioning, and satisfaction scales: Technical manual. Columbus, OH: Ohio Department of Mental Health.
Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (2001b). The Ohio Scales: Practical outcome assessment. Journal of Child and Family Studies, 10, 199–212. doi:10.1023/A:1016651508801.
Pfeiffer, S. I., & Strzelecki, S. C. (1990). Inpatient psychiatric treatment of children and adolescents: A review of outcome studies. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 847–853. doi:10.1097/00004583-199011000-00001.
Phillips, S. D., Kramer, T. L., Compton, S. N., Burns, B. J., & Robbins, J. M. (2003). Case-mix adjustment of adolescent mental health treatment outcomes. Journal of Behavioral Health Services & Research, 30, 125–136. doi:10.1007/BF02287818.
Salem-Schatz, S., Moore, G., Rucker, M., & Pearson, S. D. (1994). The case for case-mix adjustment in practice profiling. When good apples look bad. Journal of the American Medical Association, 272, 871–874. doi:10.1001/jama.272.11.871.
Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197. doi:10.1176/appi.ps.52.9.1190.
Southam-Gerow, M. A., Kendall, P. C., & Weersing, V. R. (2001). Examining outcome variability: Correlates of treatment response in a child and adolescent anxiety clinic. Journal of Clinical Child Psychology, 30, 422–436. doi:10.1207/S15374424JCCP3003_13.
Turchik, J., Karpenkov, V. V., & Ogles, B. M. (2007). Further evidence of the utility and validity of a measure of outcome for children and adolescents. Journal of Emotional and Behavioral Disorders, 15, 119–128.
Webster-Stratton, C. (1985). Predictors of treatment outcome in parent training for conduct disordered children. Behavior Therapy, 16, 223–243. doi:10.1016/S0005-7894(85)80048-4.
Yeh, M., Takeuchi, D. T., & Sue, S. (1994). Asian-American children treated in the mental health system: A comparison of parallel and mainstream outpatient service centers. Journal of Clinical Child Psychology, 23, 5–12. doi:10.1207/s15374424jccp2301_2.
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This project was supported by a grant from the Ohio Department of Mental Health, Office of Program Evaluation and Research.
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Ogles, B.M., Carlson, B., Hatfield, D. et al. Models of Case Mix Adjustment for Ohio Mental Health Consumer Outcomes Among Children and Adolescents. Adm Policy Ment Health 35, 295–304 (2008). https://doi.org/10.1007/s10488-008-0171-1
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DOI: https://doi.org/10.1007/s10488-008-0171-1