Individual and provider effects on mental health outcomes in child welfare: A three level growth curve approach

Approaches for treating children and adolescents with emotional and behavioral disorders within their communities have been implemented in counties, cities, and states throughout the United States. The goal of this study was to model course of improvement for individuals enrolled in a statewide community treatment program. Five hundred and sixty three children and adolescents (mean = 11.6 years at time of initial contact) receiving community-based services from 26 different agencies throughout Illinois were evaluated using the Child and Adolescent Needs and Strengths (CANS) measure. Hierarchical linear modeling (HLM) was applied to three levels of data: time (months in care), child-level (clinical, demographic data), and provider agency; the problem behaviors factor score of the CANS served as the measure of outcome. The results indicated that months in care, time 1 problem behavior score, caregiver needs and strengths, youth strengths, and school problems predicted course of improvement at the child level. Results also indicated that agencies (level 3) differed in client problem behavior reduction; however, this effect was much smaller than has been observed in other populations. Implications for service organization and delivery are discussed.