Clinically significant symptom change in adolescents receiving outpatient community mental health services: Does it relate to satisfaction, perceived change, therapeutic alliance, and improvement in presenting problems?
KARPENKO, VERONIKA, Ph.D. June 2010, Psychology Clinically Significant Symptom Change in Adolescents Receiving Outpatient Community Mental Health Services: Does it Relate to Satisfaction, Perceived Change, Therapeutic Alliance, and Improvement in Presenting Problems? (107 pp. Director of Dissertation: Julie Sarno Owens Treatment outcome is frequently measured by symptomatic change; however, changes in symptoms may not be as meaningful to clients as some other domains (Kazdin, 2001) Methodology has been developed to measure change that is meaningful to clients, and thus is clinically significant (CS; Ogles, Lunnen, Bonesteel, 2001) Interestingly, this methodology has been traditionally applied to measures of symptoms with an assumption that change in symptoms is meaningful to clients. It is important to know the extent to which change in symptoms corresponds with other measures that purportedly may be more meaningful to clients. The goal of this study was to examine in a diagnostically diverse sample of adolescents, receiving outpatient mental health services, the relation between adolescent rated CS symptom change and reduction in severity of primary target complaints, perceived change, satisfaction, and therapeutic alliance. Participants were 116 adolescents and their therapists from two community mental health centers. Findings revealed that on average, when all variables were rated by adolescents, CS symptom changers had significantly higher levels of perceived change, greater reduction in the severity of presenting problems, higher therapeutic alliance and satisfaction than non CS symptom changers. However, there were no differences between 4 CS symptom change groups when therapists rated the dependent variables. Individual level analyses showed that CS symptom changers were significantly more likely than non CS symptom changers to achieve Treatment Success on youth rated and one of the therapist rated Target Complaints (ranging from 63% to 79% perceived change (90% and report satisfaction with services (92% However, a sizable percentage of non CS symptom changers fell into Treatment Success group on Target Complaints (43% perceived change (73% and reported satisfaction (77% These results highlight that while symptom change corresponds with other outcome measures in group level analyses, individual analyses reveal that symptoms change alone is insufficient to define meaningful change. The findings of this study have implications for the role of adolescents in assessing treatment outcome, defining and measuring clinical significance of outcome, and recommendations for agencies in selecting outcome measures. Approved:_______________________________________________________________ Julie Sarno Owens Associate Professor of Psychology