Understanding Treatment Needs of Youth in a Remote Intensive Outpatient Program Through Solicited Journals: Quality Improvement Analysis

Abstract

Background Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. Objective The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. Methods Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. Results Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. Conclusions These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods.