Predicting Youth and Young Adult Treatment Engagement in a Transdiagnostic Remote Intensive Outpatient Program: A Latent Profile Analysis (Preprint)

Abstract

The youth mental health crisis in the United States continues to worsen, and research shows poor treatment outcomes for youth in mental health care. Despite the rise in predictive and personalized treatment, there has been a lack of research conducted with youth. Due to the complex developmental milestones of these periods, there is a need to better understand initial clinical presentation and predictors of treatment engagement to more effectively identify and tailor beneficial treatments.

This quality improvement investigation sought to identify subgroups of clients attending remote intensive outpatient (IOP) treatment based on clinical acuity data at intake to determine the predictors of outcomes for clients who present in complex developmental periods and with co-occurring conditions. The identification of these subgroups was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted.

Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using five indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic predictors and treatment engagement outcomes.

Four profiles of clinical acuity emerged: a low acuity profile, characterized by minimal anxiety, depression, and self-harm, and three high acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm. Age, gender, transgender identity, and sexual orientation were significantly related to profile membership. Clients identifying as sexual and gender marginalized populations were more likely to be classified into high acuity profiles relative to the low acuity profile, while race was unrelated to profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low acuity and high acuity + low self-harm profiles attended an average of 4-5 fewer treatment sessions relative to youth in the high acuity + moderate self-harm and high acuity + high self-harm profiles, ꭓ2(3) = 27.65, P < .001. Individuals in the high acuity + low self-harm profile completed treatment at a significantly lower rate relative to the other two high acuity profiles, ꭓ2(3) = 13.41, P = .004. Finally, those in the high acuity + high self-harm profile were significantly less likely to disengage early relative to youth in all other profiles, ꭓ2(3) = 71.12, P < .001.

This investigation represents a novel application of distilling salient variables around which to proactively assign clients to clinical programming. Identifying subgroups that differentially engage in treatment is a critical first step towards personalizing treatment within complex populations.

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