(PS5-2) Advancing Our Understanding of Youth Community Mental Healthcare: A Factor Analysis of Therapist-identified Treatment Targets in a System of Care

Abstract Text: Understanding community care processes for identifying and selecting treatment targets is an essential and foundational step for enhancing the effectiveness youth mental health interventions in public service systems (Kelley et al., 2010; Weisz et al., 2006). A “treatment target” (TT) can be defined as “the strengths and needs being addressed as part of the mental health services for youth and family clients” (Hawaii Child and Adolescent Mental Health Division (CAMHD), 2019). Example TTs include Will Misconduct/Delinquency, Anxiety, Depressed Mood, Trauma, Attending to Basic Needs, and Academic Achievement (https://health.hawaii.gov/camhd/files/2023/08/TF-TT-PE-and-PR-Codebook-2019_10_24.pdf). Within the CAMHD system of care, therapists endorse one or more TTs (from a discrete list of 49 different options) as their focus area during therapeutic interactions with their youth client and families. Leveraging monthly summary reports of youth service records within the CAMHD system, Love et al. (2016) conducted exploratory and confirmatory factor analyses of TT patterns in large samples of public sector youth and families. Their results suggested that community care therapists tended to endorse TTs in a way that aligned with five treatment factors: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. The present study has two aims. First, we re-evaluate this five-factor structure with updated session-by-session TT data (rather than monthly summaries used in Love et al.’s (2016) original work) via confirmatory factor analysis (CFA). Second, we evaluate the internal consistency of the total scale and each factor. With a sample of 950 youth receiving intensive in-home therapy (mean age = 12.5, SD = 3.5; 49.7% female, 78.9% multiracial), CFA results provided mixed support for Love et al.’s original five-factor structure (CFI = .69; TLI = .64; RMSEA = .04; SRMR = .06), suggesting potential contextual or measurement differences between session-level and monthly reports. Factor loadings varied significantly (e.g., .002–.920), with some items showing weak relationships with their respective factors. Internal consistency was near acceptable levels (e.g., ωt_Overall = .6 for the total scale) compared to the conventional 0.7 standard (Stensen & Lydersen, 2022). Additionally, McDonald’s omega for each factor was suboptimal (i.e., ωt_{Disinhibition} = 0.5, ωt_{Societal Rules Evasion} = 0.36, ωt_{Social Engagement Deficits} = 0.38, ωt_{Emotional Distress} = 0.32, ωt_{Management of Biodevelopmental Outcomes} = 0.32). These findings are mostly incongruent with Love et al.’s previous work, which suggested that community youth mental health therapists address TTs along the five dimensions of Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Additional analyses (e.g., exploring other factor structures) and future research, such as exploring demographic and contextual influences (e.g., ethnicity, gender, treatment duration) on therapists’ target endorsement patterns, will be discussed.