(PS5-7) Beyond the Label: Examining the Relationship Between Treatment Targets and Diagnoses in a Youth Mental Health System of Care

Abstract Text: Community mental health exists at the intersection of science and service, requiring adaptation of the evidence base to real-world complexities. Within Hawaiʻi’s public youth mental health system, Treatment Targets (TTs) emerge through collaborative service planning to address the multifaceted needs of children and their families (Daleiden et al., 2004). Although related to diagnoses, TTs are conceptually distinct, and offer a more responsive framework for intervention. Love et al. (2014) demonstrated the alignment between TTs and psychiatric diagnoses using Monthly Treatment Progress Summary (MTPS) data reported by providers. However, the psychometric integrity of this approach remains unclear with regards to diagnoses and recently implemented session-by-session Direct Service Progress Notes (DSPNs). Understanding how TTs function is vital to optimizing individualized, evidence-based service delivery in diverse community settings. Toward this goal, the present study leveraged clinical data from Hawaiʻi’s Child and Adolescent Mental Health Division (CAMHD) to examine the relationship between TTs and diagnoses across five core domains of youth psychopathology: Anxiety, Trauma, Depressed Mood, Inattention, and Disruptive Behavior. Specifically, we aimed to describe the frequency of TTs endorsed for each diagnostic category and assess the convergence and divergence between diagnostic categories and corresponding TTs.

Among 1,296 youth (M_age = 13.0; SD = 3.6) receiving at least one treatment episode lasting six months or longer through CAMHD since 2020, the most commonly endorsed TT categories (i.e., endorsed at least once within a treatment episode) were Depressed Mood (843, 65.0%), Disruptive Behavior (774, 59.7%), and Trauma (757, 58.4%), while the most commonly endorsed diagnostic categories were Depressed Mood (473, 36.5%), Inattention (455, 35.1%), and Disruptive Behavior (342, 26.4%). Consistent with previous findings (Love et al., 2014), diagnostic categories aligned with their respective TTs (e.g., for Anxiety TTs and diagnoses, χ² (1, N = 1296) = 152.1, p < .001). Notably, an unexpected yet compelling pattern emerged—although youth with certain diagnoses exhibited greater endorsement of related TTs than youth without those diagnoses (e.g., Anxiety, Wilcoxon Rank-Sum; W = 558067.5, p < .001), they received more non-diagnostically related TTs than related TTs (e.g., Avoidance) over the course of treatment (e.g., Anxiety, Wilcoxon Signed Rank; n = 73, Z = -2.2, p < 0.05).

Beyond their psychometric implications, these findings portray a treatment landscape far richer and more dynamic than diagnoses alone might capture. While TTs can be reliably mapped onto diagnostic categories, community treatment often involves addressing TTs that reflect treatment interference issues (e.g., suicidality, truancy) in addition to diagnoses. Owing to space considerations, the findings above have focused solely on anxiety problems. Convergence and divergence between diagnoses and TTs as well as the most prevalent treatment interference TTs for the five core domains—Anxiety, Trauma, Depressed Mood, Inattention, and Disruptive Behavior—will be presented, along with their clinical implications.