Predictors of treatment success

Sometimes major problems in the treatment of children and adolescents in youth mental health care may arise. Treatments may be terminated prematurely, families may not show up and guidelines are often not followed up. Treatments within youth mental health care can only be effective if the treatment program is fully completed.
In addition, often there is insufficient response to treatments in children and adolescents with behavioral or emotional problems. Here, an important question is which client factors do play a role. To date, there is little systematic knowledge about which general factors may hamper or foster successful treatment outcome. In this study, we focused on factors within the family, the parents, the child and his/her environment. By focusing on factors that may be reversible or influenceable, for example before or during treatment, better conditions for treatment can be created. More knowledge about these so-called 'contextual factors' may help clinicians in the treatment of their clients.

With this research study we wanted to gain insight into contextual factors in the succesful treatment of children and adolescents. A large number of factors were assessed regarding the family (eg, family functioning), the parents (eg, expectations and treatment motivation, parenting skills, parents' health), the child (eg, perceived quality of life, character traits of the child) and the environment (eg, social support, stressful circumstances). In our research, we focused on a reduction in the problem severity during the treatment trajectory of newly referred families within Accare and Karacter within the first year after clinical referral.
 

Our study included 521 families taking part in a three-wave survey over a period of about 1 year on the influence of child, family and environmental factors on response to treatment in an outpatient child and adolescent mental health clinic (both Accare and Karakter). Newly referred parents and children 8 years and older filled in a broad set of online questionnaires at baseline before the start of treatment, and after 6 and 12 months. 

It is no longer possible to participate in this study, data are currently being analyzed. Please find some important results below. 

• Main findings Study 1: Predictors of treatment success

An important result of this research study is that stress and the social network of both the parents and the child play an important role in the success of a treatment. In addition, it appears that children who have received help in the past often have more serious problems. Of all children, they benefit most from treatment. This also applies to children with learning disabilities and children who have difficulty controlling emotions. At a family level it appears that  a higher motivation among the parents to participate in the treatment and better parenting skills contribute to a better treatment result.  

• Main findings Study 2: Factors related to parental pre-treatment motivation 

For a treatment to succeed it is important that parents are sufficiently motivated to participate in treatment and that they are willing to change their own behavior. In this study, we looked at factors related to parental motivation prior to starting treatment. We found that the younger the child and the more serious the problems, the more motivated the parents were regarding treatment. Remarkably, the parents’ motivation was higher in children with feelings of anxiety and depression than in children with aggression or other behavioral problems. Regarding parental factors, parents with a higher degree of "self-effectiveness" (confidence in themselves to overcome problems) were more motivated.
Interestingly, parents had less motivation prior to treatment if they had not taken the initiative to seek help themselves, but when this was suggested through school or other institutions or healthcare providers. Also, families with financial problems were less motivated to receive treatment and be involved; the motivation was independent of the level of education or income. Since parents’ readiness to participate in treatment and motivation to bring about change are essential in facilitating successful treatment, health professionals should pay particular attention to these individual and contextual factors early during clinical counselling. 

• Main findings Study 3: Factors related to perceived public and affiliate stigma in parents of children and adolescents in outpatient mental healthcare

Stigma is of increasing concern in child mental healthcare as it may affect help-seeking behavior and the child’s treatment process. We found that a multitude of factors within the family, parents and child were related to how parents experienced stigma. Two types of stigma may be distinguished that parents may experience. First, public stigma, which refers to perceptions of the parent regarding stereotypical beliefs held by the larger public about mental illnesses or help-seeking behavior. Second, affiliate stigma, which refers to stereotypical attitudes or negative believes of the parent of a child that belongs to a stigmatized group and who turns these feelings against oneself, inducing feelings of shame, embarrassment, or belittlement. 
Parents experienced the most public stigma if their child showed more severe levels of callous-unemotional traits. The same was true in children having anxiety/depression. Further, parents who consumed mental healthcare services for their own problems in the past also experienced higher public stigma. Parents’ perceived public stigma was also higher in families who lived in neglected neighborhoods. In turn, parents experienced less public stigma if they experienced higher social support and were living in more tight-knit social structures (such as belonging to a religious denomination, or having a social network in which a child's parent knows the parents of the child's friends). Finally, parents who had a greater parenting competence experienced lower levels of public and affiliative stigma. It is important to be aware in clinical practice who does experience stigma and why, and help families to experience less stigmatization. 

From our studies it has become clear that developing better parenting skills in the child’s parents may be beneficial in a number of ways, relating to better treatment outcomes, playing a role in parental motivation before the start of treatment, and in reducing feelings of stigmatization during the child’s treatment trajectory. 

This research study involves collaboration between Accare and Karakter Child and Adolescent Psychiatry.