Study
Glisson and colleagues (2013) conducted a randomized controlled trial to evaluate the effectiveness of the Availability, Responsiveness and Continuity (ARC) intervention for reducing problem behaviors for youth. Community based mental health programs were eligible if they employed three or more clinicians who provided mental health services to a target population under 25 years of age. Programs were excluded if they were 24-hour, locked-down facilities; provided only assessment and referral; or if their target population consisted of individuals with severe developmental disabilities or psychosis. Eighteen community mental health programs, serving economically disadvantaged adults, families, and youth in a range of settings across 17 counties in a southeastern state, were identified and agreed to participate in the study. The programs provided individual, group, and family therapy using various treatment models, medication management, and a range of additional services and activities focused on youth and families. Nine programs were randomly assigned to the ARC intervention group, and nine programs were assigned to the control group. The 18-month intervention was delivered between 2009 and 2011.
A total of 402 youth were recruited and agreed to participate in the study. The intervention group consisted of 244 youth, and the control group consisted of 158 youth. The higher number in the ARC condition resulted from the cluster randomization of youth by program and the higher number of youth entering care during the recruitment period for programs randomly assigned to ARC. The overall sample was 60 percent male, 76 percent white, 25 percent Black, and 3 percent Hispanic; all youth were between the ages of 5 and 18 (the average age was 12). Family incomes ranged between $0 and $5733, averaging $1492 per month. Youth received services for behavioral or emotional problems that might place them at risk for developing chronic mental health problems. Fifty percent of services targeted chronic and mental health problems, 26 percent of services targeted mental health problems in the juvenile justice system, and 8 percent of services targeted substance abuse problems. Services were provided by 154 participating clinicians who were predominantly white (83 percent) and female (73 percent), had an average age of 32, and 7 years of experience. However, the study authors did not specify if there were any statistically significant differences between the youth in the intervention and control groups at baseline.
The outcome of interest is youths’ problem behavior, assessed using the Shortform Assessment for Children (SAC). SAC measures a youth’s functioning in terms of internalizing behaviors (such as anxiety) and externalizing behaviors (such as aggression). Caregivers completed SAC at intake and at 1-month intervals for 6 months after intake. Caregivers for 393 participating youth completed baseline SAC measures, 352 completed two or more, 247 completed four or more, 206 completed five or more, and 171 completed all six. All available repeated measures for each youth were included in hierarchical liner models (HLM) analyses that estimated each youth’s trend in total problem behavior. The researchers did not conduct subgroup analyses.
Study
Glisson and colleagues (2016) conducted a randomized controlled trial to evaluate the effectiveness of a 3-year ARC intervention for reducing problem behaviors for youth. Fourteen outpatient community mental health agencies that serve youth in a major midwestern city were randomly assigned to ARC or control conditions. Programs in the control condition were matched to those in the intervention condition on staff size and budget. The selected agencies reflected characteristics of a national representative sample of mental health agencies that serve youth (Shoenwald et al. 2008). All agencies had one or more units with 15 or more staff who delivered treatment to youth. Agencies were excluded from the study if they had adopted any new treatment programs in the prior year, or if they were part of a federally funded mental health services research network. Participating agencies delivered a variety of mental health services, including pharmacotherapy, individual psychotherapy, family therapy, skills training, and therapeutic groups. Youth were recruited in two study phases of 24 months each. Phase I youth were recruited in the first 24 months of the ARC intervention. Phase II youth were recruited in the final stage (the last 12 months) of the intervention and the 12 months following the completion of the intervention.
The overall sample from both phases included 605 youth (and their caregivers), with 304 youth served by agencies in the ARC intervention and 301 youth served by control agencies that provided treatment as usual. The overall sample was 54 percent male, 65.8 percent white, 25.5 percent Black, and the average age was 11.94 years. There were no statistically significant differences between youth served by agencies in the ARC or control conditions in either phase on baseline measures of the outcome variable or demographic variables.
The outcome of interest, youths’ total problem behavior score was assessed using the Shortform Assessment for Children (SAC). HLM analyses were used to estimate each youth’s trend in total problem behavior scores. The researchers did not conduct subgroup analyses.