'Usual Care' psychotherapy outcomes associated with therapist use of case management in the treatment of youths who have disruptive behavior problems

Children with disruptive behavior problems (DBPs) represent the majority of youth patients in community- based, usual care (UC) psychotherapy, and are at high risk for maladaptive adolescent and adult outcomes (Copeland et al., 2007; Earls, 1994a). Improved knowledge about effective treatments for this population is essential. Although there is movement towards implementing evidence- based practices (EBPs) into UC, there are numerous barriers. Among these is a lack of knowledge regarding psychotherapeutic processes in usual care. Researchers and practitioners suggest that case management (CM) is a widely-used, essential, and effective component of treatment for this population (Burns et al., 1996; Hoagwood et al., 2001; Garland et al., 2010). CM includes coordinating care with psychiatrists and school professionals, child protective services, and referring families to community-based resources (Ziguras & Stewart, 2000). The current study examines the association between intensity of therapist use of CM and six outcomes : (1) youth symptom severity, (2 &3) family functioning (parent and youth reports), (4) attendance, and (5 & 6) satisfaction (parent and youth reports). This study also examines potential moderator effects of therapist discipline and therapist experience on the relationship between CM and outcomes. Analyses were conducted using Hierarchical Linear Modeling (HLM) to account for the nested structure of the data. Results suggest that while there was no first-order effect of CM on outcomes, therapist (N=77) variables significantly moderated the relationships between CM and outcomes. For Social Workers and therapists with more experience, higher levels of CM intensity were associated with a greater decrease in youth symptomatology (N=165). For Psychologists, more intensive use of CM was associated with greater improved family functioning. This study suggests that CM can positively affect youth outcomes in the context of UC when utilized effectively. This study is a first step towards examining the role of CM in community-based psychotherapy, and its contribution to outcomes for youth with DBPs. Results also have implications for future efforts to implement EBPs in usual care psychotherap