title: Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services.
abstract: Service comparison is a policy priority but is not without controversy. This paper aims to investigate the amount of service-level variation in outcomes in child mental health, whether it differed when examining outcomes unadjusted vs. adjusted for expected change over time, and which patient-level characteristics were associated with the difference observed between services. Multilevel regressions were used on N = 3256 young people (53% male, mean age 11.33 years) from 13 child mental health services. Outcome was measured using the parent-reported Strengths and Difficulties Questionnaire. The results showed there was 4-5% service-level variation in outcomes. Findings were broadly consistent across unadjusted vs. adjusted outcomes. Young people with autism or infrequent case characteristics (e.g., substance misuse) had greater risk of poor outcomes. Comparison of services with high proportions of young people with autism or infrequent case characteristics requiring specialist input needs particular caution as these young people may be at greater risk of poor outcomes.
authors.affiliation: Evidence Based Practice Unit, Anna Freud Centre, UCL, 21 Maresfield Gardens, London, NW3 5SU, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Edbrooke-Childs
authors.affiliation: Evidence Based Practice Unit, Anna Freud Centre, UCL, 21 Maresfield Gardens, London, NW3 5SU, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Macdougall
authors.affiliation: Evidence Based Practice Unit, Anna Freud Centre, UCL, 21 Maresfield Gardens, London, NW3 5SU, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Child Outcomes Research Consortium, Anna Freud Centre, UCL, London, UK.
authors.forename: Jenna
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Evidence Based Practice Unit, Anna Freud Centre, UCL, 21 Maresfield Gardens, London, NW3 5SU, UK. EBPU@annafreud.org.
authors.forename: Miranda
authors.initials: M
authors.lastname: Wolpert
authors.affiliation: Evidence Based Practice Unit, Anna Freud Centre, UCL, 21 Maresfield Gardens, London, NW3 5SU, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Deighton
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D016896:Treatment Outcome
keywords: Added value score; Adolescent mental health; Risk adjustment; Service-level variation; Treatment outcome