To evaluate treatment outcomes of individual patients based on clinician-rated instruments, the assessment of reliable and clinically significant change (RCSC) is essential. In heterogeneous... Show moreTo evaluate treatment outcomes of individual patients based on clinician-rated instruments, the assessment of reliable and clinically significant change (RCSC) is essential. In heterogeneous samples, RCSC underestimates treatment outcome. Therefore, the Reliable Change Index (RCI) was adjusted by a stratification into subsamples.This method was tested on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) ratings (n = 12,547) at admission and discharge of youths (age 6-18 years) treated in ten psychiatric institutions. Based on the test-retest reliability of a subsample (n = 397), the RCI was calculated for three severity groups ("very severe," "moderately severe," and "subclinical/mild"). Individuals who accomplished reliable change during treatment and moved to a subclinical score were classified as recovered.Using the traditional RCSC calculation, the large majority (75.1%) of the sample would be considered as unchanged, 2.9% as deteriorated, 18.9% as improved, and 3.1% as recovered. Using RCI cutoff points based on the severity ratings at admission results in a more representative distribution of outcome groups, where 54.6% of the sample was stable, 7.5% worsened, 21.6% improved, and 16.3% recovered.This methodological framework for calculating RCSC for heterogeneous populations is applicable for all HoNOS instruments, making it very useful for mental health professionals. Show less
The aim was to identify subgroups within an inpatient cohort (N=296) of youths (age 16-20 years) characterized by psychiatric disorders combined with severe disruptive behavior, based on the age... Show moreThe aim was to identify subgroups within an inpatient cohort (N=296) of youths (age 16-20 years) characterized by psychiatric disorders combined with severe disruptive behavior, based on the age of onset of their disruptive behavior. It was examined whether the distinction in early-onset (EO) disruptive behavior and adolescent-onset (AO) disruptive behavior was relevant in clinical practice for predicting severity of problems and treatment outcome. The subgroups were compared on proximal (i.e., dropout, and psychosocial functioning at discharge) and distal outcomes (i.e., social functioning 18 months after discharge). It was found that the distinction between EO and AO, together with the other predictors (i.e., cannabis use prior to treatment, male sex), was mainly relevant in the relation to dropout. Individuals with EO disruptive behavior had higher chance at dropout, however individuals with EO disruptive behavior who completed treatment reported similar outcome as those with AO disruptive behavior. Show less
