Abstract
Little is known about rates and patterns of compliance with state policies aimed at improving the quality of mental health services youth receive in community settings. This study examined compliance with clinical practice guidelines that recommended service packages developed by the State of Texas to support an evidence-based practice policy. Under the policy, clinics were allowed to override the recommended service package, in recognition that following the practice guidelines would not always be feasible. To examine the implications of these overrides, medical records were extracted for 727 child and adolescent clients who received mental health treatment at one of 4 community mental health clinics in one Texas County. Compliance was defined as providing the recommended service package, whereas “overrides” occurred when clinics did not provide the recommended service package. Patterns of compliance were examined by breaking compliance down into two components: the level of service intensity provided and the treatment received for the youth’s specific diagnosis/problem type. Forty-six percent of youths (n = 328) received services that complied with the mental health policy guidelines. Overrides based on level of intensity occurred more frequently than overrides based on problem type. Almost all youth received treatment consistent with their diagnosis/problem type, but not all youth received the recommended level of service intensity, most often receiving less intensive services. Youth with depression and severe mental illness were more likely to receive more intensive services. Older youth and those with worse functioning at intake were more likely to receive less intensive services. On average, youth improved in problem severity and functioning regardless of compliance, but those who received less intensive services showed less improvement. Findings point to the importance of measuring and tracking compliance to state policy guidelines.