Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational, School, and Counseling Psychology

First Advisor

Dr. Robert Jeffrey Reese


Objective: The purpose of this study was to evaluate the effectiveness of a public behavioral health (PBH) agency that had implemented continuous outcome feedback as a quality improvement strategy.

Method: I investigated the pre-post treatment outcomes of 4,389 ethnically diverse youths (6 to 17 years old) at or under the poverty line participating in treatment (from January 2008 to March 2014) for a broad range of primary diagnoses including depression and anxiety disorders (23%); adjustment disorders (27%); Attention Deficit/Hyperactivity Disorder (13%), various V-codes (18%); bipolar disorders (3%); and substance use disorders (2%). I also investigated the treatment outcomes for a subset of youth (N = 469) presenting with depression-related psychological distress. Treatment outcome was measured with the Outcome Rating Scale (ORS; Duncan, 2011; Miller & Duncan, 2004) and the child version: Child Outcome Rating Scale (Duncan Sparks, Miller, Bohanske, & Claud, 2006). Benchmark methodology allowed effect size comparisons to randomized clinical trials.

Results: The average treatment effect size estimate of psychotherapy (d = 0.74) for all youth at the PBH agency was comparable to the average effect size estimate for treatment from nine clinical trials using client feedback, yet not equivalent to an average effect size estimate from feedback trials using the ORS. Compared to treatment-as-usual (TAU) groups, treatment at PBH was clinically superior to the TAU group outcomes in both the benchmark from all nine feedback trials and the TAU benchmark from the three ORS trials. The average treatment effect size estimate of psychotherapy (d = 1.51) for the PBH depression sample was clinically superior to a waitlist/no treatment benchmark drawn from 17 clinical trials of youth depression, and clinically equivalent to a treatment benchmark drawn from 13 youth depression clinical trials using intent-to-treat analyses.

Conclusions: Despite the existing socioeconomic disparities in mental healthcare for youth, these findings demonstrate that mental health services to youth in poverty across an entire agency can be effective. Continuous outcome feedback can bridge the gap between research and practice and may be a feasible strategy to ensure quality of services for PBH agencies.

Digital Object Identifier (DOI)