Publication Date




Embargo Period


Degree Type


Degree Name

Master of Science (MS)


Psychology (Arts and Sciences)

Date of Defense


First Committee Member

Amanda Jensen-Doss

Second Committee Member

Brian D. Doss

Third Committee Member

Cynthia L. Rowe


Improving mental health services for youths in usual care (UC) is one of the most critical issues in mental health services research. Identification of change trajectories in UC (e.g., improvement, no response, deterioration) can help researchers gain a richer understanding of UC and facilitate efforts to tailor UC to individuals. This study used multilevel growth mixture modeling (MGMM) to examine trajectories of change for two outcome measures (i.e., problem severity and functioning) in a sample of youths (N = 722) treated in UC served at four clinics operating under a large county-wide public mental health authority. Multinomial logistic regression was used to predict trajectory group membership from youth demographic and clinical variables, to identify the types of clients most likely to have positive or negative treatment outcomes. Results evidenced three distinct trajectories of change on a measure of problem severity: 1) Remained High (12.2%), 2) Remained Moderate (85.0%), and 3) Moderate Improvement (2.8%). Two distinct trajectories of change were identified on a measure of functioning: 1) No Change (98.7%), and 2) Moderate Improvement (1.3%). Predictors of trajectory group membership indicate that baseline problem severity and functioning, and associated clinical variables, significantly predicted trajectory group membership. Findings are discussed in terms of understanding change in youth UC and informing treatment targets.


usual care; change trajectories; psychotherapy outcomes; youth