Care in Action: A Case Study

Antelope Recovery provides individualized mental health care to adolescents who are experiencing severe symptoms and impairments in functioning and require more intensive services than weekly individual therapy. We launched our program in May 2023, and have since been collecting data on the outcomes of our program. At Antelope, we assess clients’ symptom severity and functioning before and after treatment to evaluate the effectiveness of our program. We also measure our clients’ progress and satisfaction with treatment throughout its course to make sure we adjust quickly when treatment effectiveness stagnates, or we are not making improvements. In addition, by soliciting consistent feedback from our families, we ensure that we are partners in treatment and we truly deliver on our collaborative care promise. The following case study illustrates our approach to collaborative measurement-based care and highlights some of the aspects that we believe make us successful in helping our families heal.

Our Approach

In this case study, we break down how the following three frameworks allow us to deliver effective and impactful care:

  • Treatment for children works best when the whole family is involved in treatment. Adolescents and their caregivers are our partners in treatment, and we work together to address the needs of the whole family.
  • We design a unique program that works for the individual family, not make clients work to fit our program. We respect individual needs and preferences in treatment, and our treatment recommendations are based on a comprehensive assessment of the family’s problems and needs.
  • We deliver measurement-based care, which means that we continuously evaluate treatment effectiveness and engage clients in collaborative treatment planning.

An Illustration of how we deliver and measure care

This is a case study of a 13-year-old client who participated in a 12-week intensive program at Antelope Recovery. The client presented with severe symptoms of anxiety and depression, including frequent and intense suicidal ideation. Based on information gathered during a comprehensive evaluation session with the client and the family, a treatment program proposal included:

  • Weekly individual therapy sessions to help cope with distressing emotions and thoughts;
  • Three hours of group sessions per week to increase social connectedness and support and decrease social anxiety;
  • Weekly health and wellness sessions to improve sleep and poor health habits;
  • Monthly case consultations with the parents to evaluate treatment effectiveness;
  • Weekly parent education and support groups to provide parents with tools to support their child in treatment and support them in coping with their child struggling with mental health issues.

The family consistently attended treatment sessions, as evidenced in the graph above. Individual therapy sessions employed cognitive-behavioral and acceptance and commitment therapy techniques. Health and wellness sessions provided psychoeducation and engaged the client in behavioral activation and scheduling. The client attended groups that built resilience, explored new ways of relating to others and oneself, and employed animal- and nature-based activities to increase coping resources. The parent education and support group provided a source of peer support in overcoming challenges and taught behavior modification and communication skills.

Treatment effectiveness was assessed weekly via the Young Person’s Clinical Outcomes in Routine Evaluations scale; treatment engagement was assessed using the Group Cohesiveness Scale (administered weekly) and the Therapeutic Alliance Scale for Children (administered biweekly). The treatment provider reviewed the client’s responses prior to each individual therapy session, noting the direction and degree of symptom changes. The changes in symptoms were then addressed in sessions and connected to the new coping skills and strategies the client has been practicing, highlighting the effectiveness of the work the client was putting into treatment. The client’s data was also reviewed monthly with the interdisciplinary treatment team to track progress, assess treatment satisfaction, and determine if changes to treatment warranted consideration. Employing evidence-based techniques, providing comprehensive services, and routinely evaluating progress resulted in significant decreases in symptoms and distress, as evident in the graph below.

Assessment of the client’s presenting issues included administration of the Ohio Youth Problems, Functioning, and Satisfaction Scales, the Revised Children’s Anxiety and Depression Scale, and the Child Trauma Screen. These measures were re-administered after treatment was completed. As depicted in the graph below, attending health and wellness sessions to develop healthy routines, participating in individual therapy to learn new coping skills, and incorporating social support and interpersonal skill building through group sessions resulted in significant symptom reduction. The client evidenced decreased scores on the scales assessing anxiety and depressive symptoms, as well as reductions in symptoms associated with trauma. The client exhibited improvements in functioning, reported greater coping abilities, and endorsed a greater sense of hopefulness. At the end of treatment, the client no longer experienced suicidal ideation – thoughts that occurred daily when the client first started treatment.

The client’s parents were able to share feedback on treatment progress in a weekly parent support group and in team consultation meetings. Parental involvement not only led to greater treatment satisfaction but also helped parents to support their child in developing and practicing healthier habits and a variety of coping strategies. The client and the parents reported greater feelings of self-efficacy in managing the client’s mental health issues at the end of treatment. 

The Takeaway

This case study illustrates the value of measurement-based care, a core of Antelope Recovery’s approach to treatment. Measurement-based care is an evidence-based practice of systematic and routine assessment throughout the course of treatment that aligns with delivering patient-centered care. Routinely collecting self-reported data and sharing it with the client allows providers to act on this information in real time, tailoring treatment as needed based on the client’s feedback. Measurement-based care has been associated with symptom reduction, improved retention, and greater patient satisfaction. It allows for a truer collaboration between the provider and the client in treatment. 

In addition to routinely assessing symptoms, coping, and functioning through self-report questionnaires, the clinical team empowered the family to actively collaborate in treatment via frequent check-ins and regular treatment consultations. The treatment program was adjusted based on the feedback. For example, the time spent in group sessions was adjusted from six hours per week to three hours per week due to the client feeling overwhelmed by treatment intensity and demands. To help ease the client’s anxiety about participating in group sessions, check-ins with a peer mentor/group co-facilitator were added prior to the group sessions. To complement skills taught in individual therapy, health and wellness sessions were added to increase engagement in daily living activities and improve sleep issues. Personalizing the care we deliver led to increased engagement and satisfaction with treatment. 

A hopeful story: Treatment can work for teens in crisis

The message Antelope Recovery hopes to bring to the mental health treatment community is that care can be evidence-based and individualized, measurement-driven and not burdensome, virtual and effective. By creating a true community for the whole family that is accepting and supportive, we can have an incredible impact on the lives of our teens. This case study shows that hope is possible through rigorous and collaborative care. A teen who has been struggling with severe symptoms, with precise treatment, was able to find healing. This is a story of hope for us, and we want it to be a story of hope for you too!