Youth and families who receive services in public mental health care (PMHC) often present with complex co-occurring concerns. These challenges might appear to necessitate spreading the foci of treatment across multiple targets during therapy, herein referred to as treatment focus diffusion (TFD). Higher TFD has recently been found to be related to poorer short-term clinical outcomes, but longer term clinical and system outcomes have not been examined. Utilizing routine clinical data from two PMHC-based intensive in-home service formats (implemented Multisystemic Therapy [MST] and standards-based services), this study examined whether TFD was associated with returning to the system for additional services at the same or more intensive/restrictive level and with treatment expenditures related to any service utilization following the treatment episode under study. When examined together and in separate models for MST and standards-based intensive in-home services, more TFD was significantly related to higher odds of returning to the system for additional services. Additionally, more TFD was significantly associated with higher treatment expenditure in the combined and MST-only models. These findings suggest that TFD could serve as a useful and measurable early treatment factor for predicting poorer outcomes. As such, monitoring TFD and using supervision and/or case reviews to adjust services where treatment focus diffuses would likely be beneficial in PMHC systems.
