Hillside’s 2023 Patient Outcomes & Statistics Report

Hillside’s mission is to help children and families thrive by providing outstanding residential and community mental health services. As our country faces soaring rates of mental health challenges among children, adolescents, and their families, this mission is more critical than ever before. Every day, we strive to fulfill our mission by providing compassionate therapeutic support helping the clients and families we serve build the tools and skills needed for growth and improvement, serving them now and into the future.

Measurement-Based Care

Hillside carefully assesses our clients' treatment outcomes by tracking indicators of treatment progress and success, including those evaluated by valid and reliable standardized measures completed at the start of treatment, various points of care, and at discharge. Since we began collecting this data in 2019, we have amassed more than 9000 completed bundles across our continuum. As a DBT- Linehan Board of Certification, Certified Program™ most of our measures are designed to assess the skills taught in our program such as emotion regulation, mindfulness, and distress tolerance.

Collection of these data serve two important purposes. First, data are utilized to carefully follow a client’s progress. These data, in combination with our providers’ extensive clinical expertise, allow us to flexibly customize individual treatment plans to each client’s unique needs. Second, we statistically analyze these data to evaluate the effectiveness of our programs so we can identify the therapies and approaches that result in the best treatment outcomes for our clients.

Hillside is committed to transparency regarding the effectiveness of our services. In this third installment of our Outcomes Report, we are proud to detail the results of our work from July 2022 through June 2023. This report includes data from over 600 clients served in our residential and outpatient programs, including our Experience DBT Day Treatment, Virtual Intensive Outpatient, and Intensive In-Home Therapy programs.

For this report, we conducted outcome analyses using data collected at admission or within the first week of treatment and data collected at discharge or, for some outcomes, at a time point closest to discharge, typically within 10 days of discharge.

A new addition to this year‘s report is data from our post-discharge data collection process. Since beginning this collection in 2020, we have received 798 responses from families who have discharged from our programs.

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Our Clients: All Programs

Biological Sex:

  • Female – 70%
  • Male – 30%
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Primary & Co-Occurring Diagnoses:

  • 69% MDD – major depressive disorder
  • 52% Anxiety Disorders
  • 27% ADHD – attention deficit/hyperactivity disorder
  • 23% DMDD – disruptive mood dysregulation disorder
  • 20% TRSD – trauma and stressor-related disorders
  • 13% Other Disorders – includes (but not limited to) bipolar disorder and obsessive compulsive disorder (OCD)
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Age:

  • 0-5 – 1.6%
  • 6-12 – 22.6%
  • 13-18 – 75.2%
  • 19+ – 0.6%
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Diagnostic Complexity:

  • 1 Diagnosis – 20%
  • 2-3 Diagnoses – 63%
  • 4 or more – 17%
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Gender Identity:

  • Female – 61.2%
  • Male – 27.1%
  • Transgender – 4.3%
  • Genderqueer – 1.9%
  • Don't know – 3.0%
  • Other – 3.0%
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Families often seek Hillside services after their child has received treatment in several outpatient,residential, and/or acute settings, and have treatment needs that have not been met in those settings.Hillside offers a unique residential treatment environment and continuum of services that promotehealing and hope, and has successfully treated children and adolescents with a wide array of complexmental health symptoms for 136 years.

Suicide Attempts:

  • 54% of clients had a history of suicide attempt
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Acute Hospitalizations:

60% of our admitting clients had some history of acute hospitalization. For those with a treatment history, the average number of hospitalizations was 4.

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Self-Harm:

60% of our clients had a history of non-suicidal self-injury

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Length of Stay Across Programs:

  • Intensive In-Home – 114 days
  • Residential – 78 days
  • Virtual Outpatient – 35 days
  • Day Treatment – 34 days
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Key DBT Concepts

Emotion Regulation

Although often thought of as solely negative, experiencing difficult emotions like sadness, fear, and anger serves an important purpose in our adaptation to demanding and stressful situations. While often unpleasant, the experience of difficult emotions is not always a problem. Rather, it is when we lack the ability to effectively manage our emotions in healthy ways that problems arise. Lack of healthy emotion regulation strategies and emotional dysregulation are common among many mental health disorders and linked to negative outcomes across the lifespan, including self-harm, suicidality, and health risk behaviors. At Hillside, we help children and adolescents cultivate effective and healthy emotion regulation skills and measure individuals' progress in their ability to manage their emotions.

Mindfulness

Over the years, there has been mounting evidence of the positive impact of mindfulness. Mindfulness involves being in the present moment and observing feelings and situations in a non-judgemental way and has been shown to improve mental health outcomes and contribute to an overall greater sense of well-being. At Hillside, we see mindfulness as an important tool in a child or adolescent's toolbox of skills and work with them to develop and hone this ability. We measure each client's progess in this area throughout treatment.

Distress Tolerance

Everyone feels overwhelmed by strong emotions and difficult situations sometimes. However, when we feel this way too often, it can lead to difficulty functioning at school, home, and in social situations. A lack of tolerance of distressing emotions and situations is often seen in children and adolescents struggling with their mental health and can lead to attempts to avoid feeling distressed by using harmful coping strategies like self-harm and substance use. Hopelessness among those with low distress tolerance is common, increasing the risk of suicide. At Hillside, we believe building the capacity to tolerate distress is a key therapeutic ingredient in treatment and we measure each client's progress in their ability to tolerate distress.

Residential Treatment Outcomes

Emotion Regulation

The Difficulties in Emotion Regulation Scale-16 (DERS-16) measures emotional dysregulation and has five subscales that measure critical components of effective emotion regulation. Total scores range from 16 to 80, with lower scores indicating lower levels of emotional dysregulation.

There was a significant decrease in total scores and scores on all five subscales at discharge (all p values <.001) suggesting clients had:

  • an overall improvement in their ability to regulate their negative emotions
  • greater clarity about the emotions they experience
  • increased acceptance of their negative emotions
  • an improved ability to engage in goal-directed behavior and control impulsive behaviors when experiencing negative emotions
  • greater confidence in their ability to use effective strategies to manage negative emotions
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Mindfulness

he Child and Adolescent Mindfulness Measure (CAMM) measures mindfulness, specifically in the areas of present-centered awareness and accepting inner experiences without judgement. Total scores range from 0 to 40, with higher scores indicating greater mindfulness.
There was a significant increase in scores at discharge (p <.001) suggesting clients had:

  • an increased ability to act with awareness
  • an increase in nonjudgmental and nonreactive attitudes to negative thoughts and feelings
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Distress Tolerance

The Distress Tolerance Scale (DTS) measures the capacity to withstand negative psychological states and has four subscales that assess important aspects of this capacity. Total scores and subscale scores range from 1 to 5, with higher scores indicating a greater ability to withstand negative psychological states.

There was a significant increase in total scores and on all four subscales at discharge (all p values <.001) suggesting clients had:

  • an overall improvement in their ability to handle uncomfortable emotional experiences
  • a greater ability to tolerate distress
  • a decrease in how overwhelmed they are by strong emotions
  • a greater acceptance of uncomfortable emotions and a decrease in avoidance of such emotions
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Life Difficulties

Once used predominately for the treatment of borderline personality disorder, DBT has become a treatment of choice for a variety of disorders, as the skills taught in DBT and areas of difficulty it addresses are relevant to many mental health disorders.

The Life Problems Inventory (LPI) measure was specifically created for use in adolescents to measure the symptoms and problem areas addressed in DBT - confusion about self, impulsivity, poor interpersonal functioning, and emotional lability - with subscales addressing these four domains. Total scores range from 60 to 300, with lower scores indicating less difficulty in these areas. There was a significant decrease in total score and scores on all four subscales at discharge (all p values <.001) suggesting clients had:

  • a better sense of who they are
  • improvements in relationships and/or fewer interpersonal problems
  • a greater ability to restrain from impulsive decisions and behavior and/or less engagement in impulsive behaviors
  • a increased ability to regulate their emotions and reactions to changes in their moods
lpi_total

Irritability

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Severe and/or frequent irritability is common in the presentation of many different mental health disorders in childhood and adolescence and has been linked to poor short- and long-term outcomes and increased risk of suicidal thoughts and behaviors. Using the Affective Reactivity Index, the leading measure of irritability inyouth, with possible scores ranging from 0 to 12, we found a significant decrease (p<.001) in clients’ scores from admission (Mdn=3, IQR=5) to discharge (Mdn=2, IQR=4),suggesting clients had improvements in one or more of these areas: a higher threshold for angry reaction, reduction in the frequency of their angry feelings/behaviors, or reduction in the duration of their angry feelings/behaviors.

Meaning and Purpose

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Decades of research consistently find that a sense of meaning in life - feeling that one’s life and experiences make sense and matter – and purpose in life – having intentions, goals, and a sense of direction - are critical for psychological well being and have been linked to a decreased likelihood of psychological health problems, suicidal ideation and suicide attempts, and greater happiness and life satisfaction. Using the NIH PROMIS Meaning and Purpose Measure, with possible scores ranging from 8 to 40, we found a significant increase (p <.001) in clients’ scores from admission (Mdn=31, IQR=15) to discharge (Mdn=36, IQR=10), suggesting clients had a greater sense that their lives matter, have purpose, and are predictable and goal-directed.

Psychological Stress Experiences

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The detrimental effects of stress are well known. However, the impact of stress on an individual is, in part, determined by perceptions of how unpredictable, uncontrollable, and overwhelming stressful experiences are. When an individual builds confidence in their ability to manage stressful situations and coping skills todo so, their beliefs about stressful experiences, and how stressed they feel, can change. Using the NIH PROMIS four-item Psychological Stress Experiences Measure, with possible scores ranging from 4 to 20, we found a significant decrease (p <.001)in clients' scores from admission (Mdn=15, IQR=7) to discharge (Mdn=10, IQR=5),suggesting clients felt less stressed.

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Symptom reduction and improved functioning are main goals of treatment. Using the Clinical Global Impression Improvement Scale, a gold standard in clinician-assessed measures of symptom improvement, we found that 91% of residential clients experienced reductions in their symptoms and decreased functional impairment.

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While clinician assessment of symptom improvement is essential for determining treatment progress, clients' appraisals of improvement are also valuable. When clients feel they have made progress, it can enhance commitment to utilizing the skills gained in treatment and to continuing treatment in the community once discharged. Approximately 84% of clients served in the residential program indicated that the moods, feelings, and behaviors they were treated for were much improved or very much improved at discharge

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Helping clients learn how to effectively handle difficulties they face in a healthy way is among the most critical of treatment outcomes. Eighty-nine percent of residential clients indicated that Hillside residential services helped them do just that.

Outpatient Program Outcomes

Emotional Regulation

Among clients in all non-residential programs (Day, Intensive In-Home, and Virtual Intensive Outpatient), there was a significant decrease in overall score at discharge on the Difficulties in Emotion Regulation Scale (DERS-16) (p < 0.05), a measure of emotional dysregulation. This change indicates that clients were able to more easily regulate their emotions.

outpatient_ders

Distress Tolerance

Likewise, the same group showed a significant increase, from admission to discharge, on the Distress Tolerance Scale (p < 0.05). Distress tolerance refers to an individual’s perceived and actual ability to tolerate challenging physical and emotional states. An increase in distress tolerance scores suggests that an individual would be better able to handle emotional crises.

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Psychological Stress

Finally, clients served in our non-residential programs showed a significant decrease (p < 0.05) in Psychological Stress Experiences scores from admission to discharge. When an individual builds confidence in their ability to manage stressful situations and coping skills to do so, their beliefs about stressful experiences, and how stressed they feel, can change.

outpatient_stress

Hillside's residential and outpatient programs share the same overarching goal - to deliver compassionate therapeutic support that helps the children, adolescents, and families we serve build the tools and skills needed for growth and improvement that will serve them now and in the future. However, the outpatient programs aim to do so while the client is engaged in their daily lives, in the communities where they live, rather than the more restrictive care environments, like inpatient hospitals or residential care.

Among clients who received care in Hillside’s Intensive In-Home and Virtual Outpatient programs, 96%did not require acute hospitalization while receiving services. For participants in our Experience DBT Day Treatment Program, 84% of clients were able to complete the full 240 hours of the treatment curriculum without requiring an increase in level of care such as hospitalization or residential treatment.

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Using the Clinical Global Impression Improvement Scale, a gold standard in clinician-assessed measures of symptom improvement, we found that 81% of clients served in our outpatient programs experienced improvements in symptoms and functioning.

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At discharge, 96% of outpatient clients reported that the moods, feelings, and behaviors they were treated for were improved.

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At discharge, 95% of outpatient clients reported that they were better able to handle the difficulties they face in an effective way.

Post-Discharge Outcomes

In the behavioral health industry, most providers do not collect data on the success of their clients after leaving the program because it is time consuming and expensive. Beyond measuring the immediate success of treatment during care, post-discharge outcomes provide invaluable insights into the sustained impact on individuals’ lives; it’s not merely about addressing symptoms during treatment, it’s about fostering lasting positive changes that endure beyond the treatment period. Hillside began collecting post-discharge outcomes data in the early summer of 2020. Data is collected from parents of clients three months after discharging from all Hillside services. By diligently tracking and analyzing post-treatment outcomes, we can continually refine our approach, ensuring our organization remains focused on promoting enduring mental health and enhancing the quality of life for our clients and their families.

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Parents reported observing an improvement in symptoms 3 months after leaving Hillside.

74_pct

Reported a noticeable improvement in their child’s behavior.

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Had regular school attendance since discharge.

92_pct

Had zero or one hospitalization. This is in contrast to more than 60% of admitting clients having some hospitalization history, with the average number of hospitalizations being 4.

Current Version
June 4, 2024
Written By: Gaan Akers, LPC, NCC
Edited By: Gaan Akers, LPC, NCC
May 21, 2024
Medically Reviewed By: Gaan Akers, LPC, NCC