Hillside’s 2022 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. Everyday, we strive to fulfill our mission by providing compassionate therapeutic support that helps the clients and families we serve build the tools and skills needed for growth and improvement that will serve them now and in the future.
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. Using these measures, we have collected data from over 1,500 clients since 2019.
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 that 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 2021, Hillside published its first outcomes report using data collected from May 2019 to July 2021 among clients treated in our residential program. This year, we are proud to publish our second outcomes report using data collected from July 2021 through July 2022. 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. For residential outcomes, pages 5 - 6 focus on Dialectical Behavior Therapy (DBT)-specific outcomes while pages 7 - 9 include analyses of other treatment outcomes and key indicators of treatment success that are broadly applicable across a range of evidence-based treatments and mental health disorders. For outpatient programs, we report on select outcomes relevant to the services we provide in those programs. We have recently expanded our outcome measures in our outpatient programs and look forward to reporting on these in 2023. Throughout the report, for outcomes analyzed using parametric tests, we report means and standard deviations and, for outcomes analyzed using nonparametric tests, we report medians and the interquartile range.
Our Clients: Residential and Outpatient
- Female – 76%
- Male 24%
- 13-15 – 53%
- 16-17 – 33%
- 10-12 – 12%
- Other - 3%
Primary & Co-Occurring Diagnoses:
- 67% MDD – major depressive disorder
- 46% Anxiety Disorders
- 28% Other Disorders - includes (but not limited to) bipolar disorder and obsessive compulsive disorder (OCD)
- 16% TRSD - trauma and stressor-related disorders
- 11% DMDD – disruptive mood dysregulation disorder
- 10% ADHD – attention deficit/hyperactivity disorder
The median number of acute hospitalizations among our clients was three. Approximately 45% of clients had four or more acute hospitalizations.
Key DBT Outcomes
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.
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.
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
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
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
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
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
All Outpatient Programs
Among clients in all outpatient programs (Day, Intensive In-Home, and Virtual Intensive Outpatient), there was a significant decrease in total score and scores on all five subscales at discharge on the Difficulties in Emotion Regulation Scale (DERS-16) (all ps <.001), a measure of emotional dysregulation, suggesting clients had improvements in their: 1) overall ability to regulate their difficult emotions, 2) clarity about the emotions they experience, 3) acceptance of difficult emotions, 4) ability to engage in goal-directed behavior and control impulsive behaviors when experiencing difficult emotions, and 5) confidence in their ability to use effective strategies to manage difficult emotions.
Among clients who received care in a Hillside outpatient program, 93% did not require acute hospitalization while receiving outpatient services. Additionally, 96% of outpatient clients did not require discharge to residential treatment while receiving Hillside outpatient services.
At discharge, 91% of outpatient clients reported that the moods, feelings, and behaviors they were treated for were much improved or very much improved.*
At discharge, 97% of outpatient clients reported that they were better able to handle difficulties they face in a healthy and effective way.
*This question was added to the client satisfaction survey early 2022. As such, this statistic reflects the beliefs of the clients served in the residential program since that time.