Hillside’s 2021 Patient Outcomes & Statistics Report
What We Do
We treat each child and adolescent individually, tailoring an approach that includes a broad mix of evidence-based one-on-one and group therapies that help our clients grow, recover, and reclaim their lives.
While measurement-based care (MBC) is not new, it is not always implemented in behavioral health treatment. Research shows that MBC improves mental health treatment outcomes and, as a leading provider of child and adolescent behavioral health services, MBC is Hillside’s standard of care.
Using standardized and validated instruments, we systematically collect and analyze client outcomes. These data, in combination with our providers’ extensive clinical expertise, allows us to carefully follow a client’s progress and flexibly customize individual treatment plans to each client’s unique needs.
Hillside is proud to be the first child and adolescent residential treatment facility awarded a DBT-Linehan Board of Certification, Certified Program accreditation. As a premier DBT facility, we assess client changes in key DBT domains of focus. Every two weeks, clients complete measures of emotion regulation, distress tolerance, and mindfulness.
For clients who may require a different approach than DBT, measurement of these outcomes remain relevant. Struggles with regulating emotions, tolerating distress, and being mindful are common among mental health disorders, and one or more of these areas are addressed in many evidence-based therapies.
Since 2019, we have collected data from over 700 residential clients. This report includes data from all 300 clients served between May 2019 to July 2021 who completed outcome measures at seven weeks of treatment, Hillside’s median length of stay in 2019 and 2020.
Families often come to Hillside for residential 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 treatment environment that promotes healing and hope and has successfully treated children and adolescents with a wide array of complex mental health symptoms and disorders for over 37 of our 133-year history of caring for children and their families.
- Female – 61.5%
- Male 38.5%
- 13-15% – 41%
- 10-12 – 24%
- 16-17 – 35%
Primary & Co-Occurring Diagnoses:
- 72% MDD – major depressive disorder
- 24% ADHD – attention-deficit/hyperactivity disorder
- 33% Anxiety
- 24% DMDD – disruptive mood dysregulation disorder
- 15% PTSD – post-traumatic stress disorder
- 10% Bipolar Disorder
- 8% Other
Suicidality and Self-Harm:
- 80% had a history of suicide attempt to threat
- 70% had a history of non-suicidal self-injury
The median number of acute hospitalizations among our clients was three. Approximately 45% of clients had four or more acute hospitalizations.
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 are linked to negative outcomes across the lifespan including self-harm, suicidality, and health risk behaviors. At Hillside, we help children and adolescents to cultivate effective and healthy emotion regulation skills and measure individuals’ progress in their ability to manage their emotions.
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.
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 nonjudgemental 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 and adolescent’s toolbox of skills and work with them to develop and hone this ability. We measure each client’s progress in this area throughout treatment.
Residential Treatment Key Outcomes Results
While our analyses demonstrate statistically significant changes in scores on all DBT treatment outcome measures and their subscales from the beginning of clients’ residential services to both three and five weeks of treatment (all p values <.001), we report a more comprehensive summary of outcomes for all 300 clients who completed measures at seven weeks of treatment, Hillside’s median length of stay in 2019 and 2020.
The Difficulties in Emotion Regulation Scale-16 (DERS-16) measures emotional dysregulation and has five subscales that measure critical components of effective emotion regulation. Scores on the full scale range from 16-80 with lower scores indicating lower levels of emotional dysregulation.
There was a statistically significant decrease in scores at seven weeks of treatment on the full scale and all five subscales (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 when experiencing negative emotions
- greater ability to control impulsive behaviors when feeling negative emotions
- greater confidence in their ability to use effective strategies to manage negative emotions
*Scores on the goal subscale range from 3-15
*Scores on the strategies subscale range from 5-25
The Distress Tolerance Scale (DTS) measures the capacity to withstand negative psychological states and has four subscales that assess important aspects of this capacity. Scores on the full scale and subscales range from 1-5 with higher scores indicating a greater ability to withstand negative psychological states.
There was a statistically significant increase in scores at seven weeks of treatment on the full scale and on all four subscales (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 decrease in avoidance of such emotions
*Absorption subscale of the DTS
The Child and Adolescent Mindfulness Measure (CAMM) measures mindfulness, specifically in the areas of present-centered awareness and accepting inner experiences without judgement. Scores on the measure range from 0–40 with higher scores indicating greater mindfulness.
There was a statistically significant increase in scores at seven weeks of treatment (p <.001) suggesting clients had:
- an increased ability to act with awareness
- an increase in nonjudgmental and nonreactive attitudes to negative thoughts and feelings
Other Treatment Outcomes
85% of Clients Had Improvements in Symptoms and Functioning
Symptom reduction and improved functioning are the main goals of treatment. Using the Clinician Global Impression Improvement Scale, a gold standard in clinician-assessed measures of symptom severity, we found that 85% of our clients experienced reductions in their symptoms and decreased functional impairment.
Significant Reduction in Irritability
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 in youth, we found a significant difference in irritability scores at seven weeks of treatment (p=.009)
96% of Clients Indicated That Hillside Services Helped Them to Manage Their Problems More Effectively
Helping clients learn how to effectively handle difficulties they face in a healthy way is among the most critical of treatment outcomes. Ninety-six percent of our clients indicated that Hillside residential services helped them to do just that.
- Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., … & Gratz, K. L. (2016). Development and validation of a brief version of the difficulties in emotion regulation scale: the DERS-16. Journal of psychopathology and behavioral assessment, 38(2), 284-296
- Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion, 29(2), 83-102.
- Greco, L. A., Baer, R. A., & Smith, G. T. (2011). Assessing mindfulness in children and adolescents: development and validation of the Child and Adolescent Mindfulness Measure (CAMM). Psychological assessment, 23(3), 606.
- Clinician Global Impression-Improvement scale (adapted to include functioning) from: Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology – Revised. Rockville, MD: NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs.
- Stringaris, A., Goodman, R., Ferdinando, S., Razdan, V., Muhrer, E., Leibenluft, E., & Brotman, M. A. (2012). The Affective Reactivity Index: a concise irritability scale for clinical and research settings. Journal of Child Psychology and Psychiatry, 53(11), 1109-1117.