When parents and clinicians disagree: Consequences for high-risk youth receiving in-home family-based psychiatric treatment

•Parents and clinicians often disagree about how children are doing.•Such disagreements may impact children’s psychotherapy outcomes.•Disagreeing on functioning predicted worse outcomes for high-risk youth.•Youth whose parents over-reported problems made minimal gains.•Youth whose parents under-reported made clinically significant gains. Children, parents and clinicians often disagree about how children are doing at the outset of psychotherapy. Besides complicating the formal diagnostic process, such disagreements are conspicuous indicators of distance between individuals whose ability to form constructive working relationship is crucial to ensure good treatment outcomes. No studies to date have investigated the impact of parent-clinician disagreements on child outcomes in intensive in-home psychiatric treatment. The present study used multiple regression modeling to analyze data from 7845 high-risk adolescents participating in a manualized, 6-month family-based intervention (Intensive In-Home Child and Adolescent Psychiatric Service (IICAPS). Parent-clinician disagreement on child functioning, but not symptom severity, predicted worse treatment outcomes for adolescents. Youth whose parents thought they were doing much worse than clinicians, had almost no effect of treatment at the group level whereas youth whose parents thought they were doing better than clinicians experienced clinically significant change on average. This finding lends empirical support to the notion that parent-clinician disagreements at the outset of youth psychotherapy may jeopardize not only diagnostic validity, but treatment outcomes for high-risk adolescents.