5.37 CLINICAL OUTCOMES IN SCHOOL-AVOIDANT ADOLESCENTS RECEIVING TREATMENT IN A DAY-HOSPITAL SETTING

Objectives: Comprehensive Adolescent Rehabilitation and Education Service (CARES) is a unique outpatient day program for school-avoidant adolescents with a history of poor school attendance and severe emotional disturbance, with and without co-occurring SUD. CARES uses a DBT model to integrate psychiatric treatment into an academic setting. We sought to determine whether students' motivation to change correlated with attendance in the program and to evaluate changes in problem areas over the course of two 90-day treatment periods or trimesters (180 days total). Methods: A retrospective cohort study of adolescents treated at CARES from July 2014 to June 2015 was performed. A total of 83 adolescents (54 females, 29 males) ranging in age from 14 to 20 years (mean =16.88, SD =1.28) were included. Average monthly attendance was calculated for each trimester. Motivation to change was assessed using the University of Rhode Island Change Assessment (URICA) scale. Symptom severity across 10 problem areas was assessed using the Problem Oriented Screening Instrument for Teenagers (POSIT) scale. URICAs and POSITs were administered at baseline and after each trimester. Results: Change in URICA scores in the first trimester had a moderate positive correlation with change in attendance from the first to second trimester, r(40) =0.39, P =0.012. Students demonstrated a significant increase in attendance from the first to second trimester, t(75) =5.30, P = 0.000. Change in POSIT scores showed reduced risk severity in the following areas: social skills from baseline to first follow-up, t(60=-2.37, P =0.021; and substance abuse from baseline to second follow-up, t(42) =-2.83, P =0.007. Mental health from baseline to second follow-up showed a trend toward significance, t(42) =-1.78, P =0.082. Conclusions: School-avoidant students with an increase in motivation to change in the first trimester, possibly related to treatment, also exhibited an increase in attendance in the second trimester. Furthermore, students showed reduced risk severity in the areas of social skills, substance use, and mental health. Overall, these findings provide support for the use of the CARES model as an effective intervention to improve attendance and clinical outcomes in school-avoidant adolescents.