The field of mental health treatment is making efforts to better serve all psychotherapy clients, but especially the 5–10% of clients who deteriorate in treatment (Lambert & Ogles, 2004) and the 30–60% who drop out prematurely (Pekarik & Stephenson, 1988). These efforts involve collaboration between research and practice. Both research and practice have been treatment focused for much of their history, primarily examining treatment efficacy or effectiveness, and never quite settling on the generalizability or applicability of specific treatments. The patient-focused research paradigm has shifted the focus from treatment outcomes on the group level to outcomes on the individual client level. This movement involves outcome monitoring for purposes of treatment planning and quality care. Some of these monitoring systems include early warning systems that could help identify and better serve clients who are at risk for negative outcome. The present study validated previous warning system studies for youth and replicated tests for variables that were predictive of youth change trajectories using the Youth Outcome Questionnaire-30 (YOQ; Burlingame et al., 2004). This study also replicated the accuracy of a warning system for at-risk youth clients, exploring various approaches to creating the cutoffs the warning system uses for its predictions, and reporting the respective accuracy of each. This study contributes to future studies comparing outcomes between client groups whose therapists do or do not receive systematic feedback. This endeavor offers many benefits to quality improvement efforts being made by clinicians and managed care organizations.

Providing clinicians with a clearer understanding of how clients' recover over the entire course of therapy has important implications for referral and treatment strategies. The present study compares rates of change in 160 clients in group therapy with 6632 clients in individual therapy and 864 clients receiving both individual therapy and group therapy. Therapeutic outcomes were measured using the Outcome Questionnaire-45. Data was analyzed using Hierarchical Linear Modeling (HLM), also called Multi-Level Modeling (MLM), to produce recovery curves for clients in each group. Recovery curves showed that most change occurred in the early part of group therapy and slowed near the end. Rates of change for clients in group, individual and conjoint therapy formats were also compared. This study reports that no significant differences in rates of recovery were found between group and individual or group and conjoint treatment formats. However, a significant difference was detected when individual and conjoint treatments were compared, with the individual sample improving at a faster rate.