Alternative Mental Health Therapies: Outcomes from a Program for Youth with Complex Behavioral Health Needs

Background/Purpose: Youth with serious emotional disturbance (SED) in publicly funded systems of care experience high rates of complex mental health needs. However, standard talk therapies show limited sustained effectiveness and high attrition, with over 25% of youth dropping out within three months. Research increasingly recognizes that verbal therapies alone may be insufficient for individuals with complex needs. Alternative mental health therapies — including art therapy, equine-assisted psychotherapy, music therapy, and recreational therapy — demonstrate efficacy, yet few studies have examined their impact within Medicaid-funded service delivery systems or for children and youth with more complex needs. This study examined the association between alternative mental health therapy utilization and youth mental health outcomes within a public behavioral health system.

Methods: Administrative data from one state’s 1915(c) Home and Community-Based Services (HCBS) Waiver program was used to compare youth participants who utilized any alternative mental health therapy to program participants who did not utilize any alternative mental health therapies. The sample included 2,675 youth, ages 5-18 years, who discharged from HCBS Waiver between September 2023 and August 2025 and had complete demographic, service utilization, and both baseline and follow-up needs assessment data. The primary outcome was the sum of youth needs and strengths as measured by the Child and Adolescent Needs and Strengths (CANS) assessment across five primary domains. To address potential selection bias, inverse probability weights (IPW) were estimated to compare youth who utilized Alternative mental health therapies to those who did not. Propensity scores were calculated using baseline covariates, including age, race, ethnicity, gender, and baseline needs. A weighted linear regression model was used to estimate the association between alternative mental health therapy utilization and total needs at follow-up, controlling for length of time in care.

Results:
The weighted regression model was statistically significant (F(2, 1270) = 3.79, p = .023), indicating that the predictors were associated with discharge outcomes. After applying IPWs and controlling for length of stay, youth who received Alternative mental health therapies demonstrated significantly lower levels of actionable needs at follow-up compared to those who did not (B = -0.97, SE = 0.39, p = .012). Although statistically significant, the magnitude of this effect was modest (β = -0.07).

Implications: Findings suggest that participation in alternative mental health therapies is associated with modest reduction in youth needs at discharge, even after accounting for differences in baseline characteristics. These results provide preliminary support for the inclusion of nontraditional therapeutic approaches within Medicaid-funded behavioral health systems serving youth with complex behavioral health needs. Policymakers should consider how these services are integrated with a broader continuum of care, as well as how access to and engagement in alternative mental health therapies may vary across populations. Continued evaluation using risk-adjusted methods is critical to inform decisions about the role and scalability of alternative mental health therapies within publicly funded systems of behavioral health care for youth.