(PS9-4) Agency-, Provider-, and Family-level Factors Associated with Fidelity to an Evidence Based Practice in Community-based Youth-serving Agencies

Ensuring access, quality, and equity in mental health care for youth is a top public health priority. Community mental health service agencies face significant challenges in the delivery of evidence-based practice (EBP) with fidelity (Southam-Gerow et al., 2012). Greater fidelity to evidence-based interventions is associated with better treatment outcomes (Durlak & DuPre, 2008), but is highly variable in community-based agencies (Southam-Gerow, 2004). Research is needed to identify potentially modifiable variables at the agency, provider, and family levels that can inform dissemination and implementation initiatives designed to improve fidelity. At the agency-level, organizational factors such as leader investment in innovation and overall capacity (e.g., time, funding, and training) for innovation are crucial to the successful uptake of EBPs (Beidas et al., 2015; Vroom et al., 2022). Previous research comparing community mental health clinics (CMHCs) to Child Advocacy Centers (CACs) demonstrated differences in organizational commitment and capacity for change, as well as less support for implementing a specific EBP (i.e., Trauma-Focused Cognitive Behavioral Therapy, TF-CBT; Shanholtz et al., 2023). The present study aims to examine agency-, provider-, and family-level factors that impact fidelity. We assessed the organizational environment, partnered with numerous CMHCs and CACs to allow for the exploration of differences between traditional and specialty clinics, and collected observational data of fidelity to TF-CBT – a well-established EBP. We collected data between 2017-2022 as part of a hybrid type 1 effectiveness-implementation trial of tablet-enhanced TF-CBT (Anton et al., 2020). Data were collected from 63 clinicians and 115 families receiving TF-CBT across 27 youth-serving mental health agencies, which will be analyzed using a multilevel modeling approach for differences in treatment fidelity between mental health agencies, namely community mental health clinics (CMHCs) and specialty clinics (CACs). Given a known research-to-practice gap, efforts to study implementation processes and modifiable factors associated with provider fidelity are necessary to improve quality of care in these settings (Cox et al., 2019). Findings will inform future dissemination and implementation initiatives and will identify opportunities for further study of novel solutions that aim to improve access, quality, and equity of child mental health services across diverse treatment settings.