(PS11-69) Clinician- and Client-level Predictors of Implementation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents in Community Clinics

Abstract Text: Clinicians in community mental health centers (CMHCs) often report needing to stray from single-domain or disorder-focused CBT protocols to meet the complex needs of youth in these settings. Transdiagnostic interventions may allow for greater breadth of problem focus by targeting core dysfunctions that present across diagnostic categories. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a transdiagnostic and modular intervention for youth emotional disorders with efficacy in clinical research settings, but less is known about its implementation in CMHCs. This study examined clinician- and client-level predictors of UP-A module use in CMHCs to inform efforts to facilitate use of active intervention components and improve client outcomes.
Participants were 59 youth (M = 14.6 yrs, 69% female; 71% White; 56% Non-Hispanic) who received UP-A treatment (M = 11 sessions over 28 weeks) from one of 23 trained clinicians (M = 33 years, 83% female, 74% White, 78% Non-Hispanic) at CMHCs in Florida (n = 34 clients) or Connecticut (n = 25 clients) as part of an effectiveness trial. Clinicians self-reported UP-A module use after each session. Clinician-level predictors of module use included theoretical orientation (44% primarily CBT-oriented), years of experience (M = 4), and attitudes towards evidence-based practices (assessed using the Evidence-Based Practice Attitudes Scale; Aarons, 2004). Client-level predictors included age, number of diagnoses (M = 2.6), and clinical severity (assessed via clinical interview using Clinical Global Impression–Severity Scale; M = 5.7, indicating marked severity; Guy, 2000). Hierarchical linear modeling was used to examine the effect of clinician- and client-level predictors on UP-A module use.

On average, approximately half of clients’ sessions included UP-A psychoeducation (55%). A notably smaller proportion of sessions included the more active UP-A modules such as exposure (17%), cognitive skills (15%), behavioral activation (11%), and mindfulness (7%). Controlling for other clinician- and client-level predictors, clinicians’ years of experience was the best predictor of use of active, non-psychoeducational modules (B = 0.02, SE = 0.01, t = 2.28, p = .043), and was specifically associated with increased use of exposure (B = 0.02, SE = 0.01, t = 2.44, p = .030) and mindfulness (B = 0.02, SE = 0.01, t = 2.84, p = .013). Controlling for clinicians’ years of experience, theoretical orientation and attitudes towards evidence-based practices did not impact UP-A module use (p > .05). Client factors, including age, number of diagnoses, and clinical severity, similarly did not impact module use (p > .05).
Youth clinical characteristics do not appear to adversely impact UP-A delivery in CMHCs, suggesting that the UP-A may be useful for a range of clients seen in CMHCs. Clinician-level factors—in particular, few years of clinical experience—appear to explain lower use of UP-A active, non-psychoeducational modules. Future efforts to improve UP-A delivery in CMHCs may consider strategies to augment training for more novice clinicians. Future research may also consider the impacts of organizational factors on the implementation and effectiveness of the UP-A in CMHCs.