1 - (SYM 64) A Case Example of Successful Exposure Therapy Implementation in Community Mental Health

Youth anxiety disorders are common, associated with significant impairment, and are increasing in prevalence. Exposure therapy (EXP) is a cognitive-behavioral technique with robust support for reducing the symptoms and burden of youth anxiety. Despite the evidence supporting it, EXP is rarely used by clinicians in routine settings. Implementation efforts to support EXP delivery have not resulted in clinicians’ sustained EXP use. While there are many barriers to EXP implementation, two are particularly noteworthy: (1) the complexity of EXP creates implementation challenges at the individual, organizational, and policy level, and (2) concerns about EXP’s applicability to youth from minoritized backgrounds, those with complex clinical presentations, or those who experience numerous contextual stressors (e.g., family discord, financial stress). Here we present a case example of successful community mental health EXP implementation launched through a community-academic partnership in the City of Philadelphia. Using the policy ecology of implementation framework as a guide, we discuss the factors that have been integral to successful EXP implementation in this setting. We then discuss how we are developing this program to function as a natural laboratory to learn how to enhance EXP treatment effectiveness for a population with historically low representation in clinical trials. About 50% of youth served identify as racial or ethnic minorities, over 45% report a trauma history, almost 20% present with suicidal ideation, and many have clinical presentations (e.g., psychosis, autism, epilepsy, tumors) that would exclude them from traditional trials. Despite these differences from most clinical trial samples, approximately 70% of youth treated with EXP successfully graduate from the program within one year, indicating clinical improvement. We describe the research and quality improvement infrastructure we have built to support our ability to continuously improve our practices, challenges we have faced, and our efforts to overcome them. We conclude by discussing how our findings are informing programmatic change and lessons learned for other settings.