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Symposia

Dissemination & Implementation Science

Understanding and Overcoming Barriers Within Evidence-based Practice Implementation in Youth Community and School-based Mental Health Services

3 - (SYM 110) Observing Community Therapist Augmenting Adaptations in TF-CBT Sessions and Implications for Clinical Process Outcomes with Racial/ethnic Minoritized Youth

Saturday, November 16, 2024
4:30 PM – 6:00 PM EST
Location: Liberty C, Level 3, Downtown Marriott
Abstract Body
Community therapists often adapt evidence-based practices (EBPs) when transported into public systems of care to enhance their fit for the diverse youth and families they serve. Studies of therapist-reported adaptations have identified Augmenting adaptations as those that add to or tailor the EBP in some way, such as modifying the presentation of EBP content, integrating supplemental content, and extending through repetition. Community therapists hold valuable local expertise about what may promote client engagement in their care context, especially when they identify with the communities they serve. Yet, there may be risks to EBP integrity if adaptations are unsystematic. There is a need to understand how adaptations may relate to implementation and clinical process outcomes. The aims of this study were to examine associations between Augmenting adaptations and (1) client engagement outcomes and (2) adherence in sessions of trauma-focused cognitive behavioral therapy (TF-CBT). Community therapists (n = 46) provided 190 TF-CBT session audio recordings and surveys on session and client characteristics delivered to 82 youth (Mage = 10.30; 67.07% Latinx, 21.95% Black, 7.32% Asian American/Pacific Islander, 2.44% White, 1.22% Multiracial). Two observational coding systems were developed to index Augmenting adaptations (MICC= .76) and adherence to TF-CBT (MICC =.85) at the session-level. Two independent teams of coders (n = 18) were trained to rate the occurrence and extensiveness of each adaptation type and TF-CBT component, respectively, from session audio recordings (0 = no occurrence, 6 = great extent). Client engagement behaviors were coded observationally from a prior study. Multilevel modeling was used, controlling for session, client, and therapist factors. Modifying presentation adaptations were associated with lower odds of therapist-reported client disengagement in session (OR=0.41, 95% CI [0.15, 0.86]). Integrating adaptations were associated with higher odds of therapist-reported client disengagement in session (OR=2.14, 95% CI [1.10, 5.09]). Repeat adaptations were associated with more observed client engagement behaviors in session (β=0.14, 95% CI [0.01, 0.27]). No Augmenting adaptations were related to adherence to TF-CBT at the session-level. Future work will systematically examine the direction of the relationships found. This study holds translational value for improving EBP implementation and delivery in community mental health settings serving structurally marginalized communities.