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Dickson KS, Galligan M, Holt T, Kenworthy L, Anthony L, Roesch S, Brookman-Frazee L. Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children's Mental Health Settings. J Autism Dev Disord 2024:10.1007/s10803-024-06365-8. [PMID: 38678517 DOI: 10.1007/s10803-024-06365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, CA, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Megan Galligan
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Tana Holt
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Kenworthy
- Center for Autism- Children's National Hospital, Washington, DC, USA
- George Washington University Medical School, Washington, DC, USA
| | - Laura Anthony
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital of Colorado, Aurora, CO, USA
| | - Scott Roesch
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, CA, USA
- Rady Children's Hospital- San Diego, San Diego, CA, USA
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2
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Boyd MR, Becker KD, Park AL, Pham K, Chorpita BF. Managers' Micro-Communities Matter: The Impact of Clinical Supervision Team on Therapist Perception of the Organization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01376-0. [PMID: 38676872 DOI: 10.1007/s10488-024-01376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
Positive organizational climate - employee perceptions of their work environment and the impact of this environment on well-being and functioning - is associated with desirable organizational and client-level outcomes in mental health organizations. Clinical supervisors are well-positioned to impact organizational climate, as they serve as intermediaries between higher-level administrators who drive the policies and procedures and the therapists impacted by such decisions. This cross-sectional study examined the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. Specifically, the present study investigated: (1) shared perceptions of organizational climate among therapists on the same supervisory team; (2) predictors of therapist climate perceptions. Eighty-six therapists were supervised by 22 supervisors. Indices of interrater agreement and interrater reliability of therapists on the same supervisory team were examined to determine shared or distinct perceptions of organizational climate. Multi-level models were used to examine whether supervisor attitudes towards evidence-based practices and therapist perceptions of supervisor communication predicted perceived organizational climate. Results showed perceptions of organizational cohesion and autonomy were shared among therapists on the same supervisory team and distinct from therapists on different supervisory teams. Therapist perceptions of their supervisor's communication was positively associated with perceptions of organizational cohesion and autonomy. These findings align with emerging evidence that middle managers shape their employees' experience of their work environment through communication strategies. These findings also point to the potential for intervening at lower organizational levels to improve overall organizational climate.
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Affiliation(s)
- Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alayna L Park
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Kaitlyn Pham
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
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3
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Gabrielian S, Hamilton AB, Gelberg L, Koosis ER, Hoffmann L, Carlson DM, Young AS. Testing an implementation package in a housing skills training pilot for homeless-experienced persons with serious mental illness. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241236679. [PMID: 38449910 PMCID: PMC10916471 DOI: 10.1177/26334895241236679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Background Evidence-based practices (EBPs) improve housing and health for persons who have experienced homelessness with serious mental illness (PEH-SMI) but are challenging to implement. We tested a strategy to support pilot implementation of a 12-session housing skills training intervention for PEH-SMI, tailored from effective social skills training interventions. We aimed to optimize the implementation strategy and intervention prior to an implementation trial. Method We provided training and technical assistance to nine providers to support pilot implementation of this intervention to six groups of PEH-SMI (n = 35) engaged in VA Greater Los Angeles' homeless services. We used scales and semi-structured interviews with 14 PEH-SMI and all interventionists to inform implementation strategy adaptations, identify factors that impacted implementation, and assess perceptions of the intervention. Attendance was tracked and we observed a random sample of each interventionist's groups to assess treatment fidelity. Results Interventionists perceived the implementation strategy and the intervention favorably. However, interventionists often lacked physical space, staff, and resources (e.g., computers) to conduct the intervention. Interventionists found the content valuable for participants and a few suggested that group engagement should be a prerequisite for obtaining housing services. PEH-SMI were interested in the intervention's content and receptive to the group-based format. Participants attended a mean of 4 ± 3/12 groups; all groups observed had acceptable fidelity. Problems with intervention retention were described, suggesting challenges maintaining group participation when participants transitioned between VA homeless services. Conclusions To support the implementation of an EBP for PEH-SMI in homeless programs, these data suggest the value of training/technical assistance and strategies that enhance program-level buy-in to address resource concerns. Intervention adaptations, e.g., using a drop-in, open group format, in community-based settings that are easily accessible to PEH-SMI, may also increase adoption. This project was registered as "Improving Housing Outcomes for Homeless Veterans" Trial registration NCT03646149, registered 8/24/2018.
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Affiliation(s)
- Sonya Gabrielian
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Alison B. Hamilton
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Lillian Gelberg
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA
| | | | - Lauren Hoffmann
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - David M. Carlson
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Alexander S. Young
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Pickard K, Hendrix N, Guerra K, Brane N, Islam N. Examining provider decisions around the delivery and adaptation of a parent-mediated intervention within an Early Intervention system. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2384-2396. [PMID: 36950904 DOI: 10.1177/13623613231162149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
LAY ABSTRACT Parent-mediated interventions are an evidence-based practice for autism in which providers support caregivers in learning and applying strategies that support their child's development. Research has begun to study whether parent-mediated interventions can be effectively delivered in Part C Early Intervention systems. This research has been promising; however, it has been difficult to determine how Early Intervention providers deliver and adapt parent-mediated interventions to meet the needs of the families they serve. Examining how parent-mediated interventions are delivered and adapted may help us understand whether parent-mediated interventions are a good fit in these systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by providers within an Early Intervention system. Results from 24 Early Intervention providers demonstrated that, on average, providers delivered Project ImPACT with higher quality during their time in training and consultation. However, there was also variability in how providers delivered Project ImPACT, with some delivering the program inconsistently, some increasing their quality throughout consultation, and others having consistently high-quality delivery. In addition, qualitative data demonstrated that a variety of events arose within Project ImPACT sessions that drove providers to adapt the program. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems.
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Affiliation(s)
| | - Nicole Hendrix
- Emory University, USA
- Children's Healthcare of Atlanta, USA
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Wu Q, McWey LM, Ledermann T. Which therapist perceptions best predict client outcomes? A naturalistic examination. JOURNAL OF MARITAL AND FAMILY THERAPY 2023; 49:151-168. [PMID: 36150140 DOI: 10.1111/jmft.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.
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Affiliation(s)
- Qiong Wu
- Department of Human Development and Family Science, College of Health and Human Sciences, Florida State University, Tallahassee, Florida, USA
| | - Lenore M McWey
- Department of Human Development and Family Science, College of Health and Human Sciences, Florida State University, Tallahassee, Florida, USA
| | - Thomas Ledermann
- Department of Human Development and Family Science, College of Health and Human Sciences, Florida State University, Tallahassee, Florida, USA
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Willis HA, Gonzalez JC, Call CC, Quezada D, Galán CA. Culturally Responsive Telepsychology & mHealth Interventions for Racial-Ethnic Minoritized Youth: Research Gaps and Future Directions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:1053-1069. [PMID: 36227174 PMCID: PMC9627988 DOI: 10.1080/15374416.2022.2124516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Telepsychology and mHealth (TPmH) services for youth and their families have become increasingly prevalent in recent years. However, significant limitations in theory, research, and policy introduce questions about the effectiveness of such interventions, particularly for racial-ethnic minoritized youth and their families, who already contend with inequities in mental health treatment access and outcomes. Although TPmH have the potential to reduce barriers to mental health services in ways that may benefit racial-ethnic minoritized youth and their families, the mental health field must first grapple with limitations in culturally responsive TPmH work to avoid perpetuating existing mental health inequities. As such, this article begins by briefly reviewing extant literature on (1) TPmH for youth, (2) culturally adapted or culturally responsive evidence-based interventions for racial-ethnic minoritized youth and families, and (3) the intersection of TPmH and culturally responsive interventions. Informed by the gaps identified by this review, we provide recommendations for future directions in culturally responsive TPmH for racial-ethnic minoritized youth and families. These recommendations have been organized into four overarching categories: (1) conceptual and theoretical recommendations, (2) research priorities, (3) practice and policy recommendations, and (4) engagement and access recommendations. These recommendations offer novel ideas for researchers, clinicians, funding agencies, policy-makers, and other key stakeholders and are intended to facilitate equity in TPmH for racial-ethnic minoritized youth and their families.
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Affiliation(s)
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical, & School Psychology, University of California
| | | | - David Quezada
- Department of Psychology, University of Southern California
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Wright B, Brookman-Frazee L, Kim JJ, Gellatly R, Kuckertz M, Lau AS. Observed Engagement in Community Implemented Evidence-Based Practices for Children and Adolescents: Implications for Practice Delivery. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021:1-15. [PMID: 34424121 PMCID: PMC8863978 DOI: 10.1080/15374416.2021.1955366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This observational study characterizes youth and caregiver behaviors that may pose challenges to engagement within a system-driven implementation of multiple evidence-based practices (EBPs). We examined links between Engagement Challenges and therapist EBP implementation outcomes. METHOD Community therapists (N = 102) provided audio recordings of EBP sessions (N = 666) for youth (N = 267; 71.54%, Latinx; 51.69%, female; Mage = 9.85, Range: 1-18). Observers rated the extent to which youth and/or caregivers engaged in the following behaviors: Caregiver and/or Youth Expressed Concerns about interventions, and Youth Disruptive Behaviors. Multilevel modeling was used to identify predictors of observable Engagement Challenges, and examine associations between Engagement Challenges, and therapist-reported ability to deliver planned activities, and observer-rated extensiveness of EBP strategy delivery. RESULTS At least one Engagement Challenge was observed in 43.99% of sessions. Youth Engagement Challenges were not associated with outcomes. Caregiver Expressed Concerns were negatively associated with therapist-reported ability to carry out planned session activities (B = -.21, 95% CI[-.39-(-.02)], p < .05). However, Caregiver Expressed Concerns were positively associated with extensiveness of EBP Content strategy delivery (B = .08, 95% CI[.01-.15], p < .05). CONCLUSIONS Results suggest that Youth Engagement Challenges have little observed impact on EBP delivery. In contrast, although therapists perceive that Caregiver Expressed Concerns derail their planned activities, Caregiver Expressed Concerns are associated with more extensive delivery of content about therapeutic interventions. Community therapists' implementation of EBPs appear unaffected by common youth in-session behavioral challenges, but future research is needed to clarify whether caregivers' concerns about interventions prompt, or are prompted by, more intensive therapist EBP content instruction.
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Affiliation(s)
- Blanche Wright
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA
| | - Joanna J. Kim
- Arizona State University, Department of Psychology, Tempe, AZ
| | - Resham Gellatly
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Mary Kuckertz
- Arizona State University, Department of Psychology, Tempe, AZ
| | - Anna S. Lau
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
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Ramos G, Brookman-Frazee L, Kodish T, Rodriguez A, Lau AS. Community providers' experiences with evidence-based practices: The role of therapist race/ethnicity. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2021; 27:471-482. [PMID: 32391705 PMCID: PMC7655698 DOI: 10.1037/cdp0000357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Examining therapists' experiences implementing evidence-based practices (EBPs) is fundamental to understanding how these interventions are perceived, adapted, and delivered in community settings. However, little is known about racial/ethnic variation in the experiences of therapists serving racial/ethnic minority youth and their families. Through an innovative QUAN → qual → QUAN mixed-methods approach, we examined differences in therapists' perceptions, adaptations performed, and client-engagement challenges in the largest county-operated department of mental health in the United States. METHOD Surveys were completed by 743 therapists (Latinx [44%], White [34%], other ethnic minority [22%]), most of whom were female (88%), master's level (85%), and unlicensed (58%). A subset of therapists (n = 60) completed semistructured interviews. RESULTS Latinx therapists reported more positive experiences implementing EBPs, making more adaptations to EBPs, and encountering fewer client-engagement challenges than therapists from other racial/ethnic groups. Qualitative analyses expanded on these results, revealing that Latinx therapists commonly described adapting EBPs in terms of language and culture to improve fit and promote client engagement. Informed by these qualitative themes, a refined statistical model revealed that the ability to deliver EBPs in languages other than English might have accounted for differences in therapist-reported EBP adaptations and client-engagement challenges. CONCLUSIONS The findings suggest that racial/ethnic minority therapists have positive experiences in implementing EBPs in community settings. In the case of Latinx therapists, bilingual/bicultural competence may facilitate adapting EBPs in ways that reduce perceptions of engagement challenges with racially/ethnically diverse clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles
| | - Adriana Rodriguez
- Children and Youth Behavioral Health, Health Care Agency, Orange County
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Kodish T, Weiss B, Duong J, Rodriguez A, Anderson G, Nguyen H, Olaya C, Lau AS. Interpersonal Psychotherapy-Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:147-166. [PMID: 35422577 DOI: 10.1016/j.cbpra.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT-AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT-AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.
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Rodriguez A, Kim JJ, Zhan C, Lau AS, Hamilton AB, Palinkas LA, Gellatly R, Brookman-Frazee L. A Mixed-Method Analysis on the Impacts of a System-Driven Implementation of Multiple Child Evidence-Based Practices on Community Mental Health Providers. ACTA ACUST UNITED AC 2020; 52:67-79. [PMID: 34349341 DOI: 10.1037/pro0000353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.
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Affiliation(s)
| | | | | | | | | | | | | | - Lauren Brookman-Frazee
- University of California, San Diego and San Diego State University/University of California, San Diego
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Kim JJ, Brookman-Frazee L, Barnett ML, Tran M, Kuckertz M, Yu S, Lau AS. How community therapists describe adapting evidence-based practices in sessions for youth: Augmenting to improve fit and reach. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1238-1257. [PMID: 32097494 PMCID: PMC7261649 DOI: 10.1002/jcop.22333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/09/2020] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
The study sought to (a) characterize the types and frequency of session-level adaptations made to multiple evidence-based practices (EBPs) and (b) identify therapist-, client-, and session-level predictors of adaptations. Within the community implementation of multiple EBPs, 103 community mental health therapists reported on 731 therapy sessions for 280 clients. Therapists indicated whether they adapted EBPs in specific sessions and described adaptations in open-ended responses. Responses were coded using the Augmenting and Reducing adaptations framework. Therapists reported making adaptations in 59% of sessions. Augmenting adaptations were reported more frequently than Reducing adaptations. Multilevel logistic regression analyses revealed that greater therapist openness to EBPs, younger child age, and presenting problems was associated with Augmenting adaptations. Child presenting problem of externalizing problems predicted fewer Reducing adaptations compared with internalizing problems. This study extends the growing research examining adaptations within the context of the system-driven implementation of multiple EBPs by applying the Augmenting and Reducing adaptation framework to the session-level.
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Affiliation(s)
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Miya L. Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical & School Psychology
| | - Melanie Tran
- University of California Berkeley, Department of Psychology
| | | | - Stephanie Yu
- University of California Los Angeles, Department of Psychology
| | - Anna S. Lau
- University of California Los Angeles, Department of Psychology
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Guan K, Lau AS, Zhang A, Chlebowski C, Haine-Schlagel R, Brookman-Frazee L. In-Session Caregiver Behaviors during Evidence-Based Intervention Delivery for Children with ASD in Community Mental Health Services. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2019; 4:55-71. [PMID: 31263772 PMCID: PMC6602542 DOI: 10.1080/23794925.2019.1565500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An Individualized Mental Health Intervention for ASD, ("AIM HI"), is a collaborative, caregiver-mediated and child-directed intervention for reducing challenging behaviors in children with autism spectrum disorder developed for delivery in community mental health programs. Using observational data from AIM HI sessions, the present study characterized the occurrence of two types of in-session caregiver behaviors: expressed concerns (i.e., expressing concerns about treatment strategies; expressing difficulty using skills; expressing difficulty completing homework) and participation engagement (i.e., asking questions; participating in session activities; showing commitment to therapy). Further analyses examined cultural differences in caregiver behaviors and associations between caregiver behaviors and clinician adherence. Participants included 39 caregiver-clinician dyads enrolled in a community effectiveness trial of AIM HI. Video recordings from 107 sessions during the first two months of treatment were coded for in-session caregiver behaviors and clinician adherence. Results indicated that expressed concerns were observed in 47% of sessions. When controlling for household income, Latinx caregivers were rated lower for expressing concerns about treatment strategies and demonstrated lower participation engagement behaviors in session compared with non-Latinx White caregivers, suggesting that cultural factors may impact verbal engagement in sessions. Finally, expressing concerns about treatment strategies, expressing difficulty using skills, and participation engagement were positively associated with clinician adherence. Findings suggest that some expressed concerns and participation engagement behaviors may be indicators of positive caregiver engagement in the context of a collaborative intervention, and lower levels of such caregiver engagement may actually impede clinicians' delivery of intensive evidence-based intervention in routine care.
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Affiliation(s)
- Karen Guan
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095 U.S.A
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095 U.S.A
| | - Aimee Zhang
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095 U.S.A
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego
- Child and Adolescent Services Research Center, 3020 Children’s Way, San Diego, CA 92123 U.S.A
| | - Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University
- Child and Adolescent Services Research Center, 3020 Children’s Way, San Diego, CA 92123 U.S.A
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego
- Child and Adolescent Services Research Center, 3020 Children’s Way, San Diego, CA 92123 U.S.A
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Gellatly R, Brookman-Frazee L, Barnett M, Gonzalez JC, Kim JJ, Lau AS. Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings. CHILD & YOUTH CARE FORUM 2019; 48:55-75. [PMID: 32132809 PMCID: PMC7055736 DOI: 10.1007/s10566-018-9472-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families. OBJECTIVE The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists' self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children's mental health services. METHOD One hundred and three therapists reported on two types of engagement challenges-Limited Client Engagement and Expressed Client Concerns-in 702 sessions with 274 clients. RESULTS Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists' report of their ability to carry out intended activities in the same session. CONCLUSIONS Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.
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Affiliation(s)
- R. Gellatly
- University of California, Los Angeles, Los Angeles, CA, USA
| | - L. Brookman-Frazee
- University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - M. Barnett
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. C. Gonzalez
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. J. Kim
- University of California, Los Angeles, Los Angeles, CA, USA
| | - A. S. Lau
- University of California, Los Angeles, Los Angeles, CA, USA
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