Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children's mental health services.

Abstract:

OBJECTIVE:This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children's mental health services. Based on an item set informed by Stirman and colleagues' model (2015), 2 factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We used multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. METHOD:Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. RESULTS:Analyses revealed that the 2 types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists' general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. CONCLUSIONS:Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components. (PsycINFO Database Record

journal_name

J Consult Clin Psychol

authors

Lau A,Barnett M,Stadnick N,Saifan D,Regan J,Wiltsey Stirman S,Roesch S,Brookman-Frazee L

doi

10.1037/ccp0000215

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

664-675

issue

7

eissn

0022-006X

issn

1939-2117

pii

2017-19965-001

journal_volume

85

pub_type

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