Category: Dissemination / Implementation

Symposium

Reasons for Community Therapist Adaptations to Multiple Evidence-Based Practices Within a Mental Health System Reform

Sunday, November 19
8:30 AM - 10:00 AM
Location: Sapphire Ballroom B, Level 4, Sapphire Level

Keywords: Child | Dissemination | Community-Based Assessment / Intervention
Presentation Type: Symposium

Therapist adaptations to EBPs have the potential to improve client engagement, but should not remove core components of EBPs. This study characterizes adaptations therapists made to multiple EBPs delivered within a large-scale system reform of children’s mental health services in Los Angeles County. This reform fiscally mandated the use of select evidence-based and informed practices. 


A sequential mixed-methods design was used to examine therapist reported adaptations to five EBPs. Therapists (n = 572) completed surveys and rated the extent to which they adapted the EBPs that they delivered. A multi-level confirmatory factor analysis revealed two types of adaptations, those that Augment EBPs and those that Reduce or Reorder intervention components. Follow-up qualitative interviews with therapists (n = 39) complemented and expanded survey data to understand the nature and intended purpose of adaptations. The most frequently endorsed adaptations augmented EBP delivering, including modifying the presentation of content, integrating supplemental content, and lengthening the pacing of treatment. The least frequently endorsed reduced content (e.g., removing treatment components). Consistent with the quantitative findings, therapists most often described augmenting adaptations focused on increasing engagement during the semi-structured interviews. Themes suggested that therapists identified different reasons for augmenting EBPs compared to reducing content delivery. For example, therapist reported that they omitted components of treatment if they were not developmentally appropriate or did not address the client’s presenting problem, whereas they modified the EBP’s language to better fit their clients’ culture and developmental level.


 Our findings suggest that even though therapists routinely adapt EBP, the most frequent adaptations described are related to augmenting care to improve engagement. Therapists provided reasons as to why they may omit components of treatment, which were consistent with the client’s developmental ability. EBP developers and trainers can focus on ways to appropriately adapt EBPs delivered to diverse populations.

Miya Barnett

Assistant Professor
University of California, Santa Barbara

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