Category: Dissemination / Implementation

Symposium

Therapist-Reported Barriers to Client Engagement in Evidence-Based Practices in Community Settings

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

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

Active engagement of clients in EBPs is essential to for positive outcomes in community settings (McLeod & Weisz, 2005). Difficulties in EBP implementation in diverse community settings may relate to barriers to engagement of low-income ethnic minority youth and families. 


Data for the current study were culled from a study of a large-scale children’s mental health system reform. Therapists reported on barriers encountered in session on the EBP Concordant Care Assessment (ECCA). Analyses from 94 therapists on 718 sessions with 263 clients (M age = 9.62, SD = 3.80, 51.3% female, 73% Hispanic) revealed at least one reported barrier to engagement (e.g., disinterested behavior) in 36% of sessions. Significantly more barriers related to acceptability of intervention and difficulty completing assignments were reported by therapists in caregiver-only sessions (p < .05) compared to sessions with youth. 


Multilevel analyses were conducted to identify predictors of total barriers. Overall, differences were found in the predictors associated with reported barriers in caregiver-sessions, and sessions with youth. Notably, in youth-only sessions, therapists with more openness towards EBPs reported significantly more barriers (B = 0.43, p = 0.010), while in caregiver-only sessions, therapists with worse general attitudes towards EBPs reported significantly more barriers (EBPAS Divergence: B = 1.07, p = .004; EBPAS Openness B = -2.00, p = .004). Therapists with better practice-specific attitudes reported more total barriers in caregiver-only sessions (B = 0.19, p = .029). 


Reported barriers were found to negatively impact therapists’ ability to deliver EBPs as planned. Therapists who reported more barriers were reportedly less able to carry out intended session activities (full sample: B = -0.228, p < .001). Additionally, more reported barriers predicted a more negative impact on therapists’ ability to carry out the session as planned in youth-only and combined sessions, but not in caregiver-only sessions.


These findings will be discussed in terms of potential to explain disparities in EBP implementation outcomes with ethnic minority families in community settings.

Resham Gellatly

Graduate Student
UCLA

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