The purpose of this study is to examine associations between therapist adherence, competence, and modifications of an evidence-based protocol (EBP) delivered in routine clinical care and client outcomes. Method: Data were derived from a NIMH-funded implementationeffectiveness hybrid study of Cognitive Processing Therapy (CPT) for PTSD in a diverse community health center. Providers (n ϭ 19) treated clients (n ϭ 58) as part of their routine clinical care. Clients completed the PCL-S and PHQ-9 at baseline, after each CPT session, and posttreatment. CPT sessions were rated for treatment fidelity and therapist modifications. Results: Overall, therapist adherence was high, although it decreased across sessions suggesting potential drift. Therapist competence ratings varied widely. Therapists made on average 1.6 fidelity-consistent and 0.4 fidelity-inconsistent modifications per session. Results show that higher numbers of fidelityconsistent modifications were associated with larger reductions in posttraumatic stress and depressive symptoms. High adherence ratings were associated with greater reductions in depressive symptoms, whereas higher competence ratings were associated with greater reduction in posttraumatic stress symptoms. Conclusions: The results highlight the importance of differentially assessing therapist adherence, competence, and modifications to EBP in usual care settings. The findings also suggest that effective EBP delivery in routine care may require minor adaptations to meet client needs, consistent with previous studies. Greater attention to fidelity and adaptation can enhance training so providers can tailor while retaining core components of the intervention.

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Psychosocial interventions for common emotional and behavioral difficulties have been developed for use in correctional facilities, yet these programs are largely unavailable upon community re-entry due to a shortage of trained mental health specialists. In this study, we developed and piloted a youth worker-delivered cognitive behavioral therapy (CBT) program for young men at high risk for incarceration receiving services at a youth development organization. We formed a community-academic partnership to support the conduct of research across all phases of this project (2014–2016). We analyzed data gathered through focus groups and individual interviews with program staff, administrators, and young men. This study reports on implementation process and outcomes across phases. Main findings indicate the preliminary feasibility and acceptability of the youth worker-delivered CBT curriculum. We discuss strengths and limitations of our approach and provide suggestions for future studies that aim to implement paraprofessional-delivered CBT programs within community-based organizations.

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Ensuring that evidence-based assessment measures of anxiety are reliable and valid in Latinx youth samples is a critical prerequisite for research aimed at addressing the anxiety-related disparities this population experiences. The Multidimensional Anxiety Scale for Children (MASC;March et al., 1997) is a widely used measure of anxiety in children and adolescents, yet the psychometric properties of the MASC among Latinx youth have only been examined in one small-scale study. To address this gap, the present study sought to identify the factor structure, reliability, and validity of the English version of the MASC in Latinx adolescents. A battery of questionnaires including the MASC and the Youth Self-Report (YSR; Achenbach, 1991) was administered to a sample of 676 Latinx adolescents (aged 13-17; 52.5% female). Procedures were completed in a classroom setting at a high school located in a rural, predominately Latinx community. Confirmatory factor analysis using diagonally weighted least squares estimation provided support for the original four-factor structure of the MASC, with model fit improved by moving one item related from the Harm Avoidance to the Social Anxiety subscale. Subscales and the total score showed excellent reliability and the total score demonstrated good convergent and divergent validity. The present study supports the MASC as a reliable and valid measure for assessing anxiety in English-speaking Latinx youth. Findings broaden a literature that has infrequently considered the psychometric properties of anxiety measures in diverse youth samples. Public Significance StatementA common self-report assessment of anxiety for youth was shown to appropriately measure anxiety in a rural, Latinx adolescent sample. The availability of reliable and valid assessment tools is an important step in the clinical treatment of anxiety and the mitigation of anxiety-related disparities in this population.