Community-Based Implementation of a Paraprofessional-Delivered Cognitive Behavioral Therapy Program for Youth Involved with the Criminal Justice System

Abstract

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.

Ensuring the fit of an evidence‐based curriculum for high‐risk Latina young mothers using implementation science

“…delivered by paraprofessionals wherever the need for CBT arises in both English and Spanish. Main implementation findings from the iterative development of the curriculum, pilot testing, and preliminary feasibility trials suggest good feasibility and acceptability of the CBT curriculum from the perspective of Roca staff, as well as good satisfaction with the program from the perspective of Roca's high-risk young men (for full detail on development and feasibility testing of the intervention, see Valentine et al (2019)). Ongoing training and coaching efforts were implemented within Roca to increase sustainability and maintain uptake at the organization (Youn et al, 2018).…”

Practical solutions for sustaining long-term academic-community partnerships.

“…The curriculum is designed to be flexibly delivered through “formal delivery”, including in classroom settings with the use of teaching slides, or during conversations en route to activities with transportable visuals in app format in staff’s smartphones and/or keychains (“informal delivery with visuals”) (Baldwin et al, submitted manuscript, 2018). Main implementation findings from curriculum development, pilot testing, and a preliminary feasibility trial (see Figure 1 for timeline) suggest good feasibility and acceptability of the CBT curriculum from the perspective of Roca staff, as well as good satisfaction with the program from the perspective of Roca’s young men (for full detail on development and feasibility testing of the intervention, see Valentine et al, 2019).…”

“…Widened variability in competency and fidelity across staff were also due to the amount of time staff were allocated for continued CBT-specific training and coaching after initial training (training-practice gap). Roca’s significant resources and time invested in the initial CBT training of staff (Valentine et al, 2019) led to the high overall staff competency level mentioned above. However, as the partnership continued to evaluate the feasibility of sustaining the CBT curriculum long-term, it became apparent that staff needed dedicated time to prepare for delivery of CBT formal classes, as well as continue their CBT knowledge development.…”

“…Despite Roca’s full buy-in and commitment to sustaining the delivery of CBT within the organization, there were significant obstacles related to the curriculum’s sustainability, or the extent to which the intervention is integrated and maintained within the organizations’ ongoing procedures (Proctor et al, 2011) identified during the feasibility trial. Roca staff reported difficulties when delivering formal lessons due to feeling ill-equipped to manage groups in general (Valentine et al, 2019). For example, staff described differing levels of engagement in the young men during the formal CBT lessons, especially when the group being taught was comprised of various levels of motivation.…”

“…on development and feasibility testing of the intervention, see Valentine et al, 2018). However, the "how-to" of applying CBPR strategies to implementation research is not without difficulties (Roussos & Fawcett, 2000).…”