Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions.

Abstract

Objective: Community therapists inevitably adapt evidence-based practices (EBPs) to meet the needs of their clients and practice settings. Yet, the implications of spontaneous, therapist-driven adaptations for EBP implementation outcomes are not well understood. We used a sequential QUAN → qual mixed-methods design to examine how different types of therapist-described adaptations were associated with observerrated extensiveness of therapist delivery of EBP content and technique strategies at the session level. Method: Data were drawn from an observational study of a system-driven implementation of multiple EBPs into public children's mental health services. Community therapists (n = 103) described adaptations they made in 680 sessions with 273 clients (50.92% female, 49.08% male, M age = 9.72 years, 70.70% Hispanic/ Latinx). Coders classified therapist-described adaptations into five types: (a) Modifying Presentation, (b) Integrating, (c) Extending, (d) Reducing, and (e) Generalizing. Independent observers rated the extensiveness of EBP strategy delivery from session recordings using the EBP Concordant Care Assessment (ECCA) Observational Coding System. Results: Quantitative analyses using multilevel regression revealed that Modifying Presentation adaptations were associated with higher extensiveness of EBP technique delivery, whereas Extending adaptations were associated with lower extensiveness of EBP content and technique delivery. Qualitative analysis of adaptation descriptions identified explanations for the quantitative findings. Conclusions: Findings suggest that Modifying Presentation adaptations, associated with higher extensiveness, involved creative use of activities and materials, language modification, and personalization of EBP content to meet clients' diverse needs, whereas Extending adaptations, associated with lower extensiveness, involved slowing EBP pacing in response to client challenges. Implications for provider training are discussed.What is the public health significance of this article? Community therapists adapt evidence-based practices (EBPs) when implemented in public children's mental health services, yet how such adaptations impact EBP delivery is unclear. Findings from the present study suggest that sessions in which community therapists tailored presentation of EBP concepts in creative ways to meet clients' diverse needs were associated with higher extensiveness of EBP technique delivery. In contrast, sessions in which therapists slowed down intervention pacing and relied on repetition of didactic content were associated with lower extensiveness of EBP content and technique delivery. These findings may have implications for the targeted design of supportive training strategies in the community implementation of EBPs for diverse youth.

Evidence-based tailoring of treatment to patients, providers, and processes: Introduction to the special issue.

“…Integrating theory-driven and data-driven approaches in their study, Yu et al (2021) used mixed-method analyses. Specifically, quantitative analyses (multilevel regression models) were conducted to test whether therapists adapted the treatments they provided, and qualitative analyses (grounded theory) were used to explore how and why therapists adapted their treatments.…”

“…Thus, this study demonstrates an integration of controlled and naturalistic methods. Another good example comes from the study by Yu et al (2021) in which the authors were interested in testing therapists' spontaneous adaptation of treatments to local contexts. They were interested in investigating the ways in which community therapists, who hold valuable expertise about the communities they serve, adapt treatment implementation to their patients' unique characteristics and needs.…”

Effects of an Artificial Intelligence Platform for Behavioral Interventions on Depression and Anxiety Symptoms: Randomized Clinical Trial

“…Further, although most EBPs were developed and studied in academic settings, research suggests that their dissemination in community settings requires guidance on how to maintain the course when clients struggle with EBP content [ 10 , 11 ]. When clients do not respond to treatment, therapists may need support to lean into flexible, innovative ways of delivering, teaching, or presenting EBPs to promote engagement, understanding, and fit of therapy [ 12 ]. This reality makes it an opportune time to introduce digital tools like artificial intelligence (AI) platforms that can support therapists as they provide EBPs and seek to reduce workload [ 13 ].…”

Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system

“…For example, in a study involving observation-based coding of modifications over the full treatment protocol, Marques et al found that in a sample of Spanish- and English-speaking consumers in a community mental health setting, both fidelity and modifications that remained consistent with the CPT protocol were associated with increased treatment effectiveness ( 9 ). In another study, Yu et al found that two therapist-described adaptations (extending of the protocol and modification of content) were associated with the extensiveness with which protocol elements were covered in youth mental health settings ( 10 ). High quality documentation is necessary to advance efforts to understand the types of modifications that are made and the impact that they have on both clinical and implementation outcomes ( 1 ).…”