Symposia
Dissemination & Implementation Science
Allison B. Smith, Ph.D.
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Harlee Onovbiona, BS
Doctoral Student
University of Arkansas Psychology Department
Fayetteville, Arkansas
Tim Cavell, Ph.D.
Professor
University of Arkansas
Fayetteville, Arkansas
Youth in foster care experience trauma and subsequent trauma-related disorders at prevalence rates comparable to veterans of war. Although several evidence-based treatments (EBTs) exist for the treatment of child and adolescent trauma, little is known about stakeholder (e.g., clinicians) perceptions of implementation needs. The current study used a mixed-methods approach to examine rates of treatment model use and the barriers and facilitators that stakeholders (i.e., community clinicians treating youth in foster care) to EBT use. Quantitative concepts and the qualitative coding scheme were mapped onto the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (Aarons et al., 2011). Participants (N = 148) were community clinicians recruited through electronic means (e.g., social media and email advertisements) to complete a quantitative survey, and a subset (n = 15) completed a semi-structured qualitative interview. A majority (n = 135) of clinicians endorsed using trauma-focused cognitive behavior therapy (TF-CBT) when working with youth in foster care. Some clinicians also reported using models with limited empirical support for trauma treatment, such as non-directive play therapy (n = 68) and art therapy (n = 68). TF-CBT use was positively correlated with other EBT use, including combined parent-child cognitive behavior therapy ( r(146) = .101 p </em>= .027) and parent-child interaction therapy ( r(146) = .237 p </em>= .006). Clinicians endorsed barriers (n = 127) to treatment more often than facilitators (n = 50) when working with youth in foster care. Most clinicians identified barriers as outer contextual factors, such as working with caseworkers (n = 91) and court systems (n = 77). Conversely, clinicians described inner contextual factors as facilitators, such as agency policies and support (n = 68). Qualitatively, providers described positive attitudes toward existing EBTs for youth trauma treatment but indicated barriers prevent their use with youth in foster care. Understanding the barriers and facilitators to using evidence-based trauma treatment with youth in foster care from the perspective of important stakeholders (i.e., community clinicians) has implications for policymakers and implementation developers. For example, future implementation efforts may consider addressing outer contextual barriers to support implementation, adapting existing EBTs to align with existing barriers and facilitators, and supporting policies and legislation that may increase trauma EBT use for youth in foster care.