Symposia
Child / Adolescent - Anxiety
Douglas J. Clapp, MFT
La Salle University
Philadelphia, Pennsylvania
Joshua Shields, BA
Clinician
Hall mercer Community Mental Health
Philadelphia, Pennsylvania
Amber Howard, MA
Clinician
Hall mercer Community Mental Health
Philadelphia, Pennsylvania
Emily M. Becker-Haimes, Ph.D.
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania
Background: Exposure therapy (EXP) is the leading treatment for pediatric anxiety and related disorders (ARDs) but up to 90% of youth who seek treatment for ARDs in the community do not receive it. When community youth do access EXP, treatment may not be at the dose required to meet their needs. In particular, traditional outpatient services can struggle to meet the needs of low-income and minority youth with ARDs due to sequelae of negative social determinants of health, (e.g., poverty, trauma, housing, and food insecurity) that increase psychiatric acuity, reduce engagement, and contribute to challenges with family functioning. Strategically targeting EXP implementation efforts to existing publicly-funded high-intensity treatment models can expand EXP’s reach to the most severe and at-risk children with ARDs in the community.
Methods: We will describe the implementation process of an exploratory intensive, in-home, family therapy program for youth and families on medical assistance with severe ARDs (“PHIIPATCH”). We engaged in an iterative process of intervention refinement with community stakeholders (clinicians, supervisors, payers), guided by principles of implementation mapping. Goals throughout design were to maximize EXP dosage within the feasibility constraints of an existing, high-intensity Medicaid service line for youth at high-risk of hospitalization.
Results: The resultant PHIIPATCH program integrates principles of intensive EXP with those from family systems, strengths-based approaches, and crisis stabilization. To date, program utilization has resulted in approximately 15 youth and their families treated under this pilot program, with referrals from across the Philadelphia region. We will present implementation successes and challenges and plans for sustainability and scale-up, informed by leading implementation theories.
Conclusions: Adapting an existing family systems protocol facilitated ability to provide intensive EXP to youth on Medicaid at high risk of hospitalization. Initial stakeholder feedback suggests EXP can be successfully embedded into existing services. Implementation challenges persist and future directions will be discussed.