Symposia
Dissemination & Implementation Science
Stephanie H. Yu, M.A.
University of California, Los Angeles
LOS ANGELES, California
Caroline E. Shanholtz, Ph.D.
Postdoctoral Scholar
University of California, Los Angeles
Scottsdale, Arizona
Joanna Kim, PhD
Postdoctoral Fellow
Arizona State University
Tempe, Arizona
Lauren Brookman-Frazee, Ph.D.
Professor
University of California, San Diego
San Diego, California
Anna S. Lau, Ph.D.
Professor
UCLA
Los Angeles, California
Trauma-focused cognitive behavioral therapy (TF-CBT) is a leading treatment for youth trauma and has been widely disseminated in public mental health systems serving diverse youth (Sigel et al., 2013). Community therapists frequently report adapting evidence-based practices (EBPs), including TF-CBT, when they are transported into public systems of care, to enhance their fit to the diverse contexts and clients they serve (Barnett et al., 2018). Community therapists are key stakeholders who hold valuable local expertise about what promotes client engagement in their care context and so may be in a good position to tailor EBP delivery (Alvidrez et al., 2018). Yet, there may be risks to EBP delivery if adaptations are not systematic or well-monitored. Developing methods to characterize session-level adaptations is a needed next step. Studies characterizing therapist-reported adaptations in the Los Angeles County Department of Mental Health (LACDMH) in an implementation-as-usual context have identified Augmenting adaptations as those that add to or tailor the EBP in some way and are suggested to reflect therapist engagement in the EBP (Lau et al., 2017; Kim et al., 2020). It is important to validate therapist reports of adaptations using observer measures, given that therapist self-reports may be vulnerable to biases and idiosyncratic definitions of adaptations (Yu et al., 2020). The current study will employ an observer-coded measure of previously identified types of Augmenting adaptations, including modifying presentation of EBP components, integrating supplemental EBP strategies or problem foci, and extending by way of repeating components or material in sessions of TF-CBT. A sample of 49 LACDMH therapists (93.88% female, 6.12% male, Mage = 35.7, 44.9% Latinx) provided 209 TF-CBT session audio recordings and surveys on client and session characteristics for a sample of 90 youth clients (61.11% female, 38.89% male, Mage = 10.34, 70% Latinx). Coders will rate the occurrence and extensiveness (0 = no occurrence, 4 = to a great extent) of each adaptation type. Kappas and intraclass correlations will be computed for occurrence and extensiveness of each adaptation-type, respectively, to assess interrater reliability of the observer measure. Therapist-reported Augmenting adaptations made in the same sample of sessions were characterized in a prior study (Kim et al., 2020). Kappas will be computed to examine the concordance between therapist and observer report of Augmenting adaptations. Implications and future directions will be discussed.