Symposia
Treatment - Other
Christopher Georgiadis, M.S.
Florida International University
Doral, Florida
Deepika Bose, M.S.
Clinical Intern
Florida International University
Miami, Florida
Rebecca Wolenski, M.S.
Graduate Student
Florida International University
Miami, Florida
Natalie Hong, M.S.
Clinical Intern
Florida International University
Miami, Florida
Stefany Coxe, Ph.D
Associate Professor
FIU
Miami, FL
Jeremy W. Pettit, Ph.D.
Associate Professor
Florida International University
Miami, Florida
Jonathan S. Comer, Ph.D.
Associate Professor
Florida International University
Miami, Florida
Objective: Treatment protocols for youth internalizing disorders have been developed, however these protocols have yielded mixed findings in routine care settings. Despite increased recognition of the importance of flexibility when delivering evidence-based treatments (EBTs), little is known about the extent to which protocols provide guidance to providers in flexible EBT implementation. The current study examined the extent to which supported EBTs for youth internalizing disorders explicitly incorporate guidance for treatment modification.
Methods: Supported treatment protocols for youth internalizing disorders were identified (n = 44), from which 4,021 modification guidelines were extracted and coded using a structured coding system to classify modification strategies (i.e., the forms that recommended modifications take), and associated tailoring factors (i.e., the rationale for which modification are recommended). Descriptive statistics were computed to determine the frequencies and proportions of each code, and repeated-measures ANOVA analyses were conducted to determine if modification inclusion varied as a function of treatment family or diagnostic target of the treatment protocols.
Results: Across all EBTs, modification guidelines were quite common, with the average protocol including almost 91 text passages providing guidance for modification. That said, the majority of modification guidelines functionally increase session or treatment length by recommending the addition or repetition of material, whereas less than 5% of modification guidelines provided strategies for condensing, omitting, or streamlining care. Strikingly, less than 2% of modification guidelines in EBT protocols address patient cultural factors and rarely address provider or setting limitations that can challenge standard implementation. No differences in modification inclusion were identified as a function of treatment family or diagnostic target of the treatment protocol.
Conclusions: Findings highlight critical gaps in the current portfolio of EBT protocols for youth internalizing disorders, and suggest EBT protocols, as currently written, are not optimally poised to flexibly address the broad diversity of children and adolescents across varied settings in need of mental health care.