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Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions.
Journal of Consulting and Clinical Psychology ( IF 7.156 ) Pub Date : 2021-08-19 , DOI: 10.1037/ccp0000667
Stephanie H Yu 1 , Lauren Brookman-Frazee 2 , Joanna J Kim 1 , Miya L Barnett 3 , Blanche Wright 1 , Anna S Lau 1
Affiliation  

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 observer-rated 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, Mage = 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. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译:

治疗师适应循证实践并与儿童治疗会议的实施结果相关联。

目标 社区治疗师不可避免地会调整循证实践 (EBP) 以满足其客户和实践环境的需求。然而,自发的、治疗师驱动的适应对 EBP 实施结果的影响尚不清楚。我们使用顺序 QUAN → qual 混合方法设计来检查不同类型的治疗师描述的适应如何与观察者评价的治疗师在会话级别提供 EBP 内容和技术策略的广泛性相关联。方法 数据来自一项系统驱动实施多个 EBPs 到公共儿童心理健康服务的观察性研究。社区治疗师 (n = 103) 描述了他们在与 273 名客户(50.92% 女性,49.08% 男性,Mage = 9.72 岁,70.70% 西班牙裔/拉丁裔)的 680 次会谈中所做的调整。编码人员将治疗师描述的适应分为五种类型:(a) 修改演示,(b) 整合,(c) 扩展,(d) 减少,和 (e) 概括。独立观察员使用 EBP 协调护理评估 (ECCA) 观察编码系统从会话记录中评估 EBP 策略交付的广泛性。结果 使用多级回归的定量分析表明,修改演示文稿改编与 EBP 技术传递的广泛性相关,而扩展改编与 EBP 内容和技术传递的广泛性较低相关。适应描述的定性分析确定了对定量结果的解释。结论 调查结果表明,与更高的广泛性相关的修改演示文稿改编,涉及活动和材料的创造性使用、语言修改和 EBP 内容的个性化以满足客户的多样化需求,而扩展适应性与较低的广泛性相关,涉及减缓 EBP 节奏以应对客户的挑战。讨论了对提供者培训的影响。(PsycInfo 数据库记录 (c) 2022 APA,保留所有权利)。
更新日期:2021-08-19
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