ABSTRACT

Objective

This observational study characterizes youth and caregiver behaviors that may pose challenges to engagement within a system-driven implementation of multiple evidence-based practices (EBPs). We examined links between Engagement Challenges and therapist EBP implementation outcomes.

Method

Community therapists (N = 102) provided audio recordings of EBP sessions (N = 666) for youth (N = 267; 71.54%, Latinx; 51.69%, female; M_age = 9.85, Range: 1–18). Observers rated the extent to which youth and/or caregivers engaged in the following behaviors: Caregiver and/or Youth Expressed Concerns about interventions, and Youth Disruptive Behaviors. Multilevel modeling was used to identify predictors of observable Engagement Challenges, and examine associations between Engagement Challenges, and therapist-reported ability to deliver planned activities, and observer-rated extensiveness of EBP strategy delivery.

Results

At least one Engagement Challenge was observed in 43.99% of sessions. Youth Engagement Challenges were not associated with outcomes. Caregiver Expressed Concerns were negatively associated with therapist-reported ability to carry out planned session activities (B = −.21, 95% CI[−.39-(−.02)], p < .05). However, Caregiver Expressed Concerns were positively associated with extensiveness of EBP Content strategy delivery (B = .08, 95% CI[.01-.15], p < .05).

Conclusions

Results suggest that Youth Engagement Challenges have little observed impact on EBP delivery. In contrast, although therapists perceive that Caregiver Expressed Concerns derail their planned activities, Caregiver Expressed Concerns are associated with more extensive delivery of content about therapeutic interventions. Community therapists’ implementation of EBPs appear unaffected by common youth in-session behavioral challenges, but future research is needed to clarify whether caregivers’ concerns about interventions prompt, or are prompted by, more intensive therapist EBP content instruction.

中文翻译：

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观察到的社区对儿童和青少年实施的循证实践的参与：对实践交付的影响

 抽象的

 客观的

这项观察性研究描述了青少年和护理人员的行为特征，这些行为可能会对系统驱动的多种循证实践 (EBP) 的实施带来挑战。我们研究了参与挑战与治疗师 EBP 实施结果之间的联系。

 方法

社区治疗师 (N = 102) 为青少年（N = 267；71.54%，拉丁裔；51.69%，女性； M_年龄= 9.85，范围：1–18）提供 EBP 课程（N = 666）的录音。观察员对青少年和/或看护者从事以下行为的程度进行了评估：看护者和/或青少年对干预措施表示担忧，以及青少年破坏性行为。多级建模用于识别可观察的参与挑战的预测因素，并检查参与挑战与治疗师报告的实施计划活动的能力以及观察者评价的 EBP 策略实施的广泛性之间的关联。

 结果

43.99% 的会议中至少观察到一项参与度挑战。青年参与挑战与结果无关。护理人员表达的担忧与治疗师报告的执行计划会议活动的能力呈负相关（B = −.21, 95% CI[−.39-(−.02)], p < .05）。然而，看护者表达的担忧与 EBP 内容策略交付的广泛性呈正相关（B = .08，95% CI[.01-.15]， p < .05）。

 结论

结果表明，青年参与挑战对 EBP 实施几乎没有观察到影响。相比之下，尽管治疗师认为看护者表达的担忧破坏了他们计划的活动，但看护者表达的担忧与更广泛地传递有关治疗干预的内容相关。社区治疗师对 EBP 的实施似乎不受青少年在治疗中常见行为挑战的影响，但需要未来的研究来澄清护理人员对干预措施的担忧是否会促使或受到更强化的治疗师 EBP 内容指导的影响。