RESUMO
This study explored mental health professionals' perceptions about barriers and facilitators to engaging underserved populations. Responses were coded using an iterative thematic analysis based on grounded theory. Results revealed that many professionals endorsed barriers to engaging ethnic minorities and families receiving social services. Client-provider racial and linguistic matching, therapy processes and procedures (e.g., nonjudgmental stance), and implementation supports (e.g., supervision) were commonly nominated as engagement facilitators. Many professionals felt that an organizational culture focused on productivity is detrimental to client engagement. Findings shed light on professionals' perceived barriers to delivering high-quality care to underserved communities and illuminate potential engagement strategies.
Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Saúde Mental , Pessoal de Saúde/psicologia , Área Carente de Assistência Médica , Populações Vulneráveis , Adulto , Feminino , Disparidades nos Níveis de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
OBJECTIVE: This study examined associations between ethnic minority therapists' reports of acculturation and adaptations made to multiple evidence-based practices (EBPs) in children's community mental health services. Multilevel modeling was used to analyze therapist- and practice-level predictors of Augmenting and Reducing/Reordering adaptations, the two subscales of the Adaptations to Evidence-Based Practices Scale (AES; Lau et al., 2017). METHOD: An online survey was completed by 235 therapists (86% women, Mage = 34.82 years, 68.1% Hispanic/Latino) as part of a larger study examining EBP sustainment in Los Angeles County, California. Acculturation was measured through therapist reports of cultural identity and language use using the Abbreviated Multidimensional Acculturation Scale (Zea, Asner-Self, Birman, & Buki, 2003). RESULTS: Analyses showed that the effect of Heritage Cultural Identity on Augmenting adaptations was moderated by Heritage Language Use. There was a significant interaction between Heritage and United States Cultural Identity dimensions in predicting Reducing/Reordering adaptations. Therapists who reported higher levels of Heritage Cultural Identity and lower levels of United States Cultural Identity reported the fewest Reducing/Reordering adaptations, whereas therapists who reported higher levels of affiliation with both their Heritage Culture and United States Culture reported making the most Reducing/Reordering adaptations. Language acculturation and other cultural factors such as Ethnicity and Generational Status did not predict either adaptation type. Therapists who reported more favorable perceptions of the EBP reported making fewer Reducing/Reordering adaptations. CONCLUSION: Findings suggest that cultural identity is linked to the likelihood that ethnic minority therapists may adapt EBPs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Assuntos
Aculturação , Atitude do Pessoal de Saúde , Etnicidade/psicologia , Papel Profissional , Adolescente , Adulto , California , Criança , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Grupos Minoritários/psicologia , Estados UnidosRESUMO
This study investigated therapist reports of client engagement challenges in delivering evidence-based practices (EBPs), within the context of a large-scale implementation of multiple practices in children's mental health services. Data were drawn from an online survey of 668 therapists (88% female, 35.0% Non-Hispanic White). The majority of therapists (75.4%) endorsed at least one client engagement challenge during their implementation of an EBP with an identified client over the previous two months. Two types of EBP client engagement challenges with distinct correlates but similar overall frequencies could be readily differentiated - Expressed Client Concerns and Limited Client Engagement in therapy activities. Limited Client Engagement were more commonly reported for clients with externalizing problems and by therapists with higher emotional exhaustion and negative perceptions of the specific EBP being delivered, whereas Hispanic/Latino therapists were less likely to report Limited Client Engagement. In contrast, Expressed Client Concerns were more commonly reported by therapists with positive general attitudes towards EBPs, and among therapists delivering a parent training EBP. Limited Client Engagement but not Expressed Concerns were linked with therapists' self-reported ability to carry out the EBP with the target client. Findings suggest that client engagement challenges are frequent during the delivery of EBPs, but may impact implementation differently based on whether they relate to challenges in engaging clients in therapy activities versus addressing concerns raised by clients.
RESUMO
OBJECTIVE: This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children's mental health services. Based on an item set informed by Stirman and colleagues' model (2015), 2 factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We used multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. METHOD: Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. RESULTS: Analyses revealed that the 2 types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists' general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. CONCLUSIONS: Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components. (PsycINFO Database Record
Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde da Criança , Prática Clínica Baseada em Evidências , Transtornos Mentais/terapia , Serviços de Saúde Mental , Criança , Feminino , Financiamento Governamental , Pesquisas sobre Atenção à Saúde , Humanos , MasculinoRESUMO
Therapists' perceptions toward evidence-based practices (EBPs) are important in implementation efforts, however little is known about characteristics of EBPs associated with more positive attitudes. This mixed-methods study examined how intervention and implementation characteristics of six EBPs related to therapist attitudes. Quantitative analysis of 793 cross-sectional surveys revealed that therapists endorsed more positive attitudes toward EBPs with (1) prescribed session content and order and (2) required consultation. Associations between these intervention and implementation characteristics and attitudes were not moderated by therapist experience or emotional exhaustion. Qualitative analyses complemented quantitative findings, indicating that "structure" was appealing for interventions and that therapists felt supported by consultation.