Qualitative Reports of How and When Therapists Adapt Children's Evidence-Based Practices during Community Implementation
Qualitative Reports of How and When Therapists Adapt Children's Evidence-Based Practices during Community Implementation
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DOI：
10.1080/15374416.2018.1485107
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发表时间：
2019-11-02
影响因子：
4.2
通讯作者：
Lau, Anna S.
中科院分区：
文献类型：
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作者：
Barnett, Miya L.;Brookman-Frazee, Lauren;Lau, Anna S.
本研究分析了治疗师在儿童社区心理健康服务系统驱动改革背景下对多种循证实践 (EBP) 的适应情况的定性报告，以了解治疗师如何适应 EBP 以及这些适应的背景，从而确定何时进行这些适应。该研究试图补充和扩展之前对 EBP 的增强和减少/重新排序两类适应性的定量调查结果。数据包括对 11 个心理健康机构的 20 个项目点的 60 名治疗师（88.3% 为女性，61.7% 为拉丁裔/非裔，80.0% 为无执照）的采访，这些机构为不同种族/民族的儿童提供服务。对采访进行编码，以确定围绕所进行的改编类型和这些改编的背景的主题。大多数治疗师对适应的定性描述与增强和减少/重新排序框架中的两大类一致，治疗师最常描述增强（例如，修改表现、延长或延长节奏），而减少/重新排序适应则较少讨论。儿童和家庭特征最常被引用为促使适应的迹象；然而，促使适应的具体特征因类型而异。治疗师报告在广泛的客户特征背景下使用增强适应，而减少/重新排序适应更具体地作为临床表现、家庭和护理人员功能以及紧急生活事件的函数而发生。治疗师描述了如何进行调整以提高多个 EBP 与他们所服务的客户的契合度。研究结果可能会对社区环境中服务的不同客户的实施工作产生影响。
This study analyzed qualitative therapist reports of adaptations to the delivery of multiple evidence-based practices (EBPs) within the context of a system-driven reform of children's community mental health services to understand how therapists adapt EBPs as well as contexts of these adaptations to identify when these adaptations are made. The study sought to complement and expand upon previous quantitative survey findings of two categories of Augmenting and Reducing/Reordering adaptations to EBPs. Data included interviews from 60 therapists (88.3% female, 61.7% Latina/o, 80.0% unlicensed) across 20 program sites in 11 mental health agencies that served racial/ethnically diverse children. Interviews were coded to identify themes surrounding the types of adaptations made and the contexts for these adaptations. The majority of therapists' qualitative descriptions of adaptations converged with the 2 broad categories in the Augmenting and Reducing/Reordering Framework, with therapists describing augmenting (e.g., modifying presentation, lengthening or extending pacing) most often, and reducing/reordering adaptations were discussed less frequently. Child and family characteristics were most frequently cited as indications prompting adaptations; however, the specific characteristics motivating adaptations differed by type. Therapists reporting using augmenting adaptations in the context of a wide range of client characteristics, whereas reducing/reordering adaptations occurred more specifically as a function of clinical presentation, family and caregiver functioning, and emergent life events. Therapists described making adaptations to improve the fit of multiple EBPs for the clients they served. Findings could have implications for implementation efforts with diverse clients served in community settings.