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Wright B, Brookman-Frazee L, McLeod BD, Flores A, Alegría M, Langer DA, Chavira D, Lau AS. Shared Decision-Making with Latinx Caregivers During Community Implemented Evidence-Based Practices: Determinants and Associations with Alliance. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-14. [PMID: 39058624 DOI: 10.1080/15374416.2024.2372761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers. METHOD The Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions. RESULTS Greater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = -8.79, 95% CI[-14.09, -3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance. CONCLUSIONS SDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy.
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Affiliation(s)
- Blanche Wright
- Department of Health Policy and Management, University of California, Los Angeles
- Department of Behavioral and Policy Sciences, RAND
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego
- Child and Adolescent Services Research Center
| | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University
| | - Ashley Flores
- Department of Psychology, University of California, Los Angeles
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School
- Disparities Research Unit, Massachusetts General Hospital
| | | | - Denise Chavira
- Department of Psychology, University of California, Los Angeles
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Chan V, Albaum CS, Khanlou N, Westra H, Weiss JA. Parent Involvement in Mental Health Treatment for Autistic Children: A Grounded Theory-Informed Qualitative Analysis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01621-x. [PMID: 37847326 DOI: 10.1007/s10578-023-01621-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Abstract
Cognitive behavior therapy (CBT) is an effective treatment for many autistic children experiencing mental health problems, and parents are particularly involved in their psychotherapy. This study presents a conceptual framework of successful parent involvement in CBT for autistic children. Seventeen therapists (94% female) and 11 mothers were interviewed about their involvement in a CBT program for autistic children ages 8-13 years. The conceptual framework depicts how parent involvement varies depending on child, parent, and environmental factors. Parents' contributions to therapy were grouped into five main roles. Parents' beliefs and attitudes toward therapy also influenced their involvement. This is the first study to empirically investigate how parents of autistic children contribute to the therapeutic process in CBT.
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Affiliation(s)
- Victoria Chan
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada.
| | - Carly S Albaum
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | | | - Henny Westra
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Wright B, Brookman-Frazee L, Alegría M, Langer D, Lau AS. Shared decision making between community therapists and Latinx caregivers during evidence-based practice delivery in publicly-funded children's mental health services. PATIENT EDUCATION AND COUNSELING 2023; 115:107867. [PMID: 37406470 DOI: 10.1016/j.pec.2023.107867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES This observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. Study aims were to (1) Characterize therapist use of SDM strategies and (2) Describe the types of treatment decisions that were the focus of therapist use of SDM. METHODS The OPTION instrument was used to measure SDM in 210 audio-recorded therapy sessions with 62 community therapists and 109 Latinx caregivers; frequency and mean ratings of OPTION items were examined. Qualitative analysis on the descriptions of treatment decisions being deliberated was also conducted. RESULTS Results revealed that therapists used at least one SDM step in most sessions (N = 192; 91.43%) with a mean composite score of 32.78 (SD=17.79; range: 6.25-81.25). Four superordinate categories of decisions were: (1) Treatment planning, (2) Evidence-based Parenting Strategies, (3) Addressing Youth Functioning, and (4) Addressing Family Psychosocial Needs. CONCLUSIONS Findings suggest that community therapists serving Latinx families are naturalistically engaging in SDM steps about a variety of decisions during most EBP sessions, but only at modest levels.
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Affiliation(s)
- Blanche Wright
- Department of Health Policy and Management, University of California, Los Angeles, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego; Child and Adolescent Services Research Center, San Diego, USA
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School; Disparities Research Unit, Massachusetts General Hospital, Boston, USA
| | - David Langer
- Department of Psychology, Suffolk University, Boston, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, USA
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Wright B, Brookman-Frazee L, Kim JJ, Gellatly R, Kuckertz M, Lau AS. Observed Engagement in Community Implemented Evidence-Based Practices for Children and Adolescents: Implications for Practice Delivery. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:475-489. [PMID: 34424121 PMCID: PMC8863978 DOI: 10.1080/15374416.2021.1955366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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; Mage = 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.
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Affiliation(s)
- Blanche Wright
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry, San Diego, CA
- Child and Adolescent Services Research Center, San Diego, CA
| | - Joanna J. Kim
- Arizona State University, Department of Psychology, Tempe, AZ
| | - Resham Gellatly
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Mary Kuckertz
- Arizona State University, Department of Psychology, Tempe, AZ
| | - Anna S. Lau
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
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Luelmo P, Larios R, Castellon F. Latinx caregivers and autism identification: what we know a scoping review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:571-581. [PMID: 38983495 PMCID: PMC11229736 DOI: 10.1080/20473869.2022.2114777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/14/2022] [Indexed: 07/11/2024]
Abstract
This is a scoping review driven by the broad research question: What are Latinx caregivers' specific facilitators and challenges, if any, in getting a timely diagnosis/identification for their child with autism? Our search resulted in 128 articles across various disciplines. A total of 43 articles were included in the final article set. Employing an inductive process, the experiences of Latinx caregiver(s) in obtaining a diagnosis/identification were coded and categorized. From that process, three broad themes were identified: (1) Diagnosis/identification barriers and facilitators (2) System changes and (3) Cultural adaptations and intersectionality. These themes represent the myriad of considerations that have been purported in the existing body of literature to frame an understanding of the experiences that Latinx/Hispanic caregivers encounter as they seek to obtain an autism diagnosis/identification for their child.
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Affiliation(s)
- Paul Luelmo
- Department of Special Education, San Diego State University, San Diego, CA, USA
| | - Rosalinda Larios
- Department of Special Education, California State Fullerton, Fullerton, CA, USA
| | - Fernanda Castellon
- Department of Education, University of California, Los Angeles, Los Angeles, CA, USA
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Dickson KS, Chlebowski C, Haine-Schlagel R, Ganger B, Brookman-Frazee L. Impact of Therapist Training on Parent Attendance in Mental Health Services for Children with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:230-241. [PMID: 32816564 DOI: 10.1080/15374416.2020.1796682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The current study explored the impact of training therapists in a mental health intervention for children with autism spectrum disorder (ASD) on parent attendance in their children's therapy sessions. We also examined family, therapist, and program factors as potential moderators. METHOD Data were drawn from a cluster-randomized community effectiveness trial of "An Individualized Mental Health Intervention for ASD (AIM HI)". Participants included 168 therapists yoked with 189 children recruited from publicly-funded mental health services. Data included family (caregiver strain, parent sense of competence, race/ethnicity), therapist (background, experience), and program (service setting) characteristics, and parent session attendance. Multilevel models were used to evaluate the effectiveness of AIM HI therapist training on caregiver attendance and identify moderators of training effects on parent attendance. RESULTS Parents attended a higher percentage of sessions in the AIM HI training condition compared to the Usual Care condition. Program service setting moderated the effect of AIM HI training, with higher parent attendance in non-school (mostly outpatient) settings compared to school settings and a significantly smaller difference between the settings in the AIM HI condition. CONCLUSIONS Effective strategies to promote parent engagement, especially in service settings such as schools, are warranted. Findings support the effectiveness of AIM HI training in promoting parent attendance across multiple publicly-funded mental health service settings. The larger effect in school-based programs supports the utility of training in evidence-based interventions such as AIM HI to increase the feasibility of parent attendance in such services.
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Affiliation(s)
- Kelsey S Dickson
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Services Research Center
| | - Colby Chlebowski
- Child and Adolescent Services Research Center.,Department of Psychiatry, University of California San Diego
| | - Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Services Research Center
| | - Bill Ganger
- Child and Adolescent Services Research Center.,San Diego State University Research Foundation
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center.,Department of Psychiatry, University of California San Diego.,Autism Discovery Institute at Rady Children's Hospital San Diego
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Gellatly R, Brookman-Frazee L, Barnett M, Gonzalez JC, Kim JJ, Lau AS. Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings. CHILD & YOUTH CARE FORUM 2019; 48:55-75. [PMID: 32132809 PMCID: PMC7055736 DOI: 10.1007/s10566-018-9472-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families. OBJECTIVE The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists' self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children's mental health services. METHOD One hundred and three therapists reported on two types of engagement challenges-Limited Client Engagement and Expressed Client Concerns-in 702 sessions with 274 clients. RESULTS Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists' report of their ability to carry out intended activities in the same session. CONCLUSIONS Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.
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Affiliation(s)
- R. Gellatly
- University of California, Los Angeles, Los Angeles, CA, USA
| | - L. Brookman-Frazee
- University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - M. Barnett
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. C. Gonzalez
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. J. Kim
- University of California, Los Angeles, Los Angeles, CA, USA
| | - A. S. Lau
- University of California, Los Angeles, Los Angeles, CA, USA
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