It has been widely recognized that access to mental health treatment is imperative to address current and long-term stressors for children and parents during COVID-19. Internet-delivered Parent-Child Interaction Therapy (iPCIT, previously referred to as I-PCIT) is a strong model for remote service delivery during social distancing restrictions due to its empirical base. However, this treatment modality was not widely implemented before COVID-19, likely due to barriers to providing telehealth services. This mixed methods study conducted a follow-up survey to gather therapist experiences ( N = 223) in delivering iPCIT during COVID-19, including qualitative data on the benefits and challenges to delivering iPCIT. The vast majority of therapists (82%) indicated that they transitioned to deliver PCIT via telehealth in response to COVID-19. PCIT caseloads decreased slightly from the first survey to the COVID-19 follow-up survey, but the racial and ethnic composition of caseloads were not significantly different between the two surveys. Of the 183 therapists who transitioned to deliver PCIT via telehealth, 82% expressed interest in continuing to provide iPCIT following the COVID-19 pandemic. Reported benefits of iPCIT included decreased barriers to access and the ability to practice skills within the naturalistic home environment. Challenges to iPCIT were primarily issues with technology as well as other logistical barriers, which could limit engagement for some families. Findings from this study may be beneficial in improving future implementation of iPCIT during and post-COVID-19.

Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidencebased practices for historically marginalized communities within the U.S.

No abstract

Parent–child interaction therapy (PCIT) is a best-practice treatment for behavior problems in young children. In PCIT, therapists coach parents during in-vivo interactions to strengthen the parent–child relationship and teach parents effective ways of managing difficult child behaviors. Past research has found that different therapist coaching styles may be associated with faster skill acquisition and improved parent engagement. However, most research examining therapist behaviors has been conducted with English-speaking families, and there is limited research examining therapist behaviors when working with Spanish-speaking clients. In this study, English- and Spanish-speaking therapists’ coaching behaviors (e.g., directive versus responsive) were examined, as well as their association with client outcomes, including speed of parental skill acquisition and treatment completion. Results suggested that coaching styles varied significantly between sessions conducted in Spanish versus English. In Spanish sessions, therapists had more total verbalizations than in English sessions and demonstrated higher rates of both total directive and responsive coaching. Responsive coaching was found to predict treatment completion across groups, while directive coaching was not. Directive and responsive coaching were not found to predict the rate of parental skill acquisition. Implications regarding the training of therapists and emphasizing cultural considerations are discussed.

The sudden onset of COVID-19 forced mental health therapists to rapidly transition to telehealth services. While some therapists and organizations were able to achieve an expeditious transition, others struggled. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, which outlines key phases that guide the implementation process, the current mixed methods study examined what factors predicted the transition to internet-based Parent–Child Interaction Therapy (iPCIT), a telehealth-delivered evidence-based practice (EBP). We investigated two areas related to the transition: (1) if PCIT therapists transitioned to provide iPCIT and (2) if they made this transition quickly. In Fall 2019, 324 therapists completed a survey about implementing PCIT. After stay-at-home orders, 223 of those therapists completed a follow-up survey about their transition to telehealth, organizational characteristics, their caseloads, and telehealth training. The majority of therapists (82%) transitioned to provide iPCIT, with 48% making the transition in less than a week. Open-ended responses indicated that therapists who did not transition-faced challenges related to limited client resources, a lack of training, and organizational delays. Qualitative findings informed predictors for two logistic regression models that are statistical models that predict the probability of an event occurring, with criterion variables (1) whether therapists transitioned to provide iPCIT and (2) whether they transitioned in less than a week. Results showed that caseload in Fall 2019 and receipt of iPCIT training were associated with iPCIT transition. Organizational setting, resiliency, and baseline caseload predicted rapid transition to iPCIT. Implications regarding supporting the implementation of telehealth delivery of EBPs are discussed.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth of color experience high rates of mental health disorders, yet they experience challenges to accessing mental health services. Community health worker (CHW) models of care have potential to promote equitable mental health services among LGBTQ youth. Our aim was to understand how CHW models could be adapted to better support LGBTQ youth of color in accessing mental health services. Semi-structured qualitative interviews were conducted with LGBTQ youth of color (n = 16), caregivers of LGBTQ youth (n = 11), and CHWs (n = 15) in Massachusetts and California. Interviews were coded by 8 members of the research team. A Rapid Qualitative Analysis was conducted to identify themes. Caregivers, youth, and CHWs all endorsed the value of CHW models for this population. They also almost universally suggested multiple adaptations are needed for the model to be effective. Four main categories of themes emerged related to intervention adaptations: (1) Why adaptations are needed for LGBTQ youth, (2) Who should serve as CHWs providing care, (3) How CHWs should be trained, and (4) What content needs to be included in the intervention. Broadly, findings suggest the relevance of having CHW models for LGBTQ youth of color to address stigma and discrimination experienced, access to culturally and linguistically relevant services, and the need for caregiver support of LGBTQ youth. CHWs need increased training in these areas.

No abstract