How community therapists describe adapting evidence‐based practices in sessions for youth: Augmenting to improve fit and reach

Abstract

The study sought to (a) characterize the types and frequency of session-level adaptations made to multiple evidencebased practices (EBPs) and (b) identify therapist-, client-, and session-level predictors of adaptations. Within the community implementation of multiple EBPs, 103 community mental health therapists reported on 731 therapy sessions for 280 clients. Therapists indicated whether they adapted EBPs in specific sessions and described adaptations in open-ended responses. Responses were coded using the Augmenting and Reducing adaptations framework. Therapists reported making adaptations in 59% of sessions. Augmenting adaptations were reported more frequently than Reducing adaptations. Multilevel logistic regression analyses revealed that greater therapist openness to EBPs, younger child age, and presenting problems was associated with Augmenting adaptations. Child presenting problem of externalizing problems predicted fewer Reducing adaptations compared with internalizing problems. This study extends the growing research examining adaptations within the context of the system-driven implementation of multiple EBPs by applying the Augmenting and Reducing adaptation framework to the session-level.

Leveraging implementation science to reduce inequities in Children’s mental health care: highlights from a multidisciplinary international colloquium

“…When adapting for cultural reasons it was virtually always Augmentingto frame EBPs in familiar terms and to intensify teaching new skills by extending pacing [44]. Finally, analysis of session-level therapist descriptions of adaptations and observer rated extensiveness of EBP delivery reveal that modifying presentation adaptations were related to more extensive delivery of EBP strategies, but Extending adaptations were related to less extensive strategy delivery [45,46]. Discussion after the presentation focused on the value of documenting practice-based adaptations to EBPs (i.e., the 'Adaptome' [42]) and translating these findings to inform optimal EBP design, training, and implementation strategies.…”

Applications of translation and implementation science to community psychology: An introduction to a special issue

“…IDEA guides implementation scientists and stakeholders through several steps of the adaptation process starting with identifying if there is a need for an adaptation, ensuring fidelity to core elements of the evidence‐based practice being implemented, the timeframe to make adaptations, along with a collection of pilot data, implementation, and clinical outcomes data, and stakeholder feedback. Kim et al (2020) provide a naturalistic observation of spontaneous adaptations made in community care. Clinicians often make adaptations to their EBTs when treating youth and families.…”

“…In particular, augmentation occurred among clinicians with more open attitudes about EBTs, clinicians treating younger children and certain presenting problems (externalizing vs. internalizing). Clearly, if adaptations are inevitable, understanding what these look like in community care (Kim et al, 2020) can help implementation scientists and stakeholders make informed decisions about adaptations using a framework such as IDEA (Miller et al, 2020).…”

“…This is critical when considering that adaptations are often necessary when implementing evidence‐based practices in novel community settings. Indeed, this issue provides several illustrations of how adaptations are an integral part of community care (Berkel et al, 2020; Chlebowski, Hurwich‐Reiss, Wright, & Brookman‐Frazee, 2020; Haine‐Schlagel, Rieth, Dickson, Brookman‐Frazee, & Stahmer, 2020; Kim et al, 2020). Implementation of new evidence‐based practices into community settings can cause some stress on the workforce.…”

Adapting Interventions for Occupational Therapy Practice: Application of the FRAME Coding Structure

“…This skepticism stems from concern that practitioners may adapt interventions without sufficient fidelity (e.g., adherence) to an intervention’s “core components” or the elements of the intervention that are crucial for effectiveness (Chambers & Norton, 2016; Wiltsey Stirman et al, 2013). The process of balancing fidelity and adaptation is complex, especially because health care researchers have offered little guidance on how practitioners should approach adapting interventions systematically (Kim et al, 2020). Moreover, intervention researchers seldom provide recommendations for how their evidence-based programs, manuals, and protocols can be adapted for applied use in clinical practice (Wiltsey Stirman et al, 2019); however, the field of implementation science is leading the charge in evaluating intervention adaptations and their influence on client outcomes.…”