Skip to main content
ABCT 2023 Annual Convention Main banner
Final Program


Program Flipbook
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Ticketed Session
Ticketed Session
Recorded Session
Recorded Session
Back

Child / Adolescent - Anxiety

(PS3-D85) Characterizing Usual Clinical Care for Youth Anxiety

Friday, November 17, 2023
11:30 AM – 12:30 PM PST
Location: Regency Ballroom, Level 7
Over the past two decades, there have been efforts to implement evidence-based programs (EBPs) for youth in community mental health settings. However, these implementation efforts may be premature if they do not consider the techniques delivered in usual clinical care (i.e., the mental health services typically provided to youth and families in community mental health centers). Quality improvement science suggests that implementing EBPs in community mental health centers may be made more effective if the existing service context is described before EBPs and implemented. To examine the value of describing usual clinical care, this study seeks to characterize the techniques used by clinicians providing mental health services to youth with primary anxiety problems in community mental health centers.

Treatment sessions (N = 210) from 21 youth participants (M age = 10.44 years, SD = 1.91; 33.33% White; 53.40% male) with primary anxiety problems participated in an effectiveness study were coded using the Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies scale (TPOCS-RS). The TPOCS-RS is a 42-item measure designed to assess clinician delivery of techniques across five theory-based subscales: Cognitive (4 items; e.g., Cognitive Distortions), Behavioral (9 items; e.g., Operant Interventions), Psychodynamic (5 items; e.g., Interpretation), Family (7 items; e.g., Parenting Intervention), and Client-Centered (4 items; e.g., Positive Regard). There are 13 additional items (e.g., Homework, Play Therapy) that represent techniques that play a role in treatment but are not associated with a specific theory-based subscale. Coders rated the extent to which the clinician engages in each item during an entire session on a 7-point extensiveness scale (Hogue et al., 1996): 1 = not at all, 3 = somewhat, 5 = considerably, and 7 = extensively.

Interrater reliability for the TPOCS-RS items was acceptable (ICC > .40) except for two items that were dropped from subsequent analyses (Behavioral Activation, Modeling). Clinicians used various techniques across the five theory-based subscales but at a low dose (i.e., mean item scores < 4 on a 7-point scale). Exploratory factor analysis was used to determine the techniques clinicians used together. A two-factor solution showed that clinicians tended to deliver parent-focused techniques and supportive strategies.

Clinicians used a wide range of techniques in usual clinical care for youth with primary anxiety problems. Some techniques used by clinicians are found in the empirical literature (i.e., parenting skills), but other techniques found effective for youth anxiety in the literature were not consistently used by clinicians (i.e., exposure). These findings suggest that characterizing usual clinical care for youth anxiety may help pinpoint areas for improvement.