(PS3-C60) Provider Perspectives of Tele-health Delivered CBT for Pediatric Anxiety: A Qualitative Study of Barriers and Facilitators

OBJECTIVES
This study examined providers’ perceptions and experiences delivering Cognitive Behavioral Therapy (CBT) via tele-health to ethnically diverse and under-resourced pediatric patients with anxiety disorders.

METHODS 
We conducted semi-structured interviews with 41 providers participating in a large-scale Sequential Multiple Assignment Randomized Trial (SMART) of CBT (delivered via tele-health and in person) and fluoxetine to treat anxiety in a population of diverse and under-resourced youth 8-17 in Los Angeles County. Interviews explored clinicians’ perceived strengths, challenges, acceptability, feasibility, and implementation experiences, including barriers and facilitators of tele-health delivery. Interviews were recorded, transcribed verbatim, and coded independently by two team members.  Analysis was guided by Clarke and Braun (2006)’s six phases of thematic analysis.

RESULTS
Preliminary thematic analysis using a deductive approach yielded 10 themes relating to barriers and facilitators for tele-health delivery of CBT: 1) cultural considerations 2) privacy and confidentiality 3) limited access to technology 4) caregiver involvement 5) adaptations to the treatment protocol 6) treatment engagement 7) therapeutic alliance 8) exposure delivery 9) accessibility and 10) convenience. Overall, providers found tele-health to be acceptable for most clients and their families, however, they reported needing to be adaptive, flexible, and innovative, particularly around designing and delivering exposures via video conferencing. Providers also noted a need for more caregiver involvement, especially during exposure tasks and when working with younger patients.

CONCLUSIONS
The results of this study indicate that despite a plethora of logistical challenges of delivering CBT via tele-health, providers quickly and effectively responded to an increased need for mental health treatment during the COVID-19 pandemic through innovative adaptations to treatment modules and youth engagement strategies. Future research ought to identify specific, evidence-based strategies and adaptations to EBTs to facilitate and optimize their delivery via tele-health.  Additionally, opportunities exist for the development and dissemination of best practice guidelines.