4 - (SYM 137) Provider-initiated Ad Hoc Adaptations and Their Impact on Implementation Outcomes

Background: Serious mental illness (SMI) and comorbidity can have devastating psychosocial and health consequences without effective treatment. At this time, only a small fraction of transdiagnostic EBPTs, which may offer a more viable path forward for treating comorbidity relative to single disorder treatments, have been translated into routine practice settings. The present study focused on implementation of one transdiagnostic EBPT, the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in community mental health centers (CMHCs). Although EBPTs are delivered in CMHCs, they are rarely sustained for multiple reasons, including poor fit. In an effort to improve “fit” between TranS-C and the CMHC context, two versions of TranS-C were compared in the present study, Standard and Adapted TranS-C. Prior research suggests that even with deriving an adapted version of an EBPT, it is possible that providers will make ad hoc adaptations to the treatment. Provider-initiated ad hoc adaptations are defined as the changes made by treatment providers to the delivery, structure, or content of a treatment to address perceived patient-specific needs. The present study was conducted to further knowledge on provider-initiated ad hoc adaptations and their effect on implementation outcomes.

Methods: Providers (N= 71) across CMHCs in ten counties in California participated in a Standard or Adapted TranS-C training, as part of a NIMH-funded Hybrid Type 2 trial. TranS-C fit, including acceptability, appropriateness, and feasibility, and provider-initiated ad hoc adaptations were measured via provider self-report after the training and/or after they completed treatment with a client (N = 195).

Results: The number of provider-initiated ad hoc adaptations made were not significantly different for Adapted TranS-C compared with Standard TranS-C. After controlling for provider’s pre-treatment rating of treatment fit, greater use of ad hoc adaptations was associated with lower ratings of TranS-C fit at post-treatment.

Conclusions: We have presented preliminary evidence suggesting that the number of provider-initiated ad hoc adaptations are not significantly different in the Adapted vs. Standard condition and that provider-initiated ad hoc adaptations do not improve providers perception of treatment fit to the client’s needs. There was evidence to suggest that with an increase in provider reported ad hoc adaptations, the perception of treatment fit decreased.