3 - (SYM 137) Clinician Contributions to a Diverse Adaptation Team: A Report Across Three Iterative Adaptations of Collaborative Decision Skills Training for Veterans with Psychosis

Background: The goal of adaptation science is to identify structured procedures that increase sustainability and fit without weakening fidelity and effectiveness. A key priority is to identify how various partner groups, like clinicians, contribute to adaptation to ensure adaptation optimization while minimizing partner burden. In this ongoing mixed methods, iterative, and community partner engaged adaptation of Collaborative Decision Skills Training (CDST; Treichler et al., 2020) for Veterans with psychosis, we describe clinician contributions to the first three adaptation iterations. 

Methods: CDST is a group skills training focused on improving ability to engage in treatment decision-making. Veterans with psychosis and VA clinicians were recruited at each adaptation iteration (i1, i2, i3). The Adaptation Resource Team (ART) included 14 Veterans, 5 clinicians, and 4 researchers. Mixed methods data collected included qualitative interviews, periodic reflections, survey data, and meeting minutes from ART meetings. Adaptations were documented using the Framework for Reporting Adaptations and Modifications for Evidence-based interventions (FRAME; Wiltsey-Stirman et al., 2019).

Results: Clinicians initiated 67 (39.8%) of 168 adaptations in i1, 6 (12.5%) of 48 adaptations in i2, and 2 (7.4)% of 27 adaptations in i3. Joint clinician-Veteran, clinician-researcher, and clinician-Veteran-researcher adaptations were 13.1% of i1 adaptations, 52% of i2 adaptations, and 7 (25.9)% of i3 adaptations. Clinician adaptations were based on the clinician’s professional experience or a framework like CBT, and targeted the clinician-facing materials. Clinicians contributed the majority of adaptations focused on increasing feasibility (rather than effectiveness, which described most adaptations overall). In terms of content, clinician adaptations prioritized supporting usual care clinicians to deliver CDST including increasing ability to deliver fidelity-required components within session time while allowing for flexibility to optimize to individual Veterans.

Conclusions: Clinicians were essential contributors to the ART. Clinicians were particularly likely to focus on adaptations that help usual care clinicians find the balance between manual fidelity and client personalization while addressing usual care feasibility issues. This is a key issue for implementation of evidence-based practices. Continuing to engage clinicians in adaptation will support ability to increase real-world use of evidence-based practices.