3 - (SYM 89) Prioritizing Implementation Strategies for Lgbtq-affirmative CBT: Findings from Five Clinic Trials

Background: LGBTQ-affirmative CBT is an evidence-based treatment that addresses mental health concerns among sexual minority clients. Identifying and prioritizing implementation strategies essential to LGBTQ-affirmative CBT will facilitate treatment reach, adoption, implementation, and sustainment.

Methods: Researchers who implemented LGBTQ-affirmative CBT across five clinical trials used a standardized reporting tool to document the implementation strategies that were used. The trials were for: (1) young sexual minority men in NYC and Miami, (2) gender diverse sexual minority women in NYC, (3) sexual minority youth across the US (online), (4) young gay and bisexual men of color in New Haven, CT (groups), and (5) young men who have sex with men in Hunan province China (online). To identify implementation strategies used, we developed an implementer survey, which prompted trial implementers (N=35) to rate the importance of each strategy for facilitating implementation of the treatment. The researchers examined the ratings of each strategy across the five trials.

Results: We identified approximately 25 implementation strategies per trial, most of which were rated as “absolutely essential,” including 10 which were absolutely essential in all five trials. Examples of these were: (1) facilitating problem solving to implement the treatment, (2) promoting adaptability of treatment by specifying core vs. adaptable components to implementers, (3) identifying champions who were committed to LGBTQ health as implementers, (4) preparing clients to be active in treatment, and (5) using mass media for LGBTQ-relevant outreach. Some strategies were rated as essential for certain iterations of LGBTQ-affirmative CBT; for example, changing the physical environment in which treatment was delivered to be LGBTQ-affirming and providing clinical supervision were essential for in-person treatment but not online versions of the treatment.

Conclusions: This study underscores the need for packages of implementation strategies when implementing LGBTQ-affirmative CBT, including strategies that are LGBTQ-specific and others that are general (e.g., facilitation, preparing clients to be active in treatment). Findings suggest that LGBTQ-affirmative CBT implementation packages may require some “core” strategies (e.g., promoting adaptability). Tailored strategies (e.g., modifying the physical environment, providing clinical supervision) can supplement these core strategies for certain modalities of the treatment and for certain contexts.