2 - (SYM 96) from Plan to Practice: A Qualitative Study of Public Mental Health Clinicians' Session Planning Practices

Background: Therapists must dedicate considerable time to session plan to implement evidence-based practices (EBPs) flexibly and with fidelity. However, it is unclear whether public mental health settings offer the structural and organizational support for therapists to engage in session planning or whether public mental health therapists have received training in session planning.

Methods: In Fall 2022, 18 therapists working in public mental health settings in New York City were recruited through social media and through snowball sampling to participate in 90-minute semi-structured qualitative interviews. During the interviews, therapists were prompted to review their session planning practices using a chart-stimulated recall strategy; to describe structural, organizational, and individual barriers and facilitators to session planning; and, to generate implementation strategies to support their session planning. Qualitative data were analyzed using thematic analysis. 

Results: A diverse group of therapists participated in the study—22% identified as Black; 22% as Asian; 11% as Hispanic/Latinx; and 45% as White. Seventy-two percent of the therapists were social workers; and they had on average 6.18 (SD = 5.70) years of clinical experience. Most therapists do not have the time to session plan and have not received training in EBP session planning. When therapists do session plan, they prefer to use supervision and online resources rather than treatment manuals. Session planning barriers include: 1) high productivity standards and caseloads; 2) frequent clinical emergencies; and 3) lack of fit between EBPs and client’s social needs and lived experiences. Important session planning facilitators include: 1) available and well-trained supervisors; 2) peer consultation and support; and 3) strong EBP training prior to entering the workforce. Therapists generated implementation strategies such as: 1) additional time for session planning; 2) lower caseloads; 3) more supervision, peer consultation, and EBP training; and 4) session planning resources.

Conclusion: High productivity standards, severe clinical presentations, and clients’ considerable social needs prevent therapists from having time to plan for sessions and, in turn, to implement EBPs. Efforts to implement EBPs in public mental health settings cannot neglect the structural realities faced by agencies, therapists, and clients. Our study reveals several avenues through which policymakers and agencies can directly support therapists’ EBP session planning.