(PS5-C72) Equitable Implementation of Evidence-based Treatments in Youth Community Mental Health Settings: A Scoping Review

Many evidence-based treatments (EBTs) have been evaluated with and delivered to predominantly White and middle-to-upper class populations, limiting their generalizability. As such, successful implementation of EBTs can be challenging in community mental health clinics (CMHCs) as they serve disadvantaged and/or minority groups and are also often under-resourced and understaffed. Despite the recent call for mental health equity considerations, the literature provides very few examples of equity-centered implementation projects in CMHCs serving youth. The goal of this review is to examine the different ways ‘equity’ has been informally considered in implementation projects across CMHCs to guide forthcoming equity-centered implementation projects.

We conducted a scoping review to identify key characteristics or knowledge gaps related to mental health equity in youth CMHCs as well as strategies that facilitate efforts to address these inequities. Our search encompassed four databases: MEDLINE, PsycINFO, Embase, and Cochrane Central. Included studies had to focus on youth mental health, implement an evidence-based treatment, be conducted in a CMHC, report both mental health and implementation outcomes, and were randomized controlled trials. Data extraction and synthesis were performed to describe study characteristics, treatment and implementation information, as well as equity-related elements (e.g., EBT implementation barriers, facilitation strategies)—guided by the Health Equity Implementation Framework. 

Twenty-two articles met our inclusion criteria. Studies spanned eight different countries, predominantly conducted in high-income countries (n = 20; 90.9%). Fifteen (68.1%) studies were conducted in the United States. The majority of studies included cases with disruptive behavior problems, substance use disorders and anxiety-related disorders. Sixteen studies (72.7%) reported client-level barriers (e.g., financial stress, family stress, language barriers, and treatment refusal). Eleven studies (50%) reported organizational barriers (e.g., understaffing, high caseloads, and cross-sector collaboration). Seven studies (31.8%) reported provider-level barriers (e.g., training opportunities, time, treatment fidelity). Six studies (27.3%) reported societal barriers (e.g., stigma, parenting cultural norms). Fifteen studies (68.1%) reported a facilitation strategy catered EBT implementation to the population they were serving (e.g., treatment translation and/or adaptation, home-based services, and task-shifting).

While none of the included studies were formally ‘equity-centered’ EBT implementation projects, they highlighted key client, provider, organizational, and societal factors that may hinder equitable implementation of EBTs. Further, these studies illustrated the utility of harnessing existing resources to come up with facilitation strategies that tackle context-specific determinants of health inequities. Future EBT implementation projects should systematically study context-specific determinants of health inequities and integrate appropriate facilitation strategies to optimize EBTs’ accessibility and applicability to underserved communities.