IMPLEMENTING COGNITIVE BEHAVIORAL THERAPY IN A YOUTH RESIDENTIAL SETTING: AN EVALUATION OF IMPLEMENTATION AND CLINICAL OUTCOMES

Abstract

Background: Mental health needs in residential treatment facilities (RTFs) are disproportionally higher than in the general population. There are also race, gender, and age disparities in youth who reside in RTFs. A critical gap exists about the effectiveness of evidence-based practices (EBPs) in RTFs and how to facilitate implementation of such practices. Methods: Three studies evaluated the implementation of Cognitive Behavioral Therapy (CBT) in a youth RTF using linear mixed models by: Study 1) assessing the impact of CBT implementation on implementation outcomes (i.e., attitudes towards EBPs, and intention to use CBT), Study 2) evaluating the impact of CBT implementation phases on clinical outcomes (i.e., total symptomatology, internalizing symptomatology, externalizing symptomatology, and severity of top problems), and Study 3) assessing the impact of CBT fidelity on clinical outcomes. Results: Results from Study 1 revealed that intention to use CBT and divergence towards EBPs changed at distinct implementation stages, and that staff role was important in improving overall attitudes towards EBPs and divergence toward EBPs. Results from Study 2 indicated that youth symptomatology and severity of top problems improved over time, with steeper slopes during the second implementation phase. Results for Study 3 suggested that staff monthly fidelity and therapist fidelity to cognitive restructuring, staff monthly fidelity to distress tolerance, and therapist fidelity to active listening and behavioral activation improve clinical outcomes. In addition, therapist fidelity to distress tolerance led to improvements in youth severity of top problems. Discussion: These results may have important implications for understanding how tailored implementation of CBT can improve implementation and clinical outcomes in youth residential settings.