자료유형  

 학위논문

Control Number  

0017163266

International Standard Book Number  

9798383582466

Dewey Decimal Classification Number  

157

Main Entry-Personal Name  

Yu, Stephanie Hsin-Tien.

Publication, Distribution, etc. (Imprint  

[S.l.] : University of California, Los Angeles., 2024

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2024

Physical Description  

223 p.

General Note  

Source: Dissertations Abstracts International, Volume: 86-02, Section: B.

General Note  

Advisor: Chung, Anna Shan-Lai.

Dissertation Note  

Thesis (Ph.D.)--University of California, Los Angeles, 2024.

Summary, Etc.  

요약Trauma-focused cognitive behavioral therapy (TF-CBT) is a leading youth trauma treatment that has been widely disseminated in public mental health systems to increase access to care among structurally marginalized youth and families. Community therapists frequently report adapting evidence-based practices (EBPs), including TF-CBT, when transported into public systems of care to enhance their fit for the diverse youth and families they serve. Studies of therapist-reported adaptations have identified Augmenting adaptations as those that add to or tailor the EBP in some way, such as modifying the presentation of EBP content, integrating supplemental content, and extending through repetition. Community therapists hold valuable local expertise about what may promote client understanding or engagement in their care context, especially when they identify with the communities they serve. Yet, there may be risks to intervention integrity when adaptations are unsystematic. There is a need to understand how distinct therapist adaptations may relate to implementation and clinical process outcomes. This dissertation study employed a multimethod approach to identify observable adaptations that community therapists make in sessions of TF-CBT. The aims were to: (1) characterize Augmenting adaptations and factors associated with them in a given session; (2) examine associations between Augmenting adaptations and adherence to TF-CBT at the sessionlevel; and (3) examine associations between Augmenting adaptations and client engagement within and across sessions. A sample of 46 community therapists provided 190 TF-CBT session audio recordings delivered to 82 youth (Mage=10.30; 67.07% Hispanic and/or Latine, 21.95% Black, 7.32% Asian American/ Pacific Islander, 2.44% White, 1.22% Multiracial).Two observational coding systems were developed to index Augmenting adaptations and adherence to TF-CBT. Two independent teams of nine coders each (18 total) were trained to rate the occurrence and extensiveness of each adaptation type and TF-CBT component, respectively, from session audio recordings (0 = no occurrence, 6 = great extent). Approximately one-third of sessions were double-coded and intraclass correlations (ICCs) computed to assess interrater reliability. ICCs ranged from fair to excellent for Augmenting adaptation codes (M = .76) and from fair to excellent for adherence codes (M = .85). Therapist-reported client disengagement and client engagement behaviors observationally coded from a prior study were used to index client engagement outcomes. Multilevel modeling was conducted to investigate the aims, controlling for session, client, and therapist factors.Aim 1 results indicated that community therapists made Augmenting adaptations in most sessions (n = 119; 62.63%), primarily at modest levels (M = 2.45; Range = 0 - 6). Client age was negatively associated with Modify Presentation extensiveness. Emergent life events and therapist perceptions of TF-CBT were positively associated with Integrate extensiveness, while sessions in which clients had multiple presenting problems and therapists were licensed were negatively associated with Integrate extensiveness. In Aim 2, TF-CBT components were observed in all but two sessions, with acceptable session-level adherence as indicated by the max component score (M = 4.01, Range = 0 - 6). No Augmenting adaptations were related to adherence extensiveness, either when measured by the max component score or mean composite score. In Aim 3, Modify Presentation extensiveness was related to lower odds of therapist-reported client disengagement in a given session, while Integrate extensiveness was related to higher odds of therapist-reported client disengagement. Repeat extensiveness was positively associated with client engagement behaviors. The dissertation data could not support examination of lagged associations between Augmenting adaptations and client engagement in subsequent sessions. While findings suggest meaningful relationships between adaptation and engagement, it is imperative for future work to systematically disentangle the direction of these associations. Implications for EBP practice and implementation in the context of community mental health settings serving structurally minoritized youth and families will be discussed.

Subject Added Entry-Topical Term  

Clinical psychology.

Subject Added Entry-Topical Term  

Mental health.

Subject Added Entry-Topical Term  

Cognitive psychology.

Index Term-Uncontrolled  

Client engagement

Index Term-Uncontrolled  

Community mental health settings

Index Term-Uncontrolled  

Community therapist adaptation

Index Term-Uncontrolled  

Implementation science

Index Term-Uncontrolled  

Cognitive behavioral therapy

Added Entry-Corporate Name  

University of California, Los Angeles Psychology 0780

Host Item Entry  

Dissertations Abstracts International. 86-02B.

Electronic Location and Access  

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Control Number  

joongbu:654544