Outside the Clinic Door: How Neighborhood Sociodemographic Disadvantage is Associated with Community Therapist Secondary Traumatic Stress and Emotional Exhaustion.

Therapists serving families with high rates of trauma exposure in community mental health clinics face the potential risk of experiencing secondary traumatic stress and emotional exhaustion, both of which pose barriers for the implementation and sustainment of evidence-based practices. Previous research documents negative effects of living in socioeconomic disadvantaged neighborhoods on child development but has not examined the effects of working in these neighborhoods on therapist well-being. The current study merges publicly available data, administrative claims data on mental health services, and therapy survey data to 1) identify associations between neighborhood sociodemographic disadvantage and two community therapist well-being constructs, specifically secondary traumatic stress and emotional exhaustion; and 2) examine potential clinic- and therapist-level explanatory factors in the associations between neighborhood sociodemographic disadvantage and therapist well-being. A cumulative risk index approach was applied to calculate neighborhood sociodemographic disadvantage. Greater neighborhood sociodemographic disadvantage was significantly associated with higher levels of therapist secondary traumatic stress (B=.09, p<.05) but not emotional exhaustion. Because therapists in higher risk neighborhoods face higher secondary traumatic stress levels, additional research is needed to better understand how these therapists can be best supported; thus, supporting families receiving treatment and implementation of evidence-based practices.

Training Community Therapists in AIM HI: Individual Family and Neighborhood Factors and Child/Caregiver Outcomes.

OBJECTIVE: Publicly funded mental health services play an important role in caring for children with mental health needs, including children with autism spectrum disorder (ASD). This study assessed the associations between individual family- and neighborhood-level sociodemographic factors and baseline family functioning and long-term outcomes when community therapists were trained to deliver An Individualized Mental Health Intervention for ASD (AIM HI). METHOD: Participants included 144 children with ASD (ages 5 to 13 years; 58.3% Latinx) and their caregivers whose therapists received AIM HI training within a cluster-randomized effectiveness-implementation trial in publicly funded mental health services. Sociodemographic strain (e.g., low income, less education, single-parent status, minoritized status) was coded at the individual family and neighborhood level, and caregivers rated caregiver strain at baseline. Child interfering behaviors and caregiver sense of competence were assessed at baseline and 6-, 12- and 18-months after baseline. RESULTS: Higher caregiver strain was associated with higher intensity of child behaviors (B = 5.17, p < .001) and lower caregiver sense of competence (B = -6.59, p < 001) at baseline. Child and caregiver outcomes improved over time. Higher caregiver strain (B = 1.50, p < .001) and lower family sociodemographic strain (B = -0.58, p < .01) were associated with less improvements in child behaviors. Lower caregiver strain (B = -2.08, p < .001) and lower neighborhood sociodemographic strain (B = -0.51, p < .01) were associated with greater improvements in caregiver sense of competence. CONCLUSIONS: Findings corroborate the importance of considering both family and neighborhood context in the community delivery of child-focused EBIs. TRIAL REGISTRATION: Clinical Trials NCT02416323.

Organizational factors associated with community therapists' self-efficacy in EBP delivery: The interplay between sustainment leadership, sustainment climate, and psychological safety.

Background: Inner context organizational factors proximally shape therapist experiences with evidence-based practice (EBP) implementation and may influence therapist self-efficacy, which has been linked to sustained use of EBPs in community mental health settings. Research has primarily focused on constructs such as implementation leadership and climate. However, the effects of such factors may depend upon other inner context dimensions, such as psychological safety. Psychologically safe environments are conducive to taking risks, speaking up about problems, and requesting feedback and may promote therapist self-efficacy during implementation. This study examines whether organizational sustainment leadership and sustainment climate relate to therapist EBP self-efficacy only under conditions of psychological safety. Methods: Data were collected from 410 clinicians in 85 programs during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. Therapists reported on their organization's sustainment leadership, sustainment climate, psychological safety, and their own self-efficacy in delivering specific EBPs. Multilevel regression analyses were conducted to account for nested data structure. Results: Among program-level variables, sustainment leadership and psychological safety both significantly predicted therapist self-efficacy. However, there were no significant interactions between program-level sustainment climate and psychological safety. Exploratory post-hoc analyses revealed a significant interaction between program-level sustainment leadership and therapist-level perceptions of psychological safety such that that the conditional effect of psychological safety on EBP self-efficacy was significant at high levels of sustainment leadership, but not at low or average levels. Conclusion: We noted independent links between sustainment leadership, organizational psychological safety and therapists feelings of confidence and mastery with EBPs. Therapists' individual perceptions of psychological safety were linked to self-efficacy only in programs with high sustainment leadership. Thus, sustainment leadership and psychological safety may both represent implementation intervention targets, but it may not be critical to assess for perceptions of psychological safety before deploying organizational leadership strategies.Plain language abstract Therapist self-efficacy is a therapist's belief that they are capable, knowledgeable, and skilled enough to deliver evidence-based practices (EBPs), and is thought to promote improved clinical and implementation outcomes, such as therapists' sustained use of EBPs. Conditions within community mental health organizations may influence therapists' sense of EBP self-efficacy. Leaders' support and expectations for EBP implementation, and collective staff perceptions about the organization's climate to support EBPs are linked to positive therapist attitudes and EBP adoption. However, less is known about how these implementation-specific organizational factors associated with therapist EBP self-efficacy in the long-term, and how this may depend on general workplace conditions. Specifically, psychologically safe environments - where therapists feel safe taking risks such as asking questions, admitting mistakes, and trying new skills - may be needed to promote self-efficacy when therapists are tasked with learning and using complex multi-component EBP innovations. The current study tested the prediction that leader-driven and program-wide focus on EBP sustainment may promote therapist EBP self-efficacy only in organizations where conditions for learning are psychologically safe. Our findings confirmed that fostering strong sustainment focused leadership and psychologically safe environments may each be important for increasing therapists' EBP self-efficacy. The model results suggested that individual therapist perceptions of psychological safety were more strongly related to EBP self-efficacy in programs with greater implementation leadership. Findings suggest the importance of increasing EBP leadership behavior to fully potentiate other facilitating conditions for therapist learning in the sustainment phase of EBP implementation initiatives.

Implementation facilitation strategies to promote routine progress monitoring among community therapists.

Despite substantial support for the importance of routine progress monitoring (RPM) as part of evidence-based practice, few providers utilize measurement-based care. This study sought to identify the relative importance of facilitation strategies viewed as most helpful for increasing intention to use RPM among 388 ethnically diverse community therapists serving children and families. Four types of facilitation strategies were examined: language/interpretability, automation, staffing/access, and requirements. Mixed analyses of variance found that therapists' reported intentions to use RPM were more influenced by strategies of automating assessment administration, provision of clerical assistance, and agency requirements than by making linguistically appropriate measures available. However, the importance of strategies differed depending on therapist race/ethnicity and current RPM use. Language/interpretability of RPM assessments was less emphasized for non-Hispanic White therapists and therapists who have not yet or only minimally adopted RPM compared with ethnic minority therapists and therapists who regularly use RPM, respectively. Furthermore, therapists who were not current RPM users emphasized automation more than staffing/access. Results may inform prioritization of implementation facilitation strategies for agencies to encourage RPM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Intervening With Attachment and Biobehavioral Catch-Up to Reduce Behavior Problems Among Children Adopted Internationally: Evidence From a Randomized Controlled Trial.

Children who have been adopted internationally often exhibit persistent behavior problems. The current study assessed the efficacy of the Attachment and Biobehavioral Catch-up intervention (ABC; Dozier & Bernard, 2019) for reducing behavior problems in 122 children adopted internationally. Behavior problems were measured via parent-report using the Brief Infant Toddler Social Emotional Assessment at a pre-intervention visit and after the intervention when children were between 18 and 36 months. Children's behavior problems were also observed using the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) after the intervention when children were 48 and 60 months. Parents who received ABC reported fewer child behavior problems than parents who received the control intervention immediately after the intervention through 1.5 years post-intervention. Additionally, children whose parents received ABC exhibited fewer behavior problems within the parent context of the DB-DOS when they were 48 months old (2 years post-intervention) than children whose parents received the control intervention. There were no significant intervention effects on children's observed behavior problems within the examiner contexts. These results support the efficacy of ABC in reducing behavior problems among children adopted internationally. Trial registration: ClinicalTrials.gov NCT00816621.

Caregiver Participation Engagement in Child Mental Health Prevention Programs: a Systematic Review.

Prevention programs are a key method to reduce the prevalence and impact of mental health disorders in childhood and adolescence. Caregiver participation engagement (CPE), which includes caregiver participation in sessions as well as follow-through with homework plans, is theorized to be an important component in the effectiveness of these programs. This systematic review aims to (1) describe the terms used to operationalize CPE and the measurement of CPE in prevention programs, (2) identify factors associated with CPE, (3) examine associations between CPE and outcomes, and (4) explore the effects of strategies used to enhance CPE. Thirty-nine articles representing 27 unique projects were reviewed. Articles were included if they examined CPE in a program that focused to some extent on preventing child mental health disorders. There was heterogeneity in both the terms used to describe CPE and the measurement of CPE. The majority of projects focused on assessment of caregiver home practice. There were no clear findings regarding determinants of CPE. With regard to the impact of CPE on program outcomes, higher levels of CPE predicted greater improvements in child and caregiver outcomes, as well as caregiver-child relationship quality. Finally, a small number of studies found that motivational and behavioral strategies (e.g., reinforcement, appointment reminders) were successful in promoting CPE. This review highlights the importance of considering CPE when developing, testing, and implementing prevention programs for child mental health disorders. Increased uniformity is needed in the measurement of CPE to facilitate a better understanding of determinants of CPE. In addition, the field would benefit from further evaluating strategies to increase CPE as a method of increasing the potency of prevention programs.

Outer-context determinants in the sustainment phase of a reimbursement-driven implementation of evidence-based practices in children's mental health services.

BACKGROUND: Although there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy. METHODS: This study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors. RESULTS: EBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume. CONCLUSIONS: The impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.

Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes.

Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.

Strategies that Promote Therapist Engagement in Active and Experiential Learning: Micro-Level Sequential Analysis.

Therapists' active learning increases treatment fidelity, but research is needed on supervisory strategies to engage therapists in active learning. This study used sequential analysis to examine consultant behaviors associated with increased and decreased probability of eliciting therapists' active learning. The study included 162 consultation sessions from 27 community therapists implementing Attachment and Biobehavioral Catch-up. Consultants' client discussion, information provision, and modeling were associated with reduced likelihood of active learning. Consultants' questions, engagement in active learning strategies, use of video, and silence were associated with greater likelihood of therapist active learning. These findings inform supervisors' attempts to encourage active learning.

Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy.

Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs.

A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes.

Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.

Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery.

LAY ABSTRACT: This study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI ("An Individualized Mental Health Intervention for ASD"), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, Autism Engagement Strategies and Active Teaching Strategies, while strategies used by usual care therapists grouped onto a broader single factor, General Strategies. Among usual care therapists, General Strategies were related to an increase in child behavior problems, whereas for AIM HI therapists, Active Teaching Strategies were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.

Therapist-Observer Concordance in Ratings of EBP Strategy Delivery: Challenges and Targeted Directions in Pursuing Pragmatic Measurement in Children's Mental Health Services.

Pragmatic measures of therapist delivery of evidence-based practice (EBP) are critical to assessing the impact of large-scale, multiple EBP implementation efforts. As an initial step in the development of pragmatic measurement, the current study examined the concordance between therapist and observer ratings of items assessing delivery of EBP strategies considered essential for common child EBP targets. Possible EBP-, session-, and therapist-levels factors associated with concordance were also explored. Therapists and independent observers rated the extensiveness of therapist (n = 103) EBP strategy delivery in 680 community psychotherapy sessions in which six EBPs were used. Concordance between therapist- and observer-report of the extensiveness of therapist EBP strategy use was at least fair (ICC ≥ .40) for approximately half of the items. Greater therapist-observer concordance was observed in sessions where a structured EBP was delivered and in sessions where therapists reported being able to carry out planned activities. Findings highlighted conditions that may improve or hinder therapists' ability to report on their own EBP strategy delivery in a way that is consistent with independent observers. These results can help inform the development of pragmatic therapist-report measures of EBP strategy delivery and implementation efforts more broadly.

Identifying Youth at Risk for Commercial Sexual Exploitation Within Child Advocacy Centers: A Statewide Pilot Study.

Commercial sexual exploitation of children (CSEC) is a social problem in the United States that has recently received growing attention from policy makers, advocates, and researchers. Despite increasing awareness of this issue, information on the prevalence, demographic profile, and psychosocial needs of victims of CSEC is scarce. To better understand the scope of CSEC and to examine the feasibility of screening for CSEC in Child Advocacy Centers (CACs), a pilot study was initiated through Arkansas Building Effective Services for Trauma (ARBEST) to identify youth who may be at risk for commercial sexual exploitation. Data for this pilot study were collected from all of the state's CACs (n = 14) over a 6-month period. Family advocates completed a screening questionnaire adapted from Greenbaum, Dodd, and McCracken with 918 youth aged 12 to 18 years old treated at CACs. Almost 20% of youth were identified as being at high risk for experiencing CSEC. Furthermore, youth classified as high-risk for commercial sexual exploitation reported significantly more avoidance symptoms on the UCLA (University of California at Los Angeles) PTSD (Posttraumatic Stress Disorder) Reaction Index than youth classified as low-risk. The results suggest that a significant portion of youth treated at CACs in Arkansas are at high risk for experiencing commercial sexual exploitation, which may be associated with a particular pattern of trauma symptoms. These findings also lend support for the feasibility and utilization of a screening questionnaire as part of routine care in CACs to potentially identify youth at risk for CSEC.

What educational strategies and mechanisms facilitate EBP use? A mixed methods examination of therapist perceptions within a system-driven implementation of multiple EBPs.

Background: Many strategies may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support evidence-based practice (EBP) implementation. The goal of this study was to identify which educational implementation strategies are considered by therapists to be most helpful, through which mechanisms, and whether these strategies are linked to EBP use. Methods: Semi-structured interviews were conducted with 60 therapists, and 826 therapists completed surveys regarding their perceptions of educational implementation strategies and reported delivery of EBPs within a system-driven, multiple-EBP implementation effort. Using sequential QUAL → QUAN mixed methods, we first identified qualitative themes. Next, we conducted a multilevel logistic regression to examine how quantitative survey items corresponding with qualitative themes predicted EBP use. Results: Initial qualitative thematic analyses revealed four implementation strategies perceived as essential for EBP delivery: connection to a community of trained therapists, ongoing consultation/supervision, availability of internal supervisors trained in the EBP, and access to EBP materials and resources. Quantitative results showed strategies related to connections with a community of trained therapists (i.e., percentage of other therapists at an agency with EBP training and delivery experience as opposed to those who are only trained in the EBP), ongoing consultation/supervision, and having an internal supervisor trained in the EBP (receiving EBP-specific in-house supervision) were significantly associated with EBP use while receiving EBP boosters was not. The closest quantitative indicator corresponding to access to EBP resources, EBP web-based training, was not associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. Conclusions: These findings demonstrate how considering therapist perspectives and creating a network of EBP support via supervisors, consultants, and a community of therapists experienced in the EBP may be particularly critical to EBP delivery. Plain language abstract: Public mental health systems are increasingly implementing multiple evidence-based practices (EBPs). There are many strategies that may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support EBP implementation. The goal of this study was to identify which of these internal and external implementation strategies are considered by therapists to be most helpful and how these strategies are linked with continued use of EBPs. First, qualitative interviews with therapists revealed the following strategies are key for supporting their delivery of EBPs: (1) connections to a community of trained therapists, (2) ongoing consultation/supervision, (3) having an internal supervisor at their program who was trained in the EBP, and (4) access to EBP materials and logistic resources. Next, quantitative analyses of survey data examined whether any of the strategies therapists identified as most helpful predicted the continued delivery of EBPs by therapists after initial training. Results confirmed that strategies involving connections with a community of therapists trained in and experienced with the EBP, ongoing consultation/supervision, and having an internal supervisor trained in the EBP were each significantly associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. These findings can assist systems and programs in prioritizing implementation strategies to support the sustained delivery of EBPs.

Prospective predictors of sustainment of multiple EBPs in a system-driven implementation context: Examining sustained delivery based on administrative claims.

Background: System-driven scale-up of multiple evidence-based practices (EBPs) is an increasingly common method used in public mental health to improve care. However, there are little data on the long-term sustained delivery of EBPs within these efforts, and previous studies have relied on retrospective self-report within cross-sectional studies. This study identified prospective predictors of sustained EBP delivery at the EBP-, therapist-, and organizational-levels using survey and administrative claims data within a large-scale system-driven implementation effort. Methods: 777 therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys assessing perceptions of EBPs and organizational context. These surveys were linked to administrative data to examine prospective predictors of therapists' EBP delivery over 33 months. Results: Five of the six EBPs implemented showed sustained delivery in the system, with volume varying by EBP. Although total EBP claim volume per therapist decreased over time, the volume ratio (ratio of EBP-specific claims to total EBP and non-EBP claims) stayed relatively stable. Multilevel models revealed that EBPs that required consultation, had unstructured content, higher therapist self-efficacy with the EBP, and more positive program leader perceptions of the EBP were associated with greater sustained volume and volume ratio of the EBP. Therapists who were trained in fewer EBPs, who were unlicensed, and who worked in agencies rated by program leaders as lower on organizational staff autonomy and stress showed greater sustained EBP volume and volume ratio. Finally, more direct service hours per week provided by therapist predicted greater sustained EBP volume, but lower volume ratio. Conclusions: The results point to the importance of EBP, therapist, and organizational factors that may be targeted in implementation strategies to promote the sustainment of EBPs.

Improving social-emotional competence in internationally adopted children with the Attachment and Biobehavioral Catch-up intervention.

Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social-emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social-emotional competence. Participants included 131 parent-child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent-child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social-emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social-emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social-emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social-emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social-emotional competence among children adopted internationally.

Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.

Understanding the factors that influence the use of evidence-based practices (EBPs) for autism spectrum disorder (ASD) in schools is critical to the selection of effective implementation strategies to support their sustained use. The current study has 2 aims: (a) evaluate the association between school leadership profiles (undifferentiated and optimal) and fidelity of EBP implementation and (b) examine the role of implementation climate as a mediator in this association. Participants included 56 principals, 90 special education teachers, and 133 classroom staff from 66 elementary schools. Participants completed the Multifactor Leadership Questionnaire and Implementation Climate Scale. Teachers and staff reported on intensity (frequency) of EBP delivery, and the research team rated the accuracy (adherence) to the components of the EBP. Schools were required to implement at least 1 of 3 EBPs for ASD (discrete trial training, pivotal response training, or visual supports). Using structural equation modeling, we found that schools with optimal leadership had higher observed ratings of teacher and staff fidelity for pivotal response training accuracy (p < .05), but not for discrete trial training or visual supports. However, this association became nonsignificant with the introduction of implementation climate into the models. Optimal leadership profiles were linked to more positive teacher/staff-reported implementation climate, compared with undifferentiated profiles (p < .01), but found no association between implementation climate and fidelity. Overall, the results of this study indicate that the role of principal leadership in EBP implementation is complex, which has implications for fostering a conducive organizational implementation context in schools. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention.

Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3 years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.