A qualitative study on the implementation of a transdiagnostic cognitive behavioral therapy for children in a child welfare residential treatment program.

BACKGROUND: Youth with severe emotional or behavioral issues who are involved with child welfare authorities are sometimes placed in intensive care services in a residential treatment program. Evidence-based psychotherapies are often used in residential treatments, but there is very little research on how to adapt psychotherapy for residential treatment. OBJECTIVE: To describe the implementation of a transdiagnostic cognitive behavioral therapy (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children) in a residential treatment program for children. PARTICIPANTS AND SETTING: Staff (n = 20) at a residential facility in Calgary, Canada. METHODS: A combination of qualitative interviews and focus groups were conducted before and after therapy to identify barriers and facilitators to implementation. Data were analyzed and reported using the Consolidated Framework for Implementation Research and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies. RESULTS: Modifications were made to the program including creating inclusive language, integrating relevant content targeting pediatric irritability, delivering sessions online for caregivers, and using additional staff to support youth to learn and practice the application of the content and behavioral interventions. Key barriers to implementation of the Unified Protocol included staff turnover and the difficulty of sustaining a critical mass of knowledge surrounding the Unified Protocol. The major facilitators to implementation were the perceived quality of the program and advantages of the program to children and their caregivers. CONCLUSIONS: This study supports the feasibility and acceptability of providing transdiagnostic cognitive behavioral therapies for children in residential treatment and provides a template for how to implement evidence-based practice in residential treatment.

Feasibility and acceptability of a brief, online transdiagnostic psychotherapy for young adults.

Background: The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a flexible form of cognitive behavioural therapy targeting diverse mental health disorders in children and adults. Objective: The goal was to develop a brief version of UP tailored to the unique needs of young adults that could be administered in an online therapist-directed, group format. Method: Nineteen young adults (age 18-23) receiving mental health services from a community agency or a specialty clinic were enrolled in a feasibility test of the novel transdiagnostic, online intervention (five sessions, 90 minutes each). Qualitative interviews were conducted with participants after each session they attended and upon study completion (n = 80 interviews with n = 17 participants). Standardized quantitative mental health measures were collected at baseline (n = 19), end of treatment (5 weeks; n = 15) and at follow-up (12 weeks; n = 14). Results: Thirteen of the 18 participants (72%) who began treatment attended at least four of the five sessions. During the qualitative interviews, participants noted that core UP concepts such as understanding of emotions, mindfulness, cognitive flexibility, and behavioural activation are applicable in their day-to-day lives. Quantitative data showed a significant reduction in anxiety-related life impairment at follow-up compared to baseline, but not end of treatment compared to baseline. Reductions in global anxiety and depression symptoms were not statistically significant. Conclusions: This novel, brief version of the UP may be a feasible online intervention for young adults seen at mental health clinics for diverse mental health issues and warrants further study to demonstrate effectiveness.

Contexte: Le protocole unifié (PU) pour le traitement transdiagnostique des troubles émotionnels est une forme flexible de thérapie cognitivo-comportementale ciblant divers troubles de santé mentale flexible chez les enfants et les adultes. Objectif: Le but était d'élaborer une version abrégée du PU adaptée aux besoins uniques des jeunes adultes qui pourrait être administrée à un format de groupe en ligne dirigé par un thérapeute. Méthode: Dix-neuf jeunes adultes (18­23 ans) recevant des services de santé mentale d'un organisme communautaire ou d'une clinique spécialisée ont été inscrits à un test de faisabilité de la nouvelle intervention transdiagnostique en ligne (cinq séances, 90 minutes chacune). Des entrevues qualitatives ont été menées auprès des participants après chaque séance à laquelle ils ont assisté et à la fin de l'étude (n = 80 entrevues avec n = 17 participants). Les mesures de santé mentale standardisée quantitative ont été recueillies à la base (n = 19), à la fin du traitement (5 semaines; n = 15) et au suivi (12 semaines; n = 14). Résultats: Treize des 18 participants (72 %) qui ont commencé le traitement ont assisté à au moins quatre des cinq séances. Durant les entrevues qualitatives, les participants ont noté que les principaux concepts du PU comme la compréhension des émotions, la pleine conscience, la flexibilité cognitive et l'activation comportementale sont applicables dans leur vie quotidienne. Les données quantitatives indiquaient une réduction significative dans les troubles de la vie liés à l'anxiété au suivi comparé à la base, mais pas à la fin du traitement comparé à la base. Les réductions de l'anxiété générale et des symptômes de dépression n'étaient pas statistiquement significatives. Conclusions: Cette nouvelle version abrégée du PU peut être une intervention faisable en ligne pour les jeunes adultes vus dans des cliniques de santé mentale pour divers problèmes de santé mentale et demande plus d'étude pour en démontrer l'efficacité.

Are Parent- and Teacher-Reported Executive Function Difficulties Associated With Parenting Stress for Children Diagnosed With ADHD?

Objective: To examine the relationship between parenting stress and parent- and teacher-reported executive function difficulties (EFDs) for childhood ADHD. Method: A secondary analysis using linear regression was conducted on parent- and teacher-completed Behavior Rating Inventory of Executive Function and Parenting Stress Indexes for 5- to 12-year-olds (n = 243) with ADHD. Results: The linear combination of teacher- and parent-reported EFDs accounted for 49% of the variance in child-related parenting stress. Teacher-reported school-based EFDs were relatively inconsequential, having accounted for only 3% of this variance. This stress is best explained by EFDs with emotional control in the school environment and parent-reported EFDs with emotional control, inhibit, monitor, and shift. Conclusion: Parent-reported EFDs, and less so school-based EFDs, are related to parenting stress, but only in regard to EFDs likely underpinning behavioral outbursts and those likely underpinning the daily hassles of providing specialized care to children with ADHD.