Nationally, tax dollars are invested into the community-implementation of evidence-based practices (EBPs) to improve the quality of mental health (MH) care for youth. Yet, tension lies in therapist delivery of EBPs with fidelity while simultaneously tailoring treatment to address the needs of culturally diverse families. Supporting these concerns is evidence of disparities in caregiver treatment engagement that disfavor low-income Latinx families; this is alarming given that caregiver participation has been linked to improved child clinical outcomes and is often prescribed in EBP protocols. In order to maximize the public health impact of EBPs, strategies are needed to address engagement challenges within Latinx families. Shared decision-making (SDM) is a structured care process that can potentially enhance caregiver engagement and be integrated into EBP delivery. SDM cultivates a partnership between the therapist and client (e.g., the caregiver) to exchange information, and discuss treatment options to arrive at a consensus on treatment decisions. Research on SDM within youth MH treatment is nascent with initial evidence documenting positives links between SDM and child clinical outcomes. Although federal organizations have advocated for SDM in children's MH care, to date, there is no research on the spontaneous incorporation of SDM in the community delivery of EBPs. In line with NIMH's Research Priority 4.1 to improve the efficiency and effectiveness of existing MH services, the proposed study examines the potential benefits of therapist use of SDM practices to engage Latinx caregivers in their child's treatment with an EBP. The proposed project builds upon two NIMH-funded studies (R01-MH100134 and R01-MH112536) focused on the community-implementation of multiple EBPs following a fiscal mandate in a public MH service system. A multi-method approach will be used inclusive of observational coding and quantitative measures. Primary outcomes of interest are caregiver-therapist alliance and child clinical outcomes. Specific research aims are as follows: (1) Characterize therapist use of SDM processes with Latinx caregivers within the community implementation of multiple EBPs; (2) Examine the association between therapist use of SDM processes and caregiver-therapist alliance; (3) Examine the indirect effect of therapist- initiated SDM on child symptom outcomes as mediated by caregiver-therapist alliance. To complete these aims, the applicant will be supported by an exceptional mentoring team and participate in specialized training activities. Ultimately, the applicant will: (a) Develop substantive expertise on SDM within an implementation science framework (i.e., community EBP delivery); (b) Cultivate skills in using observer-based methodology to examine treatment processes; (c) Advance statistical skills in multi-level modeling. Overall, the research- training plan will advance the applicant's technical skills and knowledge base in preparation for a productive career conducting policy-relevant studies at the intersection of disparities and implementation research.
Tension lies in therapist delivery of evidence-based practices (EBPs) with fidelity while simultaneously tailoring treatment to address the needs of culturally diverse families. In order to maximize the public health impact of EBPs that prescribe caregiver participation, strategies are needed to address engagement challenges common within Latinx families. In line with NIMH's Research Priority 4.1 to improve the efficiency and effectiveness of existing MH services, the proposed study examines the potential benefits of therapist use of shared-decision making practices to engage Latinx caregivers in their child's treatment with an EBP.
