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Utilization and Outcomes of Exposure Therapy in Child and Adolescent Usual Care.

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Title:Utilization and Outcomes of Exposure Therapy in Child and Adolescent Usual Care.
Authors:Milette-Winfree, Matthew R.
Contributors:Psychology (department)
Date Issued:Dec 2017
Publisher:University of Hawaiʻi at Mānoa
Abstract:Exposure-based therapy approaches are efficacious for a range of youth anxiety, avoidance, and related problems. However, exposure is frequently underused and there is little or no difference in effectiveness between exposure-based interventions and usual care on anxiety-related problems. The present study examined the rate and patterns of exposure therapy use and the relationship between exposure use and treatment progress in youth receiving public mental health services in Hawai‘i from 2006-2015. Therapist-reported treatment characteristics, therapist and client variables, and other outcome data were examined using two cross-classification modeling approaches. First, a cross-classified logistic regression determined predictors of exposure use in anxiety-related treatment cases. A second cross-classified regression model then examined whether anxiety-related treatment progress was predicted by amount of exposure use after controlling for other variables. Of 6,616 treatment episodes in which an anxiety-related problem was addressed at any time during treatment, exposure was used in only 1,372 (20.7%). Exposure was more likely to be used when fewer externalizing problems were also targeted, in more recent years, and when anxiety seemed a more salient problem (such as when a youth experienced increased emotional impairment, when multiple anxiety-related problems were targeted within an episode, and when a youth carried an anxiety-related diagnosis). Contrary to expectations, therapist doctorate degree was not associated with exposure use. Four or more months of exposure in an episode was associated with higher anxiety-related treatment progress. This association occurred primarily in the community-based residential treatment setting, and persisted after
accounting for other significant predictors of improved anxiety-related outcomes (longer episodes, greater number of other practices, fewer treatment months in which externalizing problems were targeted, and several variables indicative of lower impairment). These findings suggest that while usual care therapists underutilize exposure, conditions predicting its increased likelihood of use appear well-considered and appropriate. Further, dissemination efforts have likely been helpful in increasing exposure utilization in this system of care. However, any treatment improvement associated with exposure use appears contingent on a specific set of circumstances suggestive of sufficient duration of implementation and possibly when barriers to treatment success are attenuated. Practice and future research implications are discussed.
Description:Ph.D. Thesis. University of Hawaiʻi at Mānoa 2017.
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: Ph.D. - Psychology

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