Peering Into the Black Box: An Examination of Community-Based Therapists' Intentions for Treating Youth

Abstract

The construct of behavioral intentions is a key component across theories of behavior. Despite its frequent application to innovation-adoption behaviors of health care providers, the study of behavioral intentions has not yet been applied to community mental health care providers’ adoption of practice elements (PE) and specifically, to their adoption of practices derived from the evidence base (PDEBs). There were three main purposes of the current examination: (a) to develop a novel survey for assessing therapists’ PE-related intentions for treatment, (b) to examine patterns across therapists’ PE intentions across different youth diagnoses (i.e., anxiety [ANX] versus disruptive behavior [DBD]) with a relatively uncomplicated and single-diagnosis presentation, and (c) to evaluate the extent to which therapists’ intentions reflect use of PDEBs for each problem area. Regarding the first aim, the measure was developed and feedback from pilot participants (N = 11) suggested some preliminary support for test-retest reliability and face validity of the measure. Descriptive analyses and a series of multiple regressions, respectively, were used to examine the last two aims of the study. Participants were 79 youth therapists currently providing public sector mental health services. Results from the second aim of the study indicated that for both the ANX and DBD cases, therapists reported the intention to use a wide range of PEs both typically and not typically associated with the evidence base for that problem area. Overall, the most commonly endorsed PE intentions for each problem area were predominantly PDEBs. In addition, therapists’ PE intentions for the single-diagnosis ANX youth tended to be characterized by an overgeneralized application of DBD PDEBs, suggesting therapists may pull from a general toolbox of strategies that, at times, may not supported by the literature or indicated by the specific case presentation. Results from the third aim of this study suggest that neither the Theory of Planned Behavior predictors (i.e., attitudes, SN, and PBC toward using evidence-based practices) nor demographic predictors were significant predictors of therapists’ intention to use PDEBs with either the ANX or DBD clients. Interestingly, across both ANX and DBD cases, the only significant predictor of intention to use PDEBs was participant intention to use practices with minimal evidence support (PMESs). This finding indicates that therapists in this sample reported intentions to use a treatment approach characterized by applying the “kitchen sink” (i.e., a large quantity and diversity of practices) with these relatively straightforward, single-diagnosis cases. Taken together, it appears that the study of therapist intentions at this PE level may be a fruitful direction for helping better understand the nature of UC treatment and therapist decision-making, as well as provide valuable insights for future training efforts.