(Withdrawn) Defining Core Therapist Skills Necessary for Family Focused Ebps: Results of a Mixed Method Delphi Study

Background and Purpose: Evidence-based practices (EBPs) exist to support behavioral health for children and their families, yet their adoption in community mental health settings remains shockingly low (SAMHSA, 2020). Improved adoption of EBPs is critical when considering that EBPs are significant contributors to positive outcomes for children and families, e.g., reduction in serious mental health symptoms and behavioral improvements (McHugo et al., 2007). Therapist training is commonly employed in community health settings to improve EBP adoption, yet there is little agreement on what foundational skills therapists need to be successful implementing EBP approaches (NIH, 2018). Engaging families in treatment is critical to EBP implementation since there is no opportunity for intervention without it (Becker & Stirman, 2011), Therefore, this study sought to answer the question: What are the foundational therapist skills experts identify as important to improving therapist adoption of family focused EBPs targeting SED symptoms in children? Utilizing data obtained from this research question, this proposal seeks to examine the specific skills identified as necessary to engaging families in EBP treatments.

Methods: A mixed-method modified Delphi process was utilized to engage 51 experts representing 11 different family-focused EBPs commonly implemented in community mental health settings throughout the United States. The Delphi process included one round of qualitative inquiry, one round of quantitative analysis, and follow up focus groups. Content analysis procedures were utilized to code qualitative feedback describing skills seen as necessary for therapists working with children experiencing significant behavioral health symptoms. Mean, median, and interquartile range statistics were used to analyze quantitative rankings and build consensus. Participants were then invited to participate in one of eight focus groups that identified training methods congruent with consensus skills.

Results: This study produced 222 unique skill statements endorsed by participants as foundational for therapists to have when learning family focused EBPs. Consensus, as measured by an interquartile range of less than 2, was reached on 175 unique skills organized over six main skillset areas, i.e., Assessment, Family Engagement, Intervention, Adaptability, Reflexivity, and Trauma-informed Care. More specifically, the category of Family Engagement yielded 34 of the 175 unique skill statements, compromising specific themes of a therapists’ ability to: 1) establish a therapeutic bond, 2) build empathic response, 3) engage all family members in treatment, 4) facilitate agreement on therapeutic goals, and 5) enhance client motivation.

Conclusions and Implications: This study determined expert agreement on a robust foundational skillset necessary for family focused EBP implementations. Family Engagement, one skillset category, is highly reflective of the foundational relationship skills necessary for connecting families to EBP treatments. Considering how to develop these skills in clinicians has significant implications for clinical practice and supervision. These findings hold potential to inform future training interventions that support an engagement focus in EBP delivery. Results are applicable to community health providers investing in training and workforce development opportunities for their staff. Finally, this body of research calls for clinical training programs to include skills specific to family engagement in curriculum development and the assessment of therapists in training.