The value of skillfully adopting a multicultural orientation (MCO) in psychotherapy has been increasingly recognized. Deliberate practice methods may be helpful in developing this capacity, but limited opportunities for practice and feedback exist. The current study provided an initial test of the feasibility, usability, and acceptability of a self-guided, web-based deliberate practice tool designed to support the development of therapists' MCO: MCO Deliberate Practice Online (MCO-O). This tool included brief didactic instructions along with opportunities to practice responding to video vignettes of actors portraying clients discussing cultural topics in psychotherapy. A sample of therapists and trainees ( = 287) visited the MCO-O website and consented to the study. Recruitment through emails to listservs and a webinar was highly feasible. Quantitative ratings of usability were modest. Quantitative metrics of acceptability were also modest, with a minority of participants (18.8%) visiting the MCO-O website more than once and 51.2% of participants viewing two or more of the video vignettes. Younger participants found the MCO-O website more usable and having MCO-O assigned was associated with watching more videos, when controlling for participant demographics. Qualitative themes included a mixture of positive feedback along with critiques and confusion regarding the MCO-O website. Taken together, results highlight the potential of this approach along with important limitations. Ultimately, it may prove difficult for therapists and trainees to engage in self-guided MCO training, particularly if using software tools that have not undergone extensive (and potentially resource intensive) user experience testing and development.

Despite efforts to incorporate evidence-based practice into mental health settings, there has been inconsistent success doing so. Several barriers to the implementation of evidence-based practice have been identified, including limitations in time and statistical training. One promising approach to further bridge the science-practice gap is the greater use of meta-analytic studies to clarify the magnitude of treatment effects and to understand components of treatments that are more effective within specific populations. Although several articles have been published to help mental health trainees and providers understand and interpret meta-analyses, they may not be sufficient without extensive training in statistical techniques. The purpose of this article is to provide and explain the use of the as a means by which mental health providers at all professional levels can use meta-analytic findings to make clinical judgements regarding treatment approaches in the context of ongoing or new cases. A case example is provided to illustrate the use of the Worksheet in clinical decision-making.

The number of psychologists prepared to work with older adults falls far short of the demand. In the face of perceptions of a worsening geriatric workforce shortage, we describe the process of developing and implementing a national virtual conference aimed at generating solutions. A preconference survey ( = 174) found fewer applicants than desirable for aging-targeted graduate student, trainee, clinician, or academic positions (58.6%) and decreased student interest in aging (43.7%), with downstream consequences of filling age-targeted positions by those without aging backgrounds (32.3%), difficulty securing funding for aging-related positions (28.7%), and loss of aging-related positions (27.0%). Two fifths (40.7%) felt these problems have worsened as compared to 5 years ago. Qualitative responses provide detailed perspectives on these barriers and strategies generally and in particular as relates to racial and ethnic diversity and academic geropsychology. During a 2-day conference, attendees developed and prioritized strategies. Following a postconference survey to ascertain interest in volunteering, seven work groups were formed that have made progress on these issues. A virtual conference provides an inclusive, cost-effective, and fruitful opportunity to discuss workforce concerns in geropsychology and to generate numerous ideas to promote positive change.

Six states (NM, LA, IL, IA, ID, CO) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov Model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro-micro costing approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million ($USD) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of cost-effectiveness was only modestly associated with the implementation costs of the policy, but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity.

This study evaluated the effectiveness of different recruitment messages for encouraging enrollment in a digital mental health intervention (DMHI) for anxiety among 1,600 anxious patients in a large healthcare system. Patients were randomly assigned to receive a standard message, or one of five messages designed to encourage enrollment: Three messages offered varying financial incentives, one message offered coaching, and one message provided consumer testimonials. Patients could then click a link in the message to visit the DMHI website, enroll, and start the first session. We examined the effects of message features and message length (short vs. long) on rates of site clicks, enrollment, and starting the first session. We also tested whether demographic and clinical factors derived from patients' electronic health records were associated with rates of enrollment and starting the first session to understand the characteristics of patients most likely to use DMHIs in this setting. Across messages, 19.4% of patients clicked a link to visit the DMHI website, but none of the messages were significantly associated with rates of site clicks, enrollment, or starting the first session. Females (vs. males) had a greater probability of enrollment. No other demographic or clinical variables were significantly associated with enrollment or starting the first session. Findings provide guidance for resource allocation decisions in larger scale DMHI implementations in healthcare settings.

The SARS-CoV-2 (COVID-19) pandemic has placed a tremendous strain on healthcare providers. Although there is a burgeoning body of literature on how COVID-19 has impacted frontline healthcare workers (i.e., providers treating COVID-19 patients), little attention has been dedicated to second-line workers (i.e., providers treating the mental health of people impacted by COVID-19). In this paper, we present findings from a thematic analysis of open text responses ( = 136) examining how COVID-19 shaped both the wellbeing of second-line workers, specifically mental health providers, as well as their clinical work in the early months of the COVID-19 pandemic in the United States. Results indicated that mental health providers were experiencing significant COVID-19-related burnout and poor physical and mental health outcomes. Participants described diminished negative effects on the quality of their clinical care from the burnout and trauma associated with COVID-19. Many also demonstrated resilience, identifying the duality of both negative (e.g., exhaustion) and positive (e.g., pride in helping others) meaning derived from their second-line work experiences. We conclude with recommendations for preventing and addressing burnout among mental health professionals in the era of COVID-19 and subsequent health emergencies.

There is a need for integrated treatment approaches that address heavy alcohol use and posttraumatic stress disorder (PTSD) concurrently among Veterans as interactions between heavy drinking and PTSD are frequent. Veteran engagement in specialty mental health services after referral is limited with poorer outcomes following empirically-supported, exposure-based PTSD treatments that do not explicitly address alcohol use. The current project aimed to incorporate two evidenced-based interventions: Brief Motivational Intervention (BMI) with Prolonged Exposure for Primary Care (PE-PC) for Veterans with heavy drinking and PTSD. Delphi methodology was applied to adapt an intervention protocol using subject matter expert (SME) feedback to guide the refinement of a preliminary treatment manual. The newly developed brief intervention (PC-TIME) was then tested in an open trial (n=9) to gather Veteran participant feedback to modify the treatment manual.Two rounds of SME feedback resulted in 80% agreement that manual content was "acceptable as-is" across all intervention domains. The resulting protocol is a five-session, integrated intervention with session 1 primarily focused on alcohol use reduction and sessions 2-5 consisting of narrative exposure and in-vivo exercises for PTSD symptoms with brief alcohol use check-ins. Open trial results indicated high Veteran acceptance of PC-TIME structure and content, and reductions in heavy drinking and PTSD symptoms. Preliminary data suggest PC-TIME to be a promising approach for treatment of heavy alcohol use and PTSD. A pilot randomized controlled trial is necessary to demonstrate the intervention's efficacy with Veterans in a PC setting.

According to the national census, approximately a fifth of the adult population in the United States uses a language other than English in their home. Less precise information is available regarding the language preferences of children and adolescents, D/deaf individuals, and other individuals in the United States who are not represented in national surveys. The field of psychology has increasingly acknowledged and addressed the lived experiences of culturally and linguistically minoritized individuals in the United States through relevant research and clinical practice guidelines. As a result, more accessible and equitable practices for psychological assessments have been developed when working with linguistically minoritized clients. Unfortunately, there is a paucity of information in the extant literature regarding drafting psychological assessment reports for linguistically minoritized clients. This article explores the ethical and professional responsibilities of psychologists when engaged in this work, and provides proposed practices for drafting and delivering accessible assessment reports for linguistically minoritized clients. Recommendations are provided regarding how psychologists can share the results of an assessment with a referral source using written English and also support a client in accessing the information in their primary language.

Family caregivers of dementia patients experience high levels of interpersonal stress that often results in elevated anxiety, and depression, and negative impacts on interpersonal relationships. Changes in behaviors and the structure of relationships with the care recipient (CR) and others in the social milieu challenge the caregivers' ability to mentalize, or understand the links between mental states and behaviors. This study investigates the experiences and perceived benefits of family dementia caregivers who underwent Mentalizing Imagery Therapy (MIT), a treatment aiming to improve balanced self-other mentalizing and reduce psychological symptoms.

Individuals who identify as transgender or gender diverse (TGD) are presenting at mental health clinicians' offices with increasing frequency. Many TGD clients are seeking care related to affirming their gender identity but also may present with anxiety, depression, trauma, substance abuse, or other problems for which a clinician may commonly provide services. Some clinicians may hesitate to accept TGD clients into their practice if they have little specialized training to work with this population in an affirming manner, especially in more underserved areas where a generalist practice is the norm. Numerous professional associations and experts have developed guidelines for affirmative behavioral health care for TGD people. However, what is needed are community informed recommendations to bridge from the official guidelines to clinicians' in-session activities. The Trans Collaborations Practice Adaptations for Psychological Interventions for Transgender and Gender Diverse Adults are derived from iterative interviews with TGD community members and affirming mental health clinicians in the Central United States. The 12 practice adaptations are intended to guide clinicians to adapt their usual treatment approach to be TGD affirming, especially in underserved and rural areas. The practice adaptations cover numerous aspects of practice including the office setting and paperwork, understanding gender identity and incorporating it into the case conceptualization, therapist's self-awareness, and referrals. The Trans Collaborations Practice Adaptations will help clinicians work confidently and competently with adult TGD clients, regardless of the presenting problem, to ensure TGD communities receive the best interventions for their behavioral health concerns.

This article explores the potential of using systems methods for better conceptualizing the unexpected and complex sets of hurdles and opportunities that practicing psychologists frequently encounter. Examples are provided involving two distinct types of important clinical issues: 1) understanding how individuals maintain recovery from substance use disorders following treatment and 2) better understanding patients with chronic, unexplained post-viral illnesses. Traditional research methods used to explore these types of intricate social and medical issues have often lacked sophisticated dynamic systems-based perspectives, which could provide new insights into understanding how patient treatment gains can be maintained and how unexplained post-viral illnesses can be better understood. Our examples will demonstrate that systems-oriented approaches have the potential to provide psychologists unique opportunities to capture a fuller and richer depiction of a variety of clinical and community topics and thus provide new lenses that ultimately could provide better care for our patients.

We conducted a systematic review to characterize features and evaluate outcomes of cultural competence trainings delivered to mental health providers. We reviewed 37 training curricula described in 40 articles published between 1984-2019 and extracted information about curricular content (e.g., cultural identities), as well as training features (e.g., duration), methods (e.g., instructional strategies), and outcomes (i.e., attitudes, knowledge, skills). Training participants included graduate students and practicing professionals from a range of disciplines. Few studies (7.1%) employed a randomized-controlled trial design, instead favoring single-group (61.9%) or quasi-experimental (31.0%) designs. Many curricula focused on race/ethnicity (64.9%), followed by sexual orientation (45.9%) and general multicultural identity (43.2%). Few curricula included other cultural categorizations such as religion (16.2%), immigration status (13.5%), or socioeconomic status (13.5%). Most curricula included topics of sociocultural information (89.2%) and identity (78.4%), but fewer included topics such as discrimination and prejudice (54.1%). Lectures (89.2%) and discussions (86.5%) were common instructional strategies, whereas opportunities for application of material were less common (e.g., clinical experience: 16.2%; modeling: 13.5%). Cultural attitudes were the most frequently assessed training outcome (89.2%), followed by knowledge (81.1%) and skills (67.6%). To advance the science and practice of cultural competence trainings, we recommend that future studies include control groups, pre- and post-training assessment, and multiple methods for measuring multiple training outcomes. We also recommend consideration of cultural categories that are less frequently represented, how curricula might develop culturally competent providers beyond any single cultural category, and how best to leverage active learning strategies to maximize the impact of trainings.

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

Transgender and gender nonbinary (TGNB) individuals use provider information, such as websites, to ascertain whether providers are affirming of TGNB identities. Yet, providers may be unsure about what level of affirmation is sufficient to be perceived as affirming and may be concerned that cisgender people may have negative reactions to website material that is TGNB affirming. The present study undertook a user experience (UX) investigation of TGNB and cisgender participants' UX of mental health provider websites. Participants (310 cisgender, 224 TGNB) were recruited online. Participants viewed one of five mock provider websites. Results of a multivariate analysis of covariance (MANCOVA) indicated that TGNB had more positive evaluations of the three more affirming sites, compared to the less affirming sites, along UX domains related to likelihood of going to that provider, Mental Health Help-Seeking Attitudes, positive emotional UX, and negative emotional UX. Regardless of gender identity, participants rated the three more affirming sites as more welcoming. The results support the use of TGNB affirmation in the UX of TGNB individuals viewing provider websites and further suggest that TGNB affirmation does not detract from the UX of cisgender people. Implications for affirming practice with TGNB populations are reviewed.

Suicides by firearm have increased over the past decade among United States service members and veterans. As firearm access is a suicide risk factor, firearm-related lethal means safety is critical to suicide prevention. However, identity, occupational, and cultural barriers may deter efforts to promote lethal means safety with service members and veterans. The current manuscript describes a collaborative framework to guide mental health providers' in conducting firearm-related lethal means safety with service members and veterans, including within the context of Safety Planning. In approaching firearm lethal means safety conversations with patients, clinicians must work to overcome their own reticence, address patient concerns directly, and remain culturally sensitive to the values of the military and veteran communities. This approach is illustrated using case vignettes that encompass addressing firearm-related lethal means safety with service members and veterans.

Expert consensus methods, such as the Delphi procedure, are commonly employed in consumer, education, and health services research. However, the utility of this methodology has not widely been described in relation to mental health treatment adaptation efforts. This gap is noteworthy given that evidence-based treatments are often modified in terms of core intervention content, method of delivery, and target populations. Expert consensus methods such as the Delphi procedure offer multiple practical benefits (e.g., flexibility, resource-efficiency) for psychologists who need to adapt existing treatments to meet new research and clinical practice needs. The purpose of this paper is to provide a brief overview of the Delphi procedure, and to offer a practical guide to using this method for treatment adaptation. An example is offered using our team's application of a three-round Delphi procedure to render content and context modifications to an existing problem-solving intervention to optimize its use with a new treatment population. Data were collected from Department of Veterans Affairs clinical subject matter experts. Round 1 utilized semi-structured interviews to determine necessary protocol features and modifications. Rounds 2-3 utilized a forced-choice survey and feedback loop to evaluate expert consensus. More than 91% of rated items reached consensus following Round 2, with the remainder following Round 3. Recommended modifications included minor structural and content edits, and re-balancing time allotments. We conclude that consensus methods may facilitate treatment adaptation efforts, enhance treatment feasibility, and promote content and ecological validity. Considerations for future Delphi-based treatment adaptations are offered.

Informational materials from psychological associations often encourage parents to seek out "evidence-based therapies" (EBTs) to address their child's behavioral health concerns. This study examined whether parents concerned about their adolescents' substance use had distinct preferences for EBT principles and marketing language based on their adolescent's specific behavioral health problems. Parents ( = 411; 86% female; 88% non-Hispanic White) of adolescents (age 12-19 years) completed an online direct-to-consumer (DTC) marketing survey as part of a larger multi-phase study. Parents reported their adolescents had high rates of current externalizing (66%), internalizing (51%), substance-related (39%), and legal (25%) problems. Parents answered questions about their perceived definition of EBT, whether they valued underlying EBT principles (i.e., reliance on a proven approach vs. a varied approach), their preferred terms for describing EBT, and factors they considered when choosing a therapist. Most parents defined EBT correctly, regardless of their adolescent's behavioral health problems. Parents of adolescents with internalizing or legal problems were less likely to value EBT principles, with legal problems emerging as the more important multivariate predictor. Additionally, parents of adolescents with substance-related or legal problems had distinct preferences for the terms used to describe EBTs. Finally, parents of adolescents with externalizing problems had distinct preferences for factors they considered when choosing a therapist. Psychologists and psychological associations seeking to disseminate information about EBTs to parents can utilize these DTC marketing-informed results to tailor outreach strategies based on adolescent behavioral health problems.

A growing empirical literature supports contingency management (CM) as an efficacious treatment for substance use disorders, especially when reinforcers are immediate, frequent, and of sufficient magnitude on escalating schedules. However, in real world-practice, CM is often conducted in ways that are inconsistent with research protocols. One reason for these inconsistencies may be due to pragmatic challenges inherent in conducting CM. In this article, we described an outpatient CM treatment program for drug use disorders and several specific challenges associated with adherence to CM parameters from research protocols. Finally, we propose possible solutions for these challenges and discuss implications for practice.

To address concerns about limited training of psychologists working in long-term care (LTC) facilities, the Psychologists in Long-Term Care (PLTC) organization published Standards for Psychological Services in Long-Term Care Facilities (Lichtenberg et al., 1998). The expanding evidence base for knowledge and skills, the increasing diversity of LTC residents, and the complexity of presenting problems have compounded the guidance psychologists need when providing services in this setting. In this article, the PLTC Guidelines Revision Task Force presents PLTC guidelines based on the original prescriptive PLTC Standards. The content of the PLTC Standards was updated and the format changed from prescriptive standards to aspirational guidelines. We begin with general guidelines regarding knowledge and skills in LTC (education and training. understanding of LTC systems. end-of-life care), followed by specific guidelines covering the basic psychological service activities in LTC (referral, assessment, treatment, ethical issues, and advocacy). The PLTC Guidelines are designed to provide direction for psychologists who work, or plan to work, in LTC and to guide continuing education pursuits.

Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.

The U.S. Department of Veterans Affairs (VA) in collaboration with the Department of Defense has created mobile applications (apps) that target military Veteran-specific mental health challenges. With over half of Veterans being older than 65, it is essential to support these individuals' access to and use of these apps. One critical barrier to older adults using apps is that they may not be aware of mental health apps and often need assistance learning to use their devices. To address these gaps in knowledge, we designed and evaluated patient education materials teaching how to download apps and the basics of mobile device use. The materials also included step-by-step guides for three VA mobile apps: Mindfulness Coach, Mood Coach, and PTSD Coach. Guided by user-centered design and feedback from providers and older Veterans, the materials were developed and refined. Six local technology and geriatric content experts provided initial feedback. Next, six older Veterans (M = 78.5 years; 50% owned smartphones) formally evaluated the materials with a majority (83.3%) electing to 'recommend the materials to others.' Lastly, 12 providers provided feedback on the materials and 79% rated the materials as helpful. Providers viewed the materials as especially useful for patients who are unable to return to clinic. Overall, providers and Veterans found the materials easy to understand and valuable for novice users. Findings suggest the use of user-centered design principles and iterative evaluations to create patient technology education materials are vital to increase the use of mental health mobile apps among older Veterans.

Sustaining evidence-based practices after initial training and support has ended is necessary to ensure lasting improvements in youth mental health services. This study examined factors impacting community clinicians' decisions to sustain a transdiagnostic youth intervention following participation in a study. The aim of the study was to identify potentially mutable factors impacting sustainability to inform future implementation efforts. Thirteen clinicians (85% women, 92% Caucasian, age = 35.6) completed interviews after participating in an open trial of an evidence-based intervention for depression, anxiety, and conduct disorders. Interviews were analyzed using thematic analysis methods. All (100%) clinicians reported current use of the intervention. Four themes emerged related to sustainability. Clinicians (100%) reported that making modifications, alignment with prior training, and relative advantage influenced their current intervention use. Clinicians (100%) reported that knowledge transfer from treatment developers was vital to sustainability. They (92%) noted a number of logistical, inner-organizational, and client-level barriers to sustainability. Lastly, clinicians (92%) identified factors related to scaling up the intervention. A variety of personal, organizational, logistical, and client variables influence the sustainment of new interventions, and could be leveraged in future implementation efforts.

Growth in the presence of Emotional Support Animals (ESAs) in our society has recently garnered a substantial amount of attention, both in the popular media and the professional literature. Public media abounds with stories focusing on the increasing number of animals claimed as ESAs, the impact of this growth on society, the industry claiming to certify ESAs, and the various types of animals described as "certified." The authors propose an assessment model for ESAs certification comprising a four-pronged approach for conducting these types of assessments: (1) understanding, recognizing, and applying the laws regulating ESAs, (2) a thorough valid assessment of the individual requesting an ESA certification, (3) an assessment of the animal in question to ensure it actually performs the valid functions of an ESA, and (4) an assessment of the interaction between the animal and the individual to determine whether the animal's presence has a demonstrably beneficial effect on that individual. This model aligns with professional ethics, standards of professional practice, and the law and seeks to provide clear guidelines for mental health professionals conducting ESA evaluations.

Many clinicians find it challenging to obtain training in evidence-based interventions, including behavioral parent training, which is considered the front-line treatment for children with disruptive behaviors (Chacko et al., 2017). Workshops, ongoing consultation, and feedback provided in person are effective, yet are rarely feasible for clinicians in the field (Fixsen, Blase, Duda, Naoom, & Van Dyke, 2010). The purpose of the present study was to conduct a preliminary assessment of an online tutorial combined with live remote coaching for training mental health professionals in behavioral parent training.

Parent-directed marketing strategies have great potential to promote the utilization of therapy by adolescents with or at risk of substance-related problems. The extent to which marketing strategies should be tailored to parents of adolescents with various presenting problems - such as substance use, mental health, and legal involvement - is unknown. The current study represents a secondary analysis of a direct-to-consumer (DTC) marketing survey, which used a well-established framework called the Marketing Mix to solicit parent preferences about marketing across three dimensions: Promotion (i.e., how parents prefer to receive information); Place (i.e., where parents prefer to receive therapy); and Price (i.e., how much parents are willing to pay and how far parents are willing to travel). Four-hundred eleven parents of 12- to 19-year-old adolescents (51% girls, 82% Non-Hispanic White) completed the survey and answered five questions spanning Promotion, Price, and Place dimensions of the Marketing Mix. A subsample of 158 parents also reported on their actual therapy-seeking behavior, allowing us to report on both parents' ideal and actual experiences. We explored the extent to which parent preferences varied as a function of adolescent substance use, externalizing, internalizing, and legal problems. Bivariate analyses and multivariate logistic regressions were used to examine which of these variables were associated with parents' responses to specific survey items. Analyses confirmed that both parent preferences and parents' actual therapy-seeking behavior varied as a function of adolescent problems. Recommendations are offered for professional psychologists to use DTC marketing strategies to connect with adolescents in need of services.

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress associated with these transitions relates to increases in health-risk behaviors, such as substance use and high-risk sexual behavior. This research examined health-risk behavior outcomes associated with the Young Adult Family Check-Up (YA-FCU). The YA-FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session that integrates motivational interviewing (MI) techniques. This study measured treatment fidelity of the YA-FCU and the extent to which therapists adhered to principles of MI during feedback sessions. Therapists included both licensed psychologists and trainees. The study also examined the relationship between therapists' MI fidelity and client change talk (CT), in order to determine if MI fidelity and client CT predicted postintervention health-risk behaviors among emerging adults who participated in the YA-FCU. Measures of health-risk behaviors were collected pre- and post- intervention. Results indicated overall adequate treatment fidelity. MI fidelity was positively related to client CT. Several indicators of MI fidelity predicted decreases in emerging adults' health-risk behaviors. For example, therapist ratio of reflections to questions predicted a decline in emerging adults' alcohol use frequency and marijuana use quantity. These results have important implications for YA-FCU training and implementation and indicate that MI consistent skills might be a mechanism of change in the YA-FCU intervention.

This study was designed to evaluate family processes theoretically implicated in the onset and maintenance of adolescent self-harm. In the present study, we focus on understanding parental validation and invalidation in response to their adolescent in order to estimate the association between parental responses and self-harm in a high risk group of adolescents. We also sought to determine the influence of psychotherapy on parental validation and invalidation over time during participation in a randomized clinical trial of psychotherapy designed to reduce self-harm. Thirty-eight teens ( = 14.85; 94.1% female, 55.3% Caucasian, and 17.5% Latino) and their parents participated in three assessments over a six month period corresponding to pretreatment, midtreatment and end of treatment in the trial. Results indicate a robust association between parental validation, invalidation and adolescent self-harm. There were no significant associations observed between parental validation, invalidation, and adolescent suicidal ideation. Observed levels of parental validation and invalidation were not changed during the six-month course of psychotherapy.

Burnout among community mental health (CMH) therapists has been associated with poorer therapist health, high agency turnover, poorer client outcomes, and compromised quality of care. Recent mandates to learn and implement multiple evidence-based practices (EBPs) within CMH settings are intended to improve the quality of community care, yet there is mixed evidence concerning the impacts on workforce burnout. The current study sought to identify correlates of therapist emotional exhaustion, a key aspect of burnout, during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. We hypothesized that high workload and unfavorable organizational climate would relate to therapist emotional exhaustion, but that positive experiences with EBPs adopted would relate to lower exhaustion. Although agency-level indices of organizational climate were unrelated to exhaustion, a multilevel model revealed that therapists' weekly work hours, caseload, and number of EBPs delivered were associated with increased emotional exhaustion. Additionally, activities associated with the EBP implementation efforts (e.g., hours spent in EBP-related activities, supervision or consultation, or outcome monitoring), were not associated with emotional exhaustion. Therapists' knowledge and confidence delivering EBPs and their positive perceptions of EBPs were protective against emotional exhaustion, but these perceptions did not buffer the risks associated with heavy workload. Findings point to implementation strategies to prevent burnout and associated turnover that compromise the returns on investments in EBP implementation.

The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience).