(PS5-27) Novel Application of the Theory of Planned Behavior for Predicting Youth Mental Health Therapists' Practice Behaviors

Abstract Text: Despite the extensive advances in the field of dissemination and implementation science, there are still numerous and multi-level barriers to implementation of evidence-based practices (EBP). Of these barriers, therapist level characteristics has been the source of many investigations into this topic, specifically, understanding the relationships between therapists’ characteristics and a variety of practice behaviors. The Theory of Planned Behavior (TPB) posits that an individual’s intention to perform a behavior serves as the most immediate determinant of behavior and that behavioral intentions may serve as a proximal indicator of behavior (Ajzen, 1991). Only a handful of studies have examined the application of the TPB with mental health therapists’ behaviors and overall suggest the potential utility of the TPB for understanding and predicting mental health therapists’ behaviors (e.g. Hill, Mah, & Nakamura, 2020). Studying the relationships between important therapist level constructs related to attitudes, such as subjective norms, perceived behavioral control, and behavioral intentions, which are all central constructs of the Theory of Planned Behavior (TPB) with EBP use, may be a fruitful endeavor for better understanding therapist EBP adoption behaviors (Ajzen, 1991).
This study examined the extent to which 64 community mental health therapists’ evidence-based practice attitudes, subjective norms, perceived behavioral control, and behavioral intentions predicted self-reported use of practices derived from the evidence-base (PDEB) with 264 treated youth using multilevel modeling (MLM). Therapists in this sample were ethnically diverse, majority female (n = 47), ranging in age from 25 to 60 years (M = 38.0, SD = 9.3), and had an average of 5.9 years (SD = 5.7) of full-time clinical experience. The 264 youth in this sample ranged from 3.6 to 18.3 years of age (M = 13.1, SD = 3.4) and 72% (n = 189) reported as male. MLM results for the perceived behavioral control construct showed that therapists perceived behavioral control was significantly and positively related to the utilization rates of Attending (t = 2.22, p = .03) and Response Cost for Disruptive Behavior Disorders (t = 2.02, p = .04). No other TPB constructs (e.g., attitudes) predicted utilization of 7 practice elements (e.g., Commands, Ignoring) additionally investigated.
While MLM results largely did not support the TPB framework for the prediction of PDEB utilization in this context, several methodological limitations temper the potential for prematurely concluding that this framework does not apply to youth mental health evidence-based therapy. Notwithstanding several study limitations, there continues to be a large body of evidence surrounding the TPB and this study’s novelty in a variety of ways makes a contribution to the literature. Consistencies and divergence from previous literature, interpretations, limitations, and implication for future research are discussed.