(PS3-7) Caregiver Experiences with a Novel Home-based Pediatric Exposure Therapy Modality

Abstract Text:

Background: Although youth anxiety and related disorders (ARD) are prevalent, few receive evidence-based exposure therapy. Parents cite logistical challenges, like travel and limited provider availability, as obstacles to initiating and maintaining treatment. One potential way to expand the workforce and combat logistical barriers to exposure access is through home-based care, where non-licensed providers supervised by licensed clinicians deliver treatment in the home or community. The aim of this project is to examine caregiver perspectives of a home-based exposure treatment for youth with ARD.

Methods: Participants (N = 99) were caregivers of youth ages 5-18 participating in the PCORI-funded Improving Access to Child Anxiety Treatment study (#IHS-2017C1-6400), a study comparing traditional provider-centered, office-based treatment with a novel team-based, patient-centered treatment where the majority of care occurred in the patient’s home or community. At post-treatment, caregivers provided open-ended feedback about their experiences during treatment, including perceived challenges and positive experiences with the home-based modality. A systematic inductive thematic analysis was applied to identify key themes. The first through sixth authors of the current project independently developed open codes based on caregiver responders, and coders met to triangulate codes and develop key themes.

Results: Positive aspects of treatment included: learning therapeutic skills, treatment working (e.g. youth symptoms improved), personalization of treatment, therapist factors (e.g., kindness, patience, and rapport), and benefits of home-based care (e.g. comfort and access to community/school). Although many caregivers noted that they had no negative experiences with home-based treatment, challenges that were cited included: aftercare planning, loss of relationship with therapist after treatment termination, logistics (e.g. travel, scheduling), youth engagement with treatment (i.e. youth discomfort, resistance), aspects of exposure challenges (e.g. difficulty implementing exposures, logistics associated with exposure planning), structure of care (i.e. sessions too long, study too short). Finally, caregivers were asked what changes to mental health services they hoped this study would bring; the themes that emerged included: greater access (e.g. insurance coverage, provider availability), more home-based services, increased awareness of ARD and exposure therapy, reduced stigma, early identification/intervention, more diverse therapists, and more support for caregivers. Theme frequencies will be reported.

Conclusion: Results from this study may inform efforts to implement and maintain home-based exposure therapy models as well as aid in the development of future interventions designed to address barriers to accessing evidence-based pediatric mental health care.