5 - (SYM 35) Provider-directed Adaptations to Lgbtq-affirmative CBT in Community Settings

LGBTQ-affirmative CBT has been tested in several efficacy trials and, when delivered with fidelity, found to be efficacious at improving mental health for sexual and gender minorities. LGBTQ-affirmative CBT is intended to be delivered following the frequency and sequence tested by the developers, however, there are potential benefits of “flexibility within fidelity” (Kendall & Beidas, 2007) for provider-directed adaptations. Now that the treatment has been adopted widely across diverse community settings in the US and worldwide, it is important to understand how providers are adapting the treatment and whether these adaptations impact treatment effectiveness. This presentation leverages quantitative (n=617) and qualitative (n=44) data from mental health providers participating in a hybrid implementation-effectiveness trial to explore provider-directed adaptations to LGBTQ-affirmative CBT 4-months after training in LGBTQ-affirmative CBT. 

Of the 390 providers who reported delivering any aspect of LGBTQ-affirmative CBT in the prior 4 months, 91% (n=357) did so during one-on-one therapy. Providers also delivered the treatment in alternative clinical settings including support groups (11.8%), case management (10%), group therapy (9.5%),  couples counseling (8.5%) and HIV test counseling (4.4%). After training, approximately 30% of providers reported predominantly working from an LGBTQ-affirmative CBT approach, whereas 67% reported sometimes or rarely working from an LGBTQ-affirmative CBT approach. The most common treatment adaptations involved integrating components of LGBTQ-affirmative CBT into another treatment approach, integrating another treatment approach into LGBTQ-affirmative CBT, and loosening the session structure. Qualitative results provide reasons behind treatment adaptations, with providers primarily describing modifications made for logistic feasibility (e.g., reduced sessions for short-term clients) or to better meet the needs of diverse clients (e.g., modifying language to be more accessible, removing home practice for young clients). Taken together, we find that mental health providers frequently integrate other treatments when implementing LGBTQ-affirmative CBT to personalize care for each client. Future research should investigate how providers can continue to adapt LGBTQ-affirmative CBT to meet their clients’ unique needs while maintaining fidelity and effectiveness.3