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Anxiety disorders are the most common mental health problem in youth, and accommodation is prevalent among youth with anxiety disorders. The Pediatric Accommodation Scale (PAS) is an interview administered by trained evaluators and a parent-report form (PAS-PR) to assess accommodation and its impact. Both have strong psychometric properties including internal consistency, inter-rater reliability, and data supporting construct validity. The present study evaluates the Pediatric Accommodation Scale – Therapist Report (PAS-TR), a therapist-reported version of the PAS-PR. Participants were 90 youth enrolled in cognitive behavioral therapy for anxiety. Therapists completed the PAS-TR over 16 therapy sessions. Internal consistency at baseline, convergent validity, divergent validity, and parent-therapist agreement were evaluated. Results suggest that the PAS-TR has mixed psychometric qualities suggesting that while not strong prior to the initiation of treatment, the PAS-TR may be a useful measure for therapists to rate accommodation as treatment progresses. Implications for assessment, treatment, and research are discussed. [ABSTRACT FROM AUTHOR]

Efforts to examine barriers to the implementation of evidence-based practices (EBPs) have largely focused on community mental health settings, although many people receive mental health services in private practice settings. Clinicians working in private practice likely face unique barriers to EBP implementation, but identifying strategies to increase EBP use in this setting is an understudied area of implementation research. The consolidated framework for implementation research (CFIR) provides an overview of multi-level determinants that influence implementation. The Characteristics of Individuals domain of the CFIR focuses on individual-level implementation determinants, such as perceptions of an intervention and self-efficacy in delivering it. Within the private practice context, little is known about how individual clinicians perceive EBPs and how this might influence their use of them. Thus, this study examined responses from qualitative interviews with 20 private practice clinicians to assess individual-level EBP implementation determinants in this context. Clinicians identified a range of attitudes towards EBPs and described how client factors influence their EBP use. Concerns about EBPs included perceptions that EBPs are too structured, are not generalizable to clinical practice, and are not suitable for a range of client populations. Clinicians also described several barriers and facilitators related to training in EBPs. Clinicians with training in exposure therapy (a well-established, but difficult-to-implement EBP) generally reported more positive attitudes, fewer barriers, and more frequent EBP use. Potential strategies to support EBP implementation in private practice are discussed. [ABSTRACT FROM AUTHOR]

Advancing mechanism-focused research in implementation science is a priority given its potential to improve tailoring and efficiency of implementation strategies. Experimental therapeutics, or experimental medicine, offers an approach for mechanism testing that has been promoted by the NIH Science of Behavior Change and endorsed by the National Institute for Mental Health. This approach has been applied across the translational spectrum – with initial applications to biological research and more recent applications to psychosocial treatment development research. We describe further advancement of experimental therapeutics along the translational spectrum and describe how it is ideally suited to inform precision experimental tests of implementation strategy mechanisms, which we term precision implementation. Such an approach to mechanism testing will allow for identification of causal dose-response relationships between implementation strategies, presumed mechanisms, and implementation outcomes. We discuss the tension between the scientific rigor required to conduct mechanism-focused research using experimental therapeutics and the "real world" conditions in which implementation research takes place. We provide a series of example studies that show "beginning to end" application of this framework in research focused on provider implementation of an evidence-based intervention in routine clinical care settings. [ABSTRACT FROM AUTHOR]