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Managing In-Session “Surprises:” Provider Responses to Emergent Life Events during Evidence-Based Treatment Implementation

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Abstract

This study aimed to: (1) pilot a psychotherapy coding system for provider responses to emergent life events (ELEs; unexpected events that have a significant negative impact on the client), (2) examine the impact of ELEs on evidence-based treatment (EBT) delivery in community settings. Raters coded 30 randomly-sampled EBT session recordings with and without reported ELEs. Inter-rater reliability and validity for the system were generally high. When an ELE occurred, providers were significantly less likely to deliver the EBT, and when they did, they rarely linked the EBT to the event. Findings highlight the potential for ELEs to disrupt EBT implementation.

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Notes

  1. Note: Because preferred activity was defined differently for ELE cases than for non-ELE cases, the contingency table in this analysis is not symmetrical.

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Acknowledgments

This research was supported in part by a grant from the John D. and Catherine T. MacArthur Foundation as part of the Research Network on Youth Mental Health Care’s Child System and Treatment Enhancements Projects (Child STEPs). The authors would like to thank Richard Border and Alayna Park for their assistance with various technical aspects of the study.

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Correspondence to Karen Guan.

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Guan, K., Levy, M.C., Kim, R.E. et al. Managing In-Session “Surprises:” Provider Responses to Emergent Life Events during Evidence-Based Treatment Implementation. Adm Policy Ment Health 44, 164–176 (2017). https://doi.org/10.1007/s10488-015-0692-3

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