2 - (OP26) Emergent Life Events During Modular Cognitive Behavioral Therapy for Youth: Provider Responses and Client Outcomes

Objective 
Inequities in youth mental health care are perpetuated when clients experience unexpected and emotionally significant events such as death of a loved one, parental divorce, or loss of housing (i.e., emergent life events; ELE). ELEs are disproportionately experienced among minoritized populations and threaten treatment integrity in community settings where these clients are most often served. Clinical researchers have suggested that most ELEs can be addressed through a handful of therapeutic practices commonly found in existing cognitive behavioral therapies (e.g., relaxation, problem solving), yet their recommendations have not been empirically tested. This study investigated patterns of ELE occurrences and provider responses, as well as the relationship between these factors and client outcomes (clinical symptoms and premature treatment termination). 

Method 
Analyses were conducted using data from youth receiving Modular Approach to Therapy for Children (MATCH), a modular cognitive behavioral therapy for anxiety, depression, trauma, and conduct problems. The dataset included 5,184 sessions, 429 clients, 248 providers, and 54 predominantly publicly funded mental health agencies across the United States. Most clients were female (49%), White/Caucasian (50%), not of Hispanic/Latino/a/e/x origin (53%), and had a primary treatment focus of conduct problems (38%). Multilevel modelling was used to examine relationships between ELE occurrences, therapeutic practices, and client outcomes. Clinical symptoms were measured prior to each treatment session using the Brief Problem Monitor. Premature treatment termination was a binary variable based on provider report of reason for service discontinuation.

Results 
ELEs were reported during less than 3% of treatment sessions. ELEs were most commonly reported for clients with a conduct treatment focus and during sessions when family members were present. In response, providers delivered a wide array of therapeutic practices. The most frequent therapeutic practices delivered in response to a reported ELE were non-MATCH practices (e.g., supportive unstructured approaches) (33%). Interactions between ELE occurrence, provider response, and treatment outcomes did not achieve statistical significance. However, post hoc analyses revealed that ELEs reported during session was associated with an increased likelihood of clinical researcher recommended MATCH practices (e.g., relaxation, problem solving) being delivered (OR = 2.85, p < .001) and clients who reported at least one ELE exhibiting consistently higher clinical symptoms throughout treatment compared to those who never reported an ELE. 

Conclusion 
These findings highlight the complexity of effectively responding to such events within a course of cognitive behavioral therapy. Responding effectively to ELEs may require a thorough understanding of the event, client response, and appropriate therapeutic practices. In other words, ELEs may require providers to have strong case conceptualization and clinical decision-making skills. Equipping providers with skills to address ELEs is critical to minimizing treatment disruption and improving outcomes for youth, particularly minoritized populations.