UCLA

The past 25 years have been characterized by remarkable advances in the development and testing of evidence-based treatments (EBTs) for a variety of youth mental health problems. However, the public health impact of these EBTs has been less than desired or expected. The majority of youth with mental health concerns do not receive EBTs, and when EBTs are delivered in public sectors of care, they have been shown to produce effect sizes well below those seen in randomized clinical trials. A common view among providers serving diverse youth in the community is that EBTs often do not fit their clients’ characteristics, values, and needs. Accordingly, numerous questions have been raised about how to provide mental health services that are both effective and responsive to youth in the community. This dissertation sought to elucidate strategies for improving the utility of EBTs for the diverse youth referred for community mental health services. The first study examined the applicability and implementation of EBTs for youth accessing community mental health services following a county-wide EBT reform initiative. Results showed that a set of more than 30 EBTs had limited applicability to the service sample and that most youth did not receive EBTs delivered with fidelity. In light of these findings suggesting that EBTs may need to be adapted to better fit the needs of the diverse youth in the community, the second study explored providers’ perceptions of barriers and facilitators to engaging traditionally underserved youth in community mental health services. Providers identified barriers to effectively engaging ethnic minority youth as well as families receiving social services. Assigning clients to providers with similar backgrounds, striving for a respectful and nonjudgmental therapeutic style, and making use of implementation supports such as supervision were commonly nominated as strategies for improving client engagement in community mental health services. To identify commonly researched strategies for incorporating culture into psychotherapy, the third study reviewed the literature on psychosocial interventions for ethnic minority youth. This review identified various strategies for incorporating culture into psychotherapy, such as matching clients with providers with similar backgrounds, using handouts that depict ethnic minority youth and families, and allocating time in sessions to discuss issues of prejudice and discrimination. These strategies for culturally tailoring treatment were featured in one-third of effective psychosocial interventions, although most of these interventions targeted disruptive behavior problems among Black and Latinx youth. Findings from these three dissertation studies indicate that the diverse youth seen in community mental health settings may benefit from the selective adaptation of EBTs and highlight opportunities for enhancing the effectiveness and responsiveness of mental health care for traditionally underserved youth and families.