Real-World Wins and Obstacles: Therapists’ Impressions of the Unified Protocol with Adolescents in the Community

OBJECTIVE: Treatment implementation input from frontline providers working within diagnostically, socioeconomically, and ethno-racially diverse communities is essential for optimizing treatment delivery in these settings. Transdiagnostic treatments like the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) were developed to ease adoption and delivery, but no study to date has systematically examined how community therapists perceive it. This study sought to address this important issue through an in-depth, qualitative analysis. METHOD: = 20; 80% female; 25% Black; 75% White; 32% Latine/x) were recruited after they completed UP-A and measurement-based care training as part of a randomized controlled trial (RCT) evaluating the effectiveness of both treatments for adolescent anxiety and depression. Therapists served predominantly White (60.7%) and Latine/x (41.3%) adolescents from socioeconomically diverse backgrounds. RESULTS: In reflecting on their UP-A experiences, therapists' accounts converged around five themes: 1) Client engagement and psychosocial/familial factors may impact UP-A implementation, 2) The UP-A is helpful for teens in community settings, particularly for addressing anxiety, 3) The UP-A has cross-cultural relevance, especially when paired with subtle cultural tailoring for buy-in and engagement, 4) Therapist self-efficacy, distress, and prior experience shape UP-A delivery, and 5) While organizational leaders are receptive to UP-A implementation, systemic barriers within community mental health make it challenging to provide enough support. CONCLUSIONS: The in-depth perspectives of frontline providers, especially those working in under-resourced community settings, improve our understanding of the process of implementing transdiagnostic approaches in uncontrolled settings, and have implications for treatment developers and implementation researchers and practitioners.