Training and Implementation Outcomes of an Adapted Executive Functioning Intervention in Children’s Mental Health Settings

Background Challenges with executive functions are well documented in autism and can lead to negative outcomes for autistic children. Moreover, mental health therapists report a need for clinical strategies to address executive functioning, particularly for their autistic clients. Executive functioning interventions show promise in improving these abilities, making them valuable for mental health services. Unstuck and On Target (Unstuck) is a cognitive–behavioral, school-based executive functioning intervention with preliminary data supporting its effectiveness when adapted for outpatient mental health services. Further evaluation of therapist training and implementation outcomes is needed to better understand the potential of interventions such as adapted Unstuck in mental health services.Objective The current mixed-methods study reports therapist training and implementation outcomes from a randomized feasibility pilot test of an adapted version of Unstuck in outpatient children’s mental health services.Method Mental health therapists (n = 16) received training in and delivered Unstuck with participating autistic youth. Through a sequential quantitative → qualitative mixed-methods approach, we assessed therapist training outcomes and perceptions regarding the acceptability, appropriateness, feasibility, and potential for sustainability and generalization of the adapted Unstuck intervention. Qualitative themes analyzed using rapid qualitative assessment method expanded on quantitative findings regarding training and implementation outcomes of interest.Results Therapists demonstrated strong Unstuck training and delivery completion and reported significant changes in their knowledge and confidence addressing executive functioning following participation. Therapists similarly reported high acceptability, appropriateness, feasibility, and potential sustainability of Unstuck, and generalized use with autistic and non-autistic children.Conclusions Overall, results indicated the feasibility of training therapists in Unstuck, with good training completion and impacts on knowledge regarding addressing executive function challenges. Additionally, therapists found Unstuck feasible, appropriate, and acceptable for clients and families they commonly work with. Results also suggest the utility and impact of Unstuck beyond autism to other mental health conditions.