(PS7-C63) Cognitive-behavioral Therapy Competence of Community Therapists Serving Spanish-speaking Clients

Background: The Spanish-speaking Latinx population in the U.S. continues to grow. Thus, more Latinx clients are seeking mental health services in Spanish. Despite an increased demand for mental health services in Spanish, cognitive-behavioral therapy (CBT) training is almost exclusively available in English both during graduate and post-graduate education. Lack of access to CBT in Spanish partly contributes to mental health care access inequities for Latinx people. In this study, we compared the CBT abilities of therapists who reported treating Spanish-speaking clients to therapists treating only English-speaking populations in the context of a 6-month CBT training that was mostly available in Spanish.

Methods: Out of a sample of 542 community therapists, 42 reported serving Spanish-speaking populations. Therapists either participated in 22 hours of live or web-based CBT training, followed by six months of weekly group consultation with audio review. Live training, consultation, audio review, and feedback were available in Spanish. Web-based training was partly available in Spanish in that trainees had Spanish handouts while video/audio material was in English. We examined CBT competence using T tests to compare therapist scores on the Cognitive Therapy Rating Scale (CTRS), a validated and reliable observer-rated measure of CBT fidelity, at pre-training(pre), 6-months post-training (6m-post; at the conclusion of 6 months of consultation), and with their CBT certification audio (cert; highest CTRS score including retries if needed to reach competence).

Results: Results indicated that at the 6m-post timepoint, therapists serving Spanish-speaking populations had significantly higher CTRS scores (M = 41.7) than therapists working only with English-speaking clients (M = 39.4) [t(51.1) = 2.1, p < .05; d = .6]. CTRS scores between therapists at all other timepoints were similar (Spanish-speaking: pre M = 19.7; cert M = 42.8) (English-speaking: pre M = 20.3; cert M = 41.4) [pre t(47.2) = -.6, p > .05; d = -.2]; [cert t(52.2) = 1.5, p > .05; d = .4]. Notably, the 6m-post difference is also clinically meaningful because a CTRS score of 40 is considered the established benchmark for CBT competence.

Conclusions: Findings indicate that despite being at a training disadvantage in that most graduate education and available CBT resources are in English, therapists delivering CBT to Spanish-speaking populations outperformed their English-speaking counterparts at the conclusion of 6 months of CBT training. Current findings may point to the benefits of making CBT consultation and training feedback available in the language that therapists and their clients speak, especially as a strategy to mitigate inequities in access to culturally responsive CBT. Further CBT training and practice implications will be discussed.