Bridging Evidence and Practice: A Community-Engaged Adaptation of Cognitive Behavioral Therapy for Autistic Youth...

Differences between research and community care settings contribute to a research-to-practice gap. Engaging community partners in intervention adaptation may better align mental health evidence-based practices (MH-EBPs) with community-based settings and intervention recipients. This study utilized a community-engaged intervention adaptation method (i.e., Adapted Method for Program Adaptation through Community Engagement [AM-PACE]) to develop a community-adapted version of Behavioral Interventions for Anxiety in Children with Autism (BIACA). A Community Advisory Board provided ongoing input about study procedures and results. A mixed methods design was used to obtain community members' ratings of implementation outcomes and perspectives regarding facilitators, barriers, and possible improvements. Thereafter, a sample of community providers (n = 188) comparatively evaluated the original BIACA and community-adapted BIACA. Community-based data were collected in the United States from July 2024 to August 2025. Adaptations to BIACA suggested by the community included three domains: content, delivery, and training/evaluation. Comparative analyses found community providers rated the community-adapted BIACA as more acceptable and appropriate and reported higher intent to use compared to the original BIACA (p's < .05, d's > .17). Adaptations identified through community engagement may enhance the potential for MH-EBPs, such as BIACA, to be implemented in community-based settings.Lay AbstractAnxiety is common among autistic children and can interfere with daily life, school, and relationships. Cognitive behavioral therapy (CBT) is an effective therapy for anxiety, and there are well-established CBT programs designed specifically for autistic youth. However, programs that work well in research settings do not always fit easily into real-world community organizations, such as community mental health centers and outpatient clinics. One reason for this is that autistic youth and adults, caregivers, and community providers are not always involved in shaping how these programs are developed. This study focused on adapting an existing anxiety therapy program for autistic children-Behavioral Interventions for Anxiety in Children with Autism (BIACA)-so that it better fits with the characteristics of community-based settings. The research team used a community-engaged approach, which means that community members were actively involved in reviewing the program and suggesting changes. A Community Advisory Board made up of community members provided guidance throughout the study. In addition, nearly 200 community-based mental health providers reviewed both the original version of BIACA and the adapted version without knowing which was which. We collected community-based data in the United States between July 2024 and August 2025. Community members suggested changes to the therapy's content, how it is delivered, and how providers are trained and supported to use it. When providers compared the original version of the therapy and the version incorporating the community-suggested changes, they rated the community-adapted version as more acceptable, more appropriate, and more likely to be used in practice. Overall, this study shows that involving community partners to adapt mental health therapies may lead to therapies that providers are more willing and able to use. Community engagement may be a key step in helping effective anxiety therapies reach more autistic youth in everyday care settings.