A series of five studies will be presented to demonstrate a mixed methods approach to adapt evidence-based interventions for improved engagement and benefit among vulnerable sub-groups of youth with chronic pain who are at risk for poor treatment response. Results from systematic review and meta-analysis supported CBT for pain management as a first-line intervention for pediatric chronic pain but showed that not all patients benefit. Two novel clinical trials of hybrid internet-delivered CBT for pain management confirmed that sleep deficiency at baseline predicted less benefit from treatment, suggesting that this is a sub-group requiring an adapted treatment approach. Qualitative analysis of semi-structured interviews with adolescents and parents identified treatment needs and preferences (digital and hybrid approaches preferred). Component profile analysis, a unique method for identifying core treatment components of evidence-based treatments, was used to analyze existing effective CBT-Pain protocols and identified core components to retain in an adapted intervention (relaxation skills, cognitive skills, parent support). Findings informed development of two adapted CBT-Pain and CBT-insomnia internet programs for adolescents, currently being evaluated in ongoing randomized controlled trial (n = 190). Clinical and research implications for adolescents with chronic pain at risk for poor response to existing evidence-based interventions will be discussed.