1
|
Harbin SG, Hugh ML, Tagavi D, Bravo A, Joshi M, Kiche S, Michael OG, Locke J. In an Imperfect World: Barriers and Facilitators to Educators' Evidence-Based Practice Use for Elementary-Aged Autistic Students in Inclusive Settings. J Autism Dev Disord 2024:10.1007/s10803-024-06531-y. [PMID: 39261394 DOI: 10.1007/s10803-024-06531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
Educators' use of evidence-based practices (EBP) provides positive outcomes for autistic students in multiple areas of learning (e.g., peer interactions and academic skills) and may promote access and participation in general educational settings. However, many teachers report limited use of EBPs for their autistic students, with inconsistent fidelity. This study sought to understand barriers and facilitators educators identify to implementing EBPs with autistic students in general education classrooms. To understand educators' perspectives and experiences, we conducted a qualitative study with 81 educators who serve elementary-aged autistic students in one state. In response to interview questions based on the Consolidated Framework for Implementation Research framework, educators reported on multiple factors, including the general education environment, access to resources, training in EBPs, and professional collaboration. Implications for practice, training, and research are discussed. Specifically, we address educators' need for increased training and the availability of educator resources.
Collapse
Affiliation(s)
- Shawna G Harbin
- Department of Human Development and Family Science, Purdue University, Hanley Hall, Room 229, 1202 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA.
| | - Maria L Hugh
- Department of Special Education, University of Kansas, Lawrence, USA
| | - Daina Tagavi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Alice Bravo
- College of Education, University of Washington, Seattle, USA
| | - Mahima Joshi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Sharon Kiche
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Olivia G Michael
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Jill Locke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| |
Collapse
|
2
|
McLeod BD, Violante S, Ross E, Weihl A, Kaur N, Southam-Gerow MA, Jones HA, Weisz JR, Chorpita BF. The Content of Usual Clinical Care for Youth with Primary Anxiety Problems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01378-y. [PMID: 38635134 DOI: 10.1007/s10488-024-01378-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
The current study was designed to describe usual clinical care for youth with primary anxiety problems in community mental health centers. The observer-rated Therapy Process Observational Coding System for Child Psychotherapy - Revised Strategies scale (TPOCS-RS), designed to assess therapeutic techniques from five theory-based domains, was used to code sessions (N = 403) from the usual clinical care group of two randomized effectiveness trials: (a) Youth Anxiety Study (YAS) with 21 youth (M age = 10.44 years, SD = 1.91; 49.2% Latinx; 46.6%, 53.4% male) and 16 clinicians (77.5% female; 43.8% White), and (b) Child STEPS Multisite Trial with 17 youth (M age = 10.00 years, SD = 1.87; 58.8% male; 41.2% White) and 13 clinicians (M age = 40.00 years; SD = 9.18; 76.9% female; 61.5% White). The average number of TPOCS-RS items observed per treatment session was more than 10, and multiple techniques were used together in each session. All TPOCS-RS items were observed at least once throughout a clinical case, and most items reoccurred (i.e., observed in two or more sessions). The dosage of TPOCS-RS in all items was below 5 on a 7-point scale. In conclusion, clinicians in both usual care samples used a wide range of techniques from several theory-based domains at a low to medium dose. However, the type and dosage of the techniques used did vary across the two samples.
Collapse
Affiliation(s)
- Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA.
| | - Stephanie Violante
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Erica Ross
- School of Education, Virginia Commonwealth University, Richmond, USA
| | - Alexys Weihl
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Navneet Kaur
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Michael A Southam-Gerow
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Heather A Jones
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284-2018, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, USA
| |
Collapse
|
3
|
Drahota A, Sridhar A, Moskowitz LJ, Kerns CM, Soorya L, Wainer A, Cohn E, Lerner MD. Community-based care for autistic youth: community providers' reported use of treatment practices in the United States. Front Psychiatry 2023; 14:1212084. [PMID: 37791130 PMCID: PMC10544899 DOI: 10.3389/fpsyt.2023.1212084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction To illustrate the landscape of community-based care for autistic youth in the United States, we identified transdisciplinary psychosocial intervention practice sets that community providers report utilizing to care for this population, and examined characteristics associated with provider-reported utilization. Methods The Usual Care for Autism Study (UCAS) Survey assessed provider demographics and provider-reported use of transdisciplinary practices for common ASD co-occurring problems: social difficulties, externalizing behaviors, and anxiety. Community practitioners (N = 701) from allied health, behavioral, education, medical, mental health and other disciplines who treat or work with autistic youth (7-22 years) participated. Results Exploratory factor analysis yielded four factors: Consequence-Based Strategies (CBS), Cognitive-Behavioral and Therapy Strategies (CBTS), Antecedent-Based Strategies (ABS), and Teaching Strategies (TS). Providers across disciplines reported utilizing ABS more often than other sets. Providers from behavioral disciplines, with less than 4-year or Master degrees, or with more experience reported the most use of ABS, CBS and CBTS. Medical and behavioral providers reported the most use of TS. Setting and child characteristics were associated with practice set use, indicating variability by disability and client socioeconomic status. Discussion Findings reflect the complexity and inconsistency of the service landscape for autistic youth across the U.S. Only by understanding the service landscape and predictors of practice utilization, can researchers, policymakers, provider groups, and the autistic community facilitate effective implementation strategy development and use to ultimately improve community-based care.
Collapse
Affiliation(s)
- Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Connor M. Kerns
- Department of Psychology, University British Columbia, Vancouver, BC, Canada
| | - Latha Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Allison Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Cohn
- School of Nursing, Hunter College, CUNY, New York, NY, United States
| | - Matthew D. Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
4
|
Vismara LA, Nyugen L, McCormick CEB. Abbreviating the Early Start Denver Model for community-based family-centered care. Front Psychol 2023; 14:1167885. [PMID: 37546470 PMCID: PMC10399628 DOI: 10.3389/fpsyg.2023.1167885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Parent-mediated approaches for young children with or with a higher likelihood of autism have gained traction, with mounting evidence of efficacy, but a research-to-gap practice exists, and community effectiveness remains to be firmly established. Methods Using a community-participatory framework, a total of 10 parent-child dyads received a five-day workshop and six follow-up sessions of ESDM parent coaching. Intervention was implemented across two phases with in-person and telehealth delivery. Results From pre to post intervention across both phases, parents improved in their fidelity of intervention implementation and children maid gains on proximal measures of social communication. Discussion Community delivery of an evidence-based parent-mediated interventions for toddlers on the autism spectrum is feasible and promising. Giving resource efficiencies associated with parent-mediated approaches, particularly when delivered through government-funded programs, findings bolster current efforts to promote earlier and more widespread community access to necessary interventions. Facilitators and barriers to supporting parent learning and behavior change via interactive strategies are discussed.
Collapse
Affiliation(s)
| | - Lucy Nyugen
- Thrive Autism Collaborative, Denver, CO, United States
| | - Carolyn E. B. McCormick
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, United States
| |
Collapse
|
5
|
Martinez K, Chlebowski C, Roesch S, Stadnick NA, Villodas M, Brookman-Frazee L. Psychometric Assessment of the Eyberg Child Behavior Inventory in Children with Autism in Community Settings. J Autism Dev Disord 2023; 53:1693-1705. [PMID: 35278165 PMCID: PMC9464797 DOI: 10.1007/s10803-022-05427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
The Eyberg Child Behavior Inventory (ECBI) is a frequently used measure to assess interfering behaviors in children and psychometric properties have recently been examined in children with autism spectrum disorder (ASD). There is a need to confirm the identified factors and examine the factor structure in a racially/ethnically diverse, community-based sample. The current study conducts a psychometric analysis of the ECBI in a sample of children with ASD receiving publicly-funded mental health services. Data were collected from 201 children with ASD ages 5-13 years (60% Hispanic/Latinx) participating in a community effectiveness trial. Confirmatory factor analysis indicated poor model fit using previously identified factors and a new four-factor solution was identified. Clinical and research implications of these findings are discussed.
Collapse
Affiliation(s)
- Kassandra Martinez
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| |
Collapse
|
6
|
McMaughan DJD, Jones JL, Mulcahy A, Tucker EC, Beverly JG, Perez-Patron M. Hospitalizations Among Children and Youth With Autism in the United States: Frequency, Characteristics, and Costs. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:484-503. [PMID: 36454617 DOI: 10.1352/1934-9556-60.6.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/15/2022] [Indexed: 06/17/2023]
Abstract
National estimates of hospitalization diagnoses and costs were determined using the 2016 HCUP Kids' Inpatient Database. Children and youth with autism were hospitalized over 45,000 times at over $560 million in costs and 260,000 inpatient days. The most frequent principal diagnoses for hospitalizations of children and youth with autism were epilepsy, mental health conditions, pneumonia, asthma, and gastrointestinal disorders, which resulted in almost $200 million in costs and 150,000 inpatient days. Mental health diagnoses accounted for 24.8% of hospitalizations, an estimated $82 million in costs, and approximately 94,000 inpatient days. Children and youth with autism were more likely hospitalized for epilepsy, mental health diagnoses, and gastrointestinal disorders, and less likely for pneumonia and asthma compared to other children and youth.
Collapse
|
7
|
Carruthers S, Mleczko N, Page S, Ahuja S, Ellis C, Howlin P, Leadbitter K, Taylor L, Slonims V, Charman T. Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1011-1025. [PMID: 36314780 PMCID: PMC10115939 DOI: 10.1177/13623613221125630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Many early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy-Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2 years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy-Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child's behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Vicky Slonims
- King's College London, UK
- Guy's and St Thomas' NHS Foundation Trust, UK
| | | |
Collapse
|
8
|
McLeod BD, Wood JJ, Cecilione Herbst J, Dunn D, Kendall PC, Storch EA, Cho AC, Rosenau KA. Treatment Fidelity and Outcome in CBT for Youth with Autism: The MEYA Fidelity Scale. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-16. [PMID: 36175140 PMCID: PMC10050224 DOI: 10.1080/15374416.2022.2124515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Assessing treatment fidelity in effectiveness research is critical to interpreting study findings. This paper details the development and initial psychometric evaluation of the Modular Evidence-Based Practices for Youth with Autism Fidelity Scale (MEYA-FS) designed to support the assessment of cognitive-behavioral treatments for youth with autism in effectiveness research. METHOD Recorded treatment sessions (N = 338) were randomly selected from 77 youth (M age = 9.65 years, SD = 1.87; 50.67% White; 85.33% male) who received the Schema, Emotion, and Behavior-Focused Therapy for Children (SEBASTIEN) (n = 51) or Coping Cat (n = 24) program. RESULTS The MEYA-FS Adherence items displayed acceptable interrater reliability, but more than half of the MEYA-FS Competence items did not. The magnitude and pattern of correlations supported the score validity of the MEYA-FS Adherence and Competence items and subscales. However, some corresponding Adherence and Competence items displayed significant overlap. Scores on each Adherence subscale distinguished between the SEBASTIEN and Coping Cat programs, providing support for discriminant validity. Finally, higher Adherence and Competence subscales predicted significant improvements in youth clinical outcomes (adjustment problems in the school setting, social-communication difficulties, restrictive/repetitive behaviors, and externalizing problems), providing initial evidence for predictive validity. CONCLUSIONS The psychometric properties of the MEYA-FS make it appropriate for supporting efforts to evaluate cognitive-behavioral interventions for youth with autism in effectiveness and implementation research.
Collapse
Affiliation(s)
- Bryce D. McLeod
- Department of Psychology, Virginia Commonwealth University, Richmond VA
| | - Jeffrey J. Wood
- Department of Education, University of California, Los Angeles, CA
| | | | - Danielle Dunn
- Department of Psychology, Virginia Commonwealth University, Richmond VA
| | | | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - An Chuen Cho
- Department of Education, University of California, Los Angeles, CA
| | | |
Collapse
|
9
|
Williams NJ, Hugh ML, Cooney DJ, Worley JA, Locke J. Testing a Theory of Implementation Leadership and Climate Across Autism Evidence-Based Interventions of Varying Complexity. Behav Ther 2022; 53:900-912. [PMID: 35987547 PMCID: PMC9395730 DOI: 10.1016/j.beth.2022.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
Prominent theories within the field of implementation science contend that organizational leaders can improve providers' fidelity to evidence-based practices (EBPs) by using focused implementation leadership behaviors that create an organizational climate for EBP implementation. However, this work has been criticized for overreliance on nonspecific, self-report fidelity measures and poor articulation of the boundary conditions that may attenuate leadership and climate's influence. This study tests the predictions of EBP implementation leadership and climate theory on observed fidelity to three school-based EBPs for autism that vary in complexity: pivotal response training (PRT), discrete trial training (DTT), and visual schedules (VS). Educators in kindergarten to third-grade autism support classrooms in 65 schools assessed their principals' EBP implementation leadership and school EBP implementation climate prior to the school year. Mid-school year, trained observers rated educator fidelity to all three interventions. Expert raters confirmed PRT was significantly more complex than DTT or VS using the Intervention Complexity Assessment Tool for Systematic Reviews. Linear regression analyses at the school level indicated principals' increased frequency of EBP implementation leadership predicted a higher school EBP implementation climate, which in turn predicted higher educator fidelity to PRT-however, there was no evidence of a relationship between implementation climate and fidelity to DTT or VS. Comparing principals whose EBP implementation leadership was ±1 SD from the mean, there was a significant indirect association of EBP implementation leadership with PRT fidelity through EBP implementation climate (d = 0.49, 95% CI [0.04, 0.93]). Strategies that target EBP implementation leadership and climate may support fidelity to complex behavioral interventions.
Collapse
|
10
|
Brookman-Frazee L, Chlebowski C, Villodas M, Garland A, McPherson J, Koenig Y, Roesch S. The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:678-689. [PMID: 34983251 PMCID: PMC10987077 DOI: 10.1177/13623613211067844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Publicly funded mental health services play an important role in caring for school-age children with autism spectrum disorder (ASD); however, therapists report a lack of specialized ASD training, which families identity as a barrier in obtaining mental health services for their children. An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders to respond to identified needs of children and community therapists. The current study examined the effects of therapist training in AIM HI on the changes in therapist practice, including therapists' use of evidence-based intervention strategies in session. Data were collected from a study conducted in community outpatient and school based mental health programs randomly assigned to receive AIM HI therapist training or observation of routine care. Therapist and child clients were enrolled from participating programs. Therapists in AIM HI training received training and consultation for 6 months while delivering the AIM HI intervention to a participating client; therapists in usual care delivered routine care. Both groups of therapists video recorded psychotherapy sessions which were scored by trained raters. Differences between training groups were examined using multilevel modeling. Therapists trained in AIM HI were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more effective pursuit of caregiver and children skill teaching. Therapist licensure moderated some training outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | - Yael Koenig
- San Diego County Behavioral Health Services, USA
| | | |
Collapse
|
11
|
Locke J, Hernandez AM, Joshi M, Hugh ML, Bravo A, Osuna A, Pullmann MD. Supporting the inclusion and retention of autistic students: Exploring teachers' and paraeducators' use of evidence-based practices in public elementary schools. Front Psychiatry 2022; 13:961219. [PMID: 36561635 PMCID: PMC9763455 DOI: 10.3389/fpsyt.2022.961219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Educators in public schools are required to serve students in their least restrictive environment. While many evidence-based practices (EBPs), defined as practices and strategies shown by research to have meaningful effectson outcomes for autistic students are documented in the literature, less is known about EBP use among educators in public schools. METHODS Eighty-six general and special education teachers and para educators completed a survey about familiarity, training, and EBP use for included autistic children. RESULTS Across roles, educators reported familiarity (98.8%), use (97.7%), and training (83.7%) in reinforcement. They reported the least familiarity with behavioral momentum (29.1%), training in both video modeling and peer-mediated instruction and intervention (18.6%), and use of video modeling (14.0%). Follow-up interviews (n = 80) highlighted mixed understanding of EBP definitions and use. DISCUSSION Implications for inclusive education are discussed including autism-specific EBP training within pre-service teacher preparation programs.
Collapse
Affiliation(s)
- Jill Locke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Alyssa M Hernandez
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mahima Joshi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Maria L Hugh
- Department of Special Education, University of Kansas, Lawrence, KS, United States
| | - Alice Bravo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Anthony Osuna
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Michael David Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| |
Collapse
|
12
|
McLeod BD, Martinez RG, Southam-Gerow MA, Weisz JR, Chorpita BF. Can a Single Measure Estimate Protocol Adherence for Two Psychosocial Treatments for Youth Anxiety Delivered in Community Mental Health Settings? Behav Ther 2022; 53:119-136. [PMID: 35027154 PMCID: PMC8760467 DOI: 10.1016/j.beth.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
Treatment adherence measurement can be time and resource-intensive in clinical trials, so the ability to measure protocol adherence for two distinct treatment programs with a single measure may benefit the field. The present study sought to determine if the Therapy Process Observational Coding System - Revised Strategies Scale (TPOCS-RS) could assess protocol adherence to two youth treatment programs. Treatment sessions (N = 796) from 55 youth (M age = 9.89 years, SD = 1.71; range 7-15 years; 55.0% White; 46.0% female) with primary anxiety problems treatment by 39 clinicians (M age = 40.54 years, SD = 9.56; 50.0% White; 80.0% female) were independently scored by coders using observational treatment adherence and alliance measures. The youth received one of three treatments: (a) Standard (i.e., cognitive-behavioral treatment program), (b) Modular (i.e., a program with cognitive-behavioral and parent training components), or (c) Usual Care. Consultants filled out a self-report measure of protocol adherence within the Standard and Modular conditions. Interrater reliability, ICC(2,2) for the various items for the full sample ranged from .17 to .92 (M ICC = .67; SD = .17). Scores from a TPOCS-RS subscale that mapped onto the specific content of the treatment protocols used in the Standard and Modular conditions evidenced convergent validity with the consultant-report adherence measure and discriminant validity with the alliance measure. The model-specific TPOCS-RS subscales also discriminated between the Standard and Modular treatments and Usual Care. This study provides initial evidence that (a) the TPOCS-RS has utility in estimating protocol adherence in different treatment programs and (b) support the score validity of the self-report consultation records.
Collapse
Affiliation(s)
| | - Ruben G Martinez
- Virginia Commonwealth University; University of California, Los Angeles
| | | | | | | |
Collapse
|
13
|
Producing Child-Centered Interventions: Social Network Factors Related to the Quality of Professional Development for Teachers of Autistic Students. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10120453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autistic students benefit from child-centered goals that align with evidence-based practices (EBPs) that meet their individualized needs, however, most teachers are not trained in how to implement autism-specific EBPs. The challenges do not lie with teachers alone. Professional development (PD) providers, such as district or regional autism experts who train and coach teachers on how to implement autism-specific EBPs, face barriers accessing the needed supports to conduct high-quality PD and lack experience with individualizing their methods for training and coaching teachers. When PD providers have networks of professional support, they can potentially gain access to resources to provide successful individualized coaching for teachers. No research has measured the impact of the social networks of PD providers on their performance as coaches in classrooms for teachers of autistic students. To test the hypothesis that social network resources can impact the performance of PD providers who coach teachers how to use EBPs for their autistic students, we conducted social network analysis with PD providers. Findings suggest that network factors were associated with the self-reported performance for PD providers. PD providers who have more people in their networks who were autism EBP experts, as well as more people in their networks who supported them with how to individualize their PD efforts to specific teachers or districts, had higher performance as teacher coaches. We discuss future research about how to support network development for PD providers and policy implications.
Collapse
|
14
|
Lindly OJ, Shui AM, Stotts NM, Kuhlthau KA. Caregiver strain among North American parents of children from the Autism Treatment Network Registry Call-Back Study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1460-1476. [PMID: 34657479 PMCID: PMC9012781 DOI: 10.1177/13623613211052108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Caregiver strain is the adverse impact that parents of children with emotional and behavioral issues including autism often experience (e.g. negative consequences of caregiving such as financial strain and social isolation; negative feelings that are internal to the caregiver such as worry and guilt; and negative feelings directed toward the child such as anger or resentment). This study showed that on average caregiver strain did not significantly change in North American parents of children with autism during a 2-year period. Improved caregiver strain was linked to improved child functioning and behavior. Routine assessment of caregiver strain and referral to evidence-based programming and supports may help alleviate some of the burden that families of children with autism commonly experience.
Collapse
Affiliation(s)
- Olivia J Lindly
- Northern Arizona University, USA.,Massachusetts General Hospital, USA
| | | | | | - Karen A Kuhlthau
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| |
Collapse
|
15
|
McFayden TC, Gatto AJ, Dahiya AV, Antezana L, Miyazaki Y, Cooper LD. Integrating Measurement-Based Care into Treatment for Autism Spectrum Disorder: Insights from a Community Clinic. J Autism Dev Disord 2021; 51:3651-3661. [PMID: 33387241 DOI: 10.1007/s10803-020-04824-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/28/2022]
Abstract
Measurement-based care (MBC), an evidence-based approach that has demonstrated efficacy for improving treatment outcomes, has yet to be investigated in clients with Autism Spectrum Disorder. The current paper investigates the use of MBC in autistic (n = 20) and non-autistic (n = 20) clients matched on age, sex, and presenting problem. Results of change score analysis indicated that utilizing routine symptom monitoring can enhance treatment evaluation. Autistic clients participated in significantly more sessions, made significantly less progress, and were less compliant with MBC than non-autistic clients. Though hierarchical linear modeling demonstrated no significant differences in treatment slope, results indicated moderate effect size. These results inform the use of MBC in community clinics, highlighting policy implications and need for targeted measurement.
Collapse
Affiliation(s)
- Tyler C McFayden
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA.
| | - Alyssa J Gatto
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| | - Angela V Dahiya
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| | - Ligia Antezana
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| | - Yasuo Miyazaki
- Department of Education Research and Evaluation, Virginia Tech, Blacksburg, VA, USA
| | - Lee D Cooper
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| |
Collapse
|
16
|
Drahota A, Meza RD, Bustos TE, Sridhar A, Martinez JI, Brikho B, Stahmer AC, Aarons GA. Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:482-498. [PMID: 32948963 PMCID: PMC8120738 DOI: 10.1007/s10488-020-01084-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental disorder. ASD community-based organizations (ASD-CBOs) underutilize or inconsistently utilize evidence-based practices (ASD-EBPs) despite numerous available EBPs to treat ASD. Nonetheless, ASD-CBOs implement changes to practices regularly. Understanding ASD-CBO's implementation-as-usual (IAU) processes may assist to develop strategies to facilitate ASD-EBP adoption, implementation and sustainment. A convergent mixed methods (quan + QUAL) design was utilized. Twenty ASD-CBO agency leaders (ALs) and 26 direct providers (DPs), from 21 ASD-CBOs, completed the Autism Model of Implementation Survey Battery, including demographic and agency IAU process questions. Surveys were analyzed through descriptive and content analyses. A subset of 10 ALs provided qualitative interview data that were analyzed using coding, consensus and comparison methods to allow for a more comprehensive understanding of the IAU process within their ASD-CBOs. Quantitative analyses and qualitative coding were merged utilizing a joint display and compared. Results suggest that the IAU process follows some phases identified in the Exploration, Preparation, Implementation, Sustainment (EPIS) framework but were conducted in an informal manner-lacking specificity, structure and consistency across and within ASD-CBOs. Moreover, data suggest adding a specific adoption decision phase to the framework. Nonetheless, most ALs felt previous implementation efforts were successful. IAU processes were explored to determine whether the implementation process may be an area for intervention to increase ASD-EBP utilization in ASD-CBOs. Developing a systematized implementation process may facilitate broader utilization of high quality ASD-EBPs within usual care settings, and ultimately improve the quality of life for individuals with ASD and their families.
Collapse
Affiliation(s)
- Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Rosemary D Meza
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Tatiana E Bustos
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Jonathan I Martinez
- Department of Psychology, California State University, Northridge, Northridge, CA, USA
| | - Brigitte Brikho
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Aubyn C Stahmer
- Child and Adolescent Services Research Center, San Diego, CA, USA
- MIND Institute, University of California, Davis, Davis, CA, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
17
|
Jessel J, Rosenthal D, Hanley GP, Rymill L, Boucher MB, Howard M, Perrin J, Lemos FM. On the Occurrence of Dangerous Problem Behavior during Functional Analysis: An Evaluation of 30 Applications. Behav Modif 2021; 46:834-862. [PMID: 33890495 DOI: 10.1177/01454455211010698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional analyses are often conducted by behavior analysts to understand the environmental variables contributing to an individual's problem behavior to better inform treatment implementation. While functional analyses are integral for designing function-based interventions, they often arrange contingencies to evoke and reinforce dangerous problem behavior. In Study 1 we reviewed 22 functional analyses with open-contingency classes including non-dangerous topographies of problem behavior and we found that participants were more likely to exhibit the non-dangerous behavior in 82% of the applications. We then conducted a single-subject comparison of closed and open-contingency classes with four additional participants in Study 2. Our results suggest that the functional analyses with the open-contingency class reduced the likelihood of observing dangerous problem behavior.
Collapse
Affiliation(s)
- Joshua Jessel
- Queens College of the City University of New York, NY, USA
| | | | | | | | | | | | - Jesse Perrin
- Pathways Strategic Teaching Center, Warwick, RI, USA
| | - Felipe M Lemos
- Federal University of São Carlos (UFSCar), Sao Carlos, Brazil
| |
Collapse
|
18
|
Brookman-Frazee L, Chlebowski C, Villodas M, Roesch S, Martinez K. Training Community Therapists to Deliver an Individualized Mental Health Intervention for Autism Spectrum Disorder: Changes in Caregiver Outcomes and Mediating Role on Child Outcomes. J Am Acad Child Adolesc Psychiatry 2021; 60:355-366. [PMID: 32755632 DOI: 10.1016/j.jaac.2020.07.896] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examines the impact of training therapists to deliver "An Individualized Mental Health Intervention for Autism Spectrum Disorder (ASD)" (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes. METHOD Data were drawn from a cluster randomized trial conducted in 29 publicly funded mental health programs randomized to receive AIM HI training or usual care. Therapists were recruited from enrolled programs and child/caregiver participants enrolled from therapists' caseloads. Participants included 202 caregivers of children 5 to 13 years of age with autism spectrum disorder. Caregiver strain and sense of competence were assessed at baseline and 6 month postbaseline. Child behaviors were assessed at baseline and 6, 12, and 18 months postbaseline. Therapist delivery of evidence-based intervention strategies were assessed between baseline and 6 months. RESULTS A significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months. CONCLUSION Combined with research demonstrating effectiveness of therapist AIM HI training on child outcomes, this study provides further evidence of the positive impact of training community therapists in the AIM HI intervention. CLINICAL TRIAL REGISTRATION INFORMATION Effectiveness and Implementation of a Mental Health Intervention for ASD (AIM HI); https://clinicaltrials.gov/; NCT02416323.
Collapse
Affiliation(s)
- Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; Rady Children's Hospital, San Diego, California
| | - Colby Chlebowski
- Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego.
| | - Miguel Villodas
- Child and Adolescent Services Research Center, San Diego, California; San Diego State University, California
| | | | - Kassandra Martinez
- Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; San Diego State University, California
| |
Collapse
|
19
|
Characterizing Shared and Unique Implementation Influences in Two Community Services Systems for Autism: Applying the EPIS Framework to Two Large-Scale Autism Intervention Community Effectiveness Trials. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:176-187. [PMID: 30905009 DOI: 10.1007/s10488-019-00931-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to examine common and unique factors influencing implementation process for two evidence-based interventions for children with autism spectrum disorder (ASD) in mental health and education service contexts. This study prospectively collected qualitative data from intervention developers and research staff on the implementation process within the context of two separate ASD intervention effectiveness trials. Results reveal common and unique factors influencing implementation in both study contexts. Implementation leadership and provider attitudes and motivation emerge as key influences on implementation across systems. These findings provide promising targets for modular implementation interventions that can be leveraged within growing, large-scale translation efforts in usual care.
Collapse
|
20
|
Caregiver- and Child-Reported Anxiety Using an Autism-Specific Measure: Measurement Properties and Correlates of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) in Verbal Young People with ASD. J Autism Dev Disord 2020; 51:2646-2662. [PMID: 33025362 DOI: 10.1007/s10803-020-04739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Identifying and measuring anxiety in young people on the autism spectrum can be challenging. The present study investigated the use of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD), a self- and caregiver-rated screening tool in a Singaporean sample of ninety-one verbal autistic youths and their caregivers. Internal consistency ranged from satisfactory to desirable (α = .74-.92). Convergent validity with medium-large effect size was established using a structured diagnostic interview, the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ASC-ASD scores were positively associated with autistic symptoms and response patterns indicated strong endorsement of autism-specific items. The findings are discussed in relation to existing literature on assessment of anxiety in ASD and in light of the study's strengths and limitations.
Collapse
|
21
|
Dickson KS, Chlebowski C, Haine-Schlagel R, Ganger B, Brookman-Frazee L. Impact of Therapist Training on Parent Attendance in Mental Health Services for Children with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:230-241. [PMID: 32816564 DOI: 10.1080/15374416.2020.1796682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The current study explored the impact of training therapists in a mental health intervention for children with autism spectrum disorder (ASD) on parent attendance in their children's therapy sessions. We also examined family, therapist, and program factors as potential moderators. METHOD Data were drawn from a cluster-randomized community effectiveness trial of "An Individualized Mental Health Intervention for ASD (AIM HI)". Participants included 168 therapists yoked with 189 children recruited from publicly-funded mental health services. Data included family (caregiver strain, parent sense of competence, race/ethnicity), therapist (background, experience), and program (service setting) characteristics, and parent session attendance. Multilevel models were used to evaluate the effectiveness of AIM HI therapist training on caregiver attendance and identify moderators of training effects on parent attendance. RESULTS Parents attended a higher percentage of sessions in the AIM HI training condition compared to the Usual Care condition. Program service setting moderated the effect of AIM HI training, with higher parent attendance in non-school (mostly outpatient) settings compared to school settings and a significantly smaller difference between the settings in the AIM HI condition. CONCLUSIONS Effective strategies to promote parent engagement, especially in service settings such as schools, are warranted. Findings support the effectiveness of AIM HI training in promoting parent attendance across multiple publicly-funded mental health service settings. The larger effect in school-based programs supports the utility of training in evidence-based interventions such as AIM HI to increase the feasibility of parent attendance in such services.
Collapse
Affiliation(s)
- Kelsey S Dickson
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Services Research Center
| | - Colby Chlebowski
- Child and Adolescent Services Research Center.,Department of Psychiatry, University of California San Diego
| | - Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Services Research Center
| | - Bill Ganger
- Child and Adolescent Services Research Center.,San Diego State University Research Foundation
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center.,Department of Psychiatry, University of California San Diego.,Autism Discovery Institute at Rady Children's Hospital San Diego
| |
Collapse
|
22
|
Drahota A, Sadler R, Hippensteel C, Ingersoll B, Bishop L. Service deserts and service oases: Utilizing geographic information systems to evaluate service availability for individuals with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2008-2020. [PMID: 32564619 DOI: 10.1177/1362361320931265] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LAY ABSTRACT Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers' availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.
Collapse
Affiliation(s)
- Amy Drahota
- Michigan State University, USA.,Child and Adolescent Services Research Center, USA
| | | | | | | | | |
Collapse
|
23
|
Pellecchia M, Beidas RS, Lawson G, Williams NJ, Seidman M, Kimberly JR, Cannuscio CC, Mandell DS. Does implementing a new intervention disrupt use of existing evidence-based autism interventions? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1713-1725. [PMID: 32431162 DOI: 10.1177/1362361320919248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Interventions for children with autism spectrum disorder are complex and often are not implemented successfully within schools. When new practices are introduced in schools, they often are layered on top of existing practices, with little attention paid to how introducing new practices affects the use of existing practices. This study evaluated how introducing a computer-assisted intervention, called TeachTown:Basics, affected the use of other evidence-based practices in autism support classrooms. We compared how often teachers reported using a set of evidence-based practices in classrooms that either had access to TeachTown:Basics or did not have the program. We found that teachers who had access to the computer-assisted intervention reported using the other evidence-based practices less often as the school year progressed. Teachers also reported that they liked the computer-assisted intervention, found it easy to use, and that it helped overcome challenges to implementing other evidence-based practices. This is important because the computer-assisted intervention did not improve child outcomes in a previous study and indicates that teachers may use interventions that are appealing and easier to implement, even when they do not have evidence to support their effectiveness. These findings support the idea of interventions' complexity and how well the intervention fits within the classroom affect how teachers use it and highlight the need to develop school-based interventions that both appeal to the practitioner and improve child outcomes.
Collapse
|
24
|
Dickson KS, Aarons GA, Anthony LG, Kenworthy L, Crandal BR, Williams K, Brookman-Frazee L. Adaption and pilot implementation of an autism executive functioning intervention in children's mental health services: a mixed-methods study protocol. Pilot Feasibility Stud 2020; 6:55. [PMID: 32699642 PMCID: PMC7371471 DOI: 10.1186/s40814-020-00593-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with ASD as well as common co-occurring conditions (e.g., attention-deficit/hyperactivity disorder) and an evidence-based intervention has been developed and tested to address executive functioning within the school context. There is an urgent need to implement indicated evidence-based interventions for youth with ASD receiving care in community mental health settings. Interventions that optimally "fit" the mental health services context as well as the complex and co-occurring mental health needs of these youth have the potential to improve key clinical outcomes for this high priority population. METHODS This mixed-methods developmental study will apply the Exploration, Preparation, Implementation, Sustainment implementation framework and a community-academic partnership approach to systematically adapt and test an evidence-based executive functioning intervention for youth with ASD for delivery in community mental health settings. Specific aims are to (1) conduct a need and context assessment to inform the systematic adaptation an executive functioning evidence-based intervention; (2) systematically adapt the clinical intervention and develop a corresponding implementation plan, together entitled "Executive Functioning for Enhancing Community-based Treatment for ASD," (EFFECT for ASD); and (3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings. DISCUSSION Tailoring evidence-based interventions for delivery in community-based mental health services for youth with ASD has the potential to increase quality of care and improve child outcomes. Results from the current study will serve as the foundation for large-scale hybrid implementation and effectiveness trials and a generalizable approach for different service systems of care and clinical populations. TRIAL REGISTRATION Clinicaltrials.gov, NCT04295512.
Collapse
Affiliation(s)
- Kelsey S. Dickson
- San Diego State University, San Diego, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Gregory A. Aarons
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Laura Gutermuth Anthony
- University of Colorado School of Medicine, Aurora, CO USA
- Children’s Hospital of Colorado, Aurora, CO USA
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC USA
| | | | - Katherine Williams
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Rady Children’s Hospital-San Diego, San Diego, CA USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Autism Disovery Institute at Rady Children’s Hospital, San Diego, CA USA
| |
Collapse
|
25
|
Locke J, Kang-Yi C, Frederick L, Mandell DS. Individual and organizational characteristics predicting intervention use for children with autism in schools. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:1152-1163. [PMID: 31867987 DOI: 10.1177/1362361319895923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Several interventions or treatment programs have been shown through research to improve social outcomes for children with autism, but they often are not used in schools. This study examined individual (school personnel) and organizational (school level) factors associated with the use of a research-informed social engagement intervention, Remaking Recess, for children with autism in elementary schools. A total of 28 school personnel from 12 schools in 5 districts in the northeastern United States participated. Schools were randomly assigned to (1) training in Remaking Recess only or (2) training in Remaking Recess with implementation support (tailored strategies to remove barriers to increase use of Remaking Recess). School personnel rated their attitudes about research-informed interventions, organizational readiness (school's readiness to use a research-informed intervention), and fidelity or the degree to which an intervention is used as it was originally designed. Observers rated school personnel's fidelity at baseline (pre-intervention training) and exit (post-intervention training). The results suggest that self-rated fidelity was lower when staff perceived the use of Remaking Recess was required; however, observer-rated fidelity was lower when staff rated Remaking Recess as appealing. In addition, self-rated fidelity was higher when there was a sufficient number of staff, positive individual growth, and organizational adaptability. The results also indicated higher observer-rated fidelity when staff perceived positive influence over their coworkers. The results suggest that both individual (attitudes) and organizational (influence, staffing, growth, adaptability) characteristics may affect implementation success in schools. A collaborative decision-making approach for evidence-based practice use is recommended.
Collapse
|
26
|
Vasa RA, Hagopian L, Kalb LG. Investigating mental health crisis in youth with autism spectrum disorder. Autism Res 2019; 13:112-121. [DOI: 10.1002/aur.2224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Roma A. Vasa
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore Maryland
| | - Louis Hagopian
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore Maryland
- Department of Behavioral PsychologyKennedy Krieger Institute Baltimore Maryland
| | - Luke G. Kalb
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Johns Hopkins University School of Public Health Baltimore Maryland
| |
Collapse
|
27
|
Brookman-Frazee L, Roesch S, Chlebowski C, Baker-Ericzen M, Ganger W. Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services: A Cluster Randomized Clinical Trial. JAMA Psychiatry 2019; 76:574-583. [PMID: 30840040 PMCID: PMC6551846 DOI: 10.1001/jamapsychiatry.2019.0011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. OBJECTIVE To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. INTERVENTIONS The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. MAIN OUTCOMES AND MEASURES Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. RESULTS In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = -0.38; P = .02) and ECBI Problem (B = -1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = -1.36; P < .001) relative to the usual care group (B = -0.98; P < .001) and a significantly larger decrease in ECBI Problem scores in the AIM HI group (B = -1.22; P < .001) relative to the usual care group (B = -0.20; P = .29). Therapist fidelity moderated these intervention effects. CONCLUSIONS AND RELEVANCE The present findings support the effectiveness of training therapists to deliver the AIM HI model to children with ASD receiving publicly funded mental health services. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02416323.
Collapse
Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla,Child and Adolescent Services Research Center, San Diego, California,Rady Children’s Hospital–San Diego, University of California San Diego School of Medicine, La Jolla
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, California
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, La Jolla,Child and Adolescent Services Research Center, San Diego, California
| | - Mary Baker-Ericzen
- Child and Adolescent Services Research Center, San Diego, California,Rady Children’s Hospital–San Diego, University of California San Diego School of Medicine, La Jolla
| | - William Ganger
- Child and Adolescent Services Research Center, San Diego, California,San Diego State University Research Foundation, San Diego, California
| |
Collapse
|
28
|
Stadnick NA, Lau AS, Barnett M, Regan J, Aarons GA, Brookman-Frazee L. Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:447-461. [PMID: 29101604 DOI: 10.1007/s10488-017-0835-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Agency leaders and therapists are essential stakeholders in implementation of evidence-based practices (EBPs) within publicly-funded mental health services. Little is known about how these stakeholders differ in their perceptions of specific EBPs and which individual and organizational factors differentially influence these perceptions. Within the context of a system-driven implementation of multiple EBPs, survey data from 160 leaders and 720 therapists were examined to assess differences in perceptions of six EBPs. Findings indicated that leaders and therapists have unique perspectives and preferences regarding EBPs that are shaped by distinct sociodemographic and professional characteristics and aspects of organizational functioning.
Collapse
Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA.
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, USA
| | - Jennifer Regan
- Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| |
Collapse
|
29
|
Brookman-Frazee L, Stadnick N, Chlebowski C, Baker-Ericzén M, Ganger W. Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:938-952. [PMID: 28914082 PMCID: PMC6491206 DOI: 10.1177/1362361317712650] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
Collapse
Affiliation(s)
- Lauren Brookman-Frazee
- University of California, San Diego, USA
- Rady Children’s Hospital, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Nicole Stadnick
- University of California, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Colby Chlebowski
- University of California, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Mary Baker-Ericzén
- Rady Children’s Hospital, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - William Ganger
- Child and Adolescent Services Research Center, USA
- San Diego State University, USA
| |
Collapse
|
30
|
Pellecchia M, Mandell DS, Nuske HJ, Azad G, Benjamin Wolk C, Maddox BB, Reisinger EM, Skriner LC, Adams DR, Stewart R, Hadley T, Beidas RS. Community-academic partnerships in implementation research. JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 46:941-952. [PMID: 30565736 DOI: 10.1002/jcop.21981] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 05/26/2023]
Abstract
Community-academic partnerships(CAPs) are a critical component of implementing and sustaining evidence-based practices (EBPs) in community settings; however, the approaches used and mechanisms of change within CAPs have not been rigorously studied. The first step to advancing the science of CAP is to operationally define and contextualize the approaches used in CAP as part of the implementation process. Our research group has gleaned valuable lessons about the best ways to develop, support, and nurture community partnerships within the context of implementation. In this article, we share these lessons learned and relate them to implementation strategies that are most relevant to community-partnered implementation endeavors. The implementation strategies most relevant to CAPs are as follows: (a) building a coalition, (b) conducting local consensus discussions, (c) identifying barriers and facilitators to implementation, (d) facilitating interactive problem solving, (e) using an advisory board or workgroup, (f) tailoring strategies, (g) promoting adaptability, and (h) auditing and providing feedback. We offer suggestions for future research to systematically evaluate these strategies, with an eye toward advancing the science of CAP and implementation science and the goal of guiding future research and improving the implementation of EBPs in community settings.
Collapse
|
31
|
Martinez JI, Haine-Schlagel R. Observational Assessment of Engagement Strategies to Promote Parent Homework Planning in Community-Based Child Mental Health Treatment: A Pilot Study. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:1968-1980. [PMID: 30220834 PMCID: PMC6135535 DOI: 10.1007/s10826-018-1030-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Therapy homework includes tasks given to clients to complete outside of session to facilitate new knowledge/skills or to advance treatment goals. Homework completion, an important element of parent engagement in child mental health (MH) treatment, has been associated with improved child outcomes. The current pilot study assessed the design/assign phase of the therapy homework process to examine a) the extent to which therapists implemented engagement strategies with parents and b) whether therapist deployment of engagement strategies in early treatment predicted subsequent parent participation in homework planning. We included an ethnically-diverse sample of 10 therapists and 11 parent/child dyads receiving community-based MH services who participated in a pilot intervention study. Two observational coding systems were developed to code treatment session recordings for the extent to which a) therapists implemented engagement strategies with parents and b) parents contributed to therapy homework planning. Findings revealed low extensiveness of therapist implementation of engagement strategies with parents. As hypothesized, therapist use of engagement strategies (Collaboration, Empowerment, and Psychoeducation) in early treatment significantly predicted subsequent parent homework planning (sharing perspective on homework planning). However, therapist use of Alliance was unrelated to parent homework planning. These preliminary results suggest that therapist implementation of engagement strategies in early treatment may promote parent participation in homework planning, which is an important precursor to homework completion. This pilot study suggests potential future directions for both research on and training for community-based therapists in implementing successful strategies to promote parent homework planning in child MH treatment.
Collapse
Affiliation(s)
| | - Rachel Haine-Schlagel
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| |
Collapse
|
32
|
Brookman-Frazee L, Stahmer AC. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 2018; 13:66. [PMID: 29743090 PMCID: PMC5944167 DOI: 10.1186/s13012-018-0757-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. METHODS A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. DISCUSSION This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.
Collapse
Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
| | - Aubyn C. Stahmer
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, UC Davis MIND Institute, 2825 50th Street, Sacramento, CA 95817 USA
| |
Collapse
|
33
|
Rodriguez A, Lau AS, Wright B, Regan J, Brookman-Frazee L. Mixed-method analysis of program leader perspectives on the sustainment of multiple child evidence-based practices in a system-driven implementation. Implement Sci 2018. [PMID: 29534745 PMCID: PMC5850972 DOI: 10.1186/s13012-018-0737-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Understanding program leader perspectives on the sustainment of evidence-based practice (EBP) in community mental health settings is essential to improving implementation. To date, however, much of the literature has focused on direct service provider perspectives on EBP implementation. The aim of this mixed-method study was to identify factors associated with the sustainment of multiple EBPs within a system-driven implementation effort in children's mental health services. METHODS Data were gathered from 186 leaders at 59 agencies within the Los Angeles County Department of Mental Health who were contracted to deliver one of six EBPs within the Prevention and Early Intervention initiative. RESULTS Multi-level analyses of quantitative survey data (N = 186) revealed a greater probability of leader-reported EBP sustainment in large agencies and when leaders held more positive perceptions toward the EBP. Themes from semi-structured qualitative interviews conducted with a subset of survey participants (n = 47) expanded quantitative findings by providing detail on facilitating conditions in larger agencies and aspects of EBP fit that were perceived to lead to greater sustainment, including perceived fit with client needs, implementation requirements, aspects of the organizational workforce, availability of trainings, and overall therapist attitudes about EBPs. CONCLUSIONS Findings inform EBP implementation efforts regarding decisions around organizational-level supports and promotion of EBP fit.
Collapse
Affiliation(s)
- Adriana Rodriguez
- Department of Psychology, University of California, Los Angeles, California, USA.
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Blanche Wright
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Jennifer Regan
- Hathaway-Sycamores Child and Family Services, Pasadena, California, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, California, USA.,Child and Adolescent Services Research Center, San Diego, California, USA
| |
Collapse
|
34
|
Keefer A, White SW, Vasa RA, Reaven J. Psychosocial interventions for internalizing disorders in youth and adults with ASD. Int Rev Psychiatry 2018. [PMID: 29537895 DOI: 10.1080/09540261.2018.1432575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.
Collapse
Affiliation(s)
- Amy Keefer
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Susan W White
- c Department of Psychology , Virginia Tech , Blacksburg , VA , USA
| | - Roma A Vasa
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Judy Reaven
- d Department of Psychiatry , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| |
Collapse
|
35
|
Kerns CM, Moskowitz LJ, Rosen T, Drahota A, Wainer A, Josephson AR, Soorya L, Cohn E, Chacko A, Lerner MD. A Multisite, Multidisciplinary Delphi Consensus Study Describing "Usual Care" Intervention Strategies for School-Age to Transition-Age Youth With Autism. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S247-S268. [PMID: 29384389 DOI: 10.1080/15374416.2017.1410826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Understanding usual care is important to reduce health disparities and improve the dissemination of evidence-based practices for youth (ages 7-22 years) with autism spectrum disorder (ASD). A barrier to describing "usual ASD care" is the lack of a common vocabulary and inventory of the practices used by a diverse provider field. To address this barrier, we gathered input from expert providers to develop an inventory of usual care practices and assess expert familiarity and perceptions of these practices as interventions for anxiety, externalizing, and social difficulties in ASD. Purposeful sampling recruited 66 expert ASD providers representing multiple disciplines from 5 sites. Via a 2-round Delphi poll, experts reviewed, suggested revisions to and rated 49 literature-derived practices on several dimensions (familiarity, usefulness, common use, research support). A revised list of 55 practices and anonymous summary of group characteristics and ratings was then returned for further review. Results yielded 55 intervention practices, 48 of which were identified as "familiar" approaches by consensus (≥ 75% endorsement). Greater variation was observed in practices identified by consensus as most often used, useful, and research supported, depending upon the target problem. Findings provide an inventory of practices, reflective of the multidisciplinary language and approaches of expert ASD providers. This inventory may be used to better assess what constitutes usual care for youth with ASD in the United States. Moreover, findings offer insights from clinical experts regarding the range and acceptability of practices that may inform and ground treatment research, dissemination, and implementation efforts.
Collapse
Affiliation(s)
- Connor M Kerns
- a A.J. Drexel Autism Institute and Community Health & Prevention, School of Public Health , Drexel University
| | | | - Tamara Rosen
- c Department of Psychology , Stony Brook University
| | - Amy Drahota
- d Department of Psychology , Michigan State University, Child & Adolescent Services Research Center
| | - Allison Wainer
- e Department of Psychiatry , Rush University Medical Center
| | | | - Latha Soorya
- e Department of Psychiatry , Rush University Medical Center
| | - Elizabeth Cohn
- f Center for Health Innovation, College of Nursing and Public Health , Adelphi University
| | - Anil Chacko
- g Department of Applied Psychology , New York University
| | | |
Collapse
|
36
|
Caregiver-Teacher Concordance of Challenging Behaviors in Children with Autism Spectrum Disorder Served in Community Mental Health Settings. J Autism Dev Disord 2017; 47:1780-1790. [PMID: 28343342 DOI: 10.1007/s10803-017-3101-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the intensity of challenging behaviors in children with ASD receiving MH services, and identified child clinical factors associated with concordance. This sample included 141 children (M = 9.07 years), their caregivers, and teachers. Caregiver-teacher concordance of challenging behaviors was low and impacted by the degree and type of child psychiatric comorbidity. Findings support need for increased attention to the range of psychiatric problems children with ASD present to tailor treatment recommendations and service delivery.
Collapse
|
37
|
Pickard K, Meza R, Drahota A, Brikho B. They're Doing What? A Brief Paper on Service Use and Attitudes in ASD Community-Based Agencies. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2017; 11:111-123. [PMID: 30369999 PMCID: PMC6200345 DOI: 10.1080/19315864.2017.1408725] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This brief paper examined the community services delivered to youth with autism spectrum disorder (ASD) in a Southern Californian city as a way to better understand ASD service provision and service attitudes. Specific goals of the study were to identify the services being delivered within the area, and how the use, perceived evidence and value attached to these services mapped onto recent systematic ASD service reviews. Forty-six providers completed the ASD Strategies and Interventions Survey (ASD-SIS), which consisted of 21 treatment strategies and 22 interventions packages commonly used with children with ASD. Participants: 1) indicated each treatment strategy and intervention package they use; and 2) rated the perceived evidence and value of each treatment strategy and intervention package they endorsed using. Results demonstrated that a variety of treatment strategies and intervention packages, both with and without an established evidence base, were reportedly being delivered to youth with ASD through community-based agencies. Additionally, a large number of providers reported not knowing the evidence of many treatment strategies and intervention packages. Finally, although no relationship was found between evidence base and use, perceived evidence, and value for treatment strategies, providers reported significantly higher use, perceived evidence and value for established intervention packages. Results demonstrate the need to more effectively disseminate strategies that can support providers in selecting services to deliver to youth with ASD, and underscore the need to better understand the community service landscape on a larger scale.
Collapse
Affiliation(s)
| | | | - Amy Drahota
- Michigan State University, Department of Psychology
- Child & Adolescent Services Research Center
| | - Brigitte Brikho
- San Diego State University, Department of Counseling and School Psychology
| |
Collapse
|
38
|
Hill TL, Gray SAO, Baker CN, Boggs K, Carey E, Johnson C, Kamps JL, Varela RE. A Pilot Study Examining the Effectiveness of the PEERS Program on Social Skills and Anxiety in Adolescents with Autism Spectrum Disorder. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2017; 29:797-808. [PMID: 29576723 PMCID: PMC5863753 DOI: 10.1007/s10882-017-9557-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The Program for the Evaluation of the Enrichment of Relational Skills (PEERS), a social skills intervention for high functioning adolescents with autism spectrum disorder (ASD), has been proven efficacious in randomized control trials. However, the effectiveness of the PEERS program in community settings has not been studied. The present small-scale pilot study examined the effectiveness of the PEERS program in a community setting. Five adolescents and their caregivers participated in the PEERS intervention. Results indicated that the adolescents showed significant improvement in their social engagement, social cognition, social communication, social motivation, and knowledge of PEERS skills and concepts from pre- to post-intervention. Furthermore, adolescents showed significant reductions in their internalizing and autistic symptoms from pre- to post-intervention. The findings from this small-scale pilot study support the effectiveness of the PEERS program in community-based settings.
Collapse
Affiliation(s)
- Trenesha L Hill
- Department of Psychology, Tulane University, 2007 Percival Stern Hall, 6400 Freret St, New Orleans, LA 70118-5636, USA
| | - Sarah A O Gray
- Department of Psychology, Tulane University, 2007 Percival Stern Hall, 6400 Freret St, New Orleans, LA 70118-5636, USA
| | - Courtney N Baker
- Department of Psychology, Tulane University, 2007 Percival Stern Hall, 6400 Freret St, New Orleans, LA 70118-5636, USA
| | - Koren Boggs
- Children's Hospital, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Elizabeth Carey
- Children's Hospital, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Corinn Johnson
- Children's Hospital, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Jodi L Kamps
- Children's Hospital, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - R Enrique Varela
- Department of Psychological Sciences, Loyola University, 6363 St. Charles Ave, New Orleans, LA 70118, USA
| |
Collapse
|
39
|
Lewis CC, Marti CN, Marriott BR, Scott K, Ayer D. Patterns of practice in community mental health treatment of adult depression. Psychother Res 2017; 29:70-77. [PMID: 28327079 DOI: 10.1080/10503307.2017.1303210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Community mental health therapists often endorse an eclectic orientation, but few studies reveal how therapists utilize elements of evidence-based psychotherapies. This study aimed to characterize treatment as usual patterns of practice among therapists treating depressed adults in community mental health settings. METHOD Therapists (N = 165) from the USA's largest not-for-profit provider of community-based mental health services completed surveys assessing their demographics and practice element use with depressed adult clients. Specifically, therapists indicated whether they utilized each of 45 unique practice elements from the following evidence-based psychotherapies: Acceptance and Commitment Therapy, Behavioral Activation, Brief Psychodynamic Therapy, Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Mindfulness-Based CBT, Problem-Solving Therapy, and Self-Control Therapy. Principal component analysis was employed to identify practice patterns. RESULTS The principal component analysis included 31 practice elements and revealed a three-factor model with distinct patterns of practice that did not align with traditional evidence-based practice approaches, including: (i) Planning, Practice, and Monitoring; (ii) Cognitive, Didactic, and Interpersonal; and (iii) Between Session Activities. CONCLUSIONS Therapist-reported practice patterns confirmed an eclectic approach that brought together elements from theoretically distinct evidence-based psychotherapies. Future research is needed to explore how these patterns of practice relate to client outcomes to inform focused training and/or de-implementation efforts.
Collapse
Affiliation(s)
- Cara C Lewis
- a Department of Psychological and Brain Sciences , Indiana University , Bloomington , IN , USA.,b Group Health Research Institute MacColl Center for Health Care Innovation , Seattle , WA , USA.,c Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA
| | | | - Brigid R Marriott
- e Department of Psychological Sciences , University of Missouri , Columbia , MO , USA
| | - Kelli Scott
- a Department of Psychological and Brain Sciences , Indiana University , Bloomington , IN , USA
| | - David Ayer
- f Centerstone Research Institute , Bloomington , IN , USA
| |
Collapse
|
40
|
Lima RC, Couto MCV, Solis FP, Oliveira BDCD, Delgado PGG. Atenção psicossocial a crianças e adolescentes com autismo nos CAPSi da região metropolitana do Rio de Janeiro. SAUDE E SOCIEDADE 2017. [DOI: 10.1590/s0104-12902017168443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Os Centros de Atenção Psicossocial Infanto-juvenil (CAPSi) são equipamentos públicos destinados ao cuidado de crianças e adolescentes com problemas mentais graves, incluindo aqueles com transtornos do espectro do autismo (TEA). Revisão da literatura nacional indica falta de informações sistematizadas sobre o tratamento oferecido a esta clientela. O artigo apresenta e discute dados referentes a perfil psicossocial e projetos terapêuticos para usuários com autismo e seus familiares, em CAPSi situados na região metropolitana do Rio de Janeiro. Metodologia: estudo descritivo, quantitativo, baseado em questionários enviados a 14 CAPSi em 2011. Resultados: havia 782 usuários com diagnóstico de autismo nos CAPSi pesquisados, constituindo 1/3 dos usuários em atendimento. A maioria era do sexo masculino, na faixa dos 10 aos 19 anos. A maior parte residia com a família, na área de abrangência do serviço, e estava em regime assistencial semi-intensivo, com atendimentos individuais e coletivos, incluindo os familiares. Cerca de 1/5 estava fora da escola e menos de 1/3 recebia o Benefício de Prestação Continuada da Lei Orgânica da Assistência Social (BPC - Loas). Concluiu-se que os CAPSi da região ofereciam cuidado a número expressivo de autistas, requerendo, no entanto, investimento em articulações intersetoriais para ampliar condições de inclusão social, aprimoramento das informações sobre o cuidado oferecido e incentivo para o uso de metodologias avaliativas visando a qualificar a assistência a usuários com autismo e a outros sob seu cuidado.
Collapse
|
41
|
Locke J, Beidas RS, Marcus S, Stahmer A, Aarons GA, Lyon AR, Cannuscio C, Barg F, Dorsey S, Mandell DS. A mixed methods study of individual and organizational factors that affect implementation of interventions for children with autism in public schools. Implement Sci 2016; 11:135. [PMID: 27724933 PMCID: PMC5057436 DOI: 10.1186/s13012-016-0501-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/01/2022] Open
Abstract
Background The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and sustained in schools, the primary setting in which children with ASD receive services. Individual- and organizational-level factors have been shown to predict the implementation of evidence-based interventions (EBIs) for the prevention and treatment of other mental disorders in schools, and may be potential targets for implementation strategies in the successful use of autism EBIs in schools. The purpose of this study is to examine the individual- and organizational-level factors associated with the implementation of EBIs for children with ASD in public schools. Methods We will apply the Domitrovich and colleagues (2008) framework that examines the influence of contextual factors (i.e., individual- and organizational-level factors) on intervention implementation in schools. We utilize mixed methods to quantitatively test whether the factors identified in the Domitrovich and colleagues (2008) framework are associated with the implementation of autism EBIs, and use qualitative methods to provide a more comprehensive understanding of the factors associated with successful implementation and sustainment of these interventions with the goal of tailoring implementation strategies. Discussion The results of this study will provide an in-depth understanding of individual- and organizational-level factors that influence the successful implementation of EBIs for children with ASD in public schools. These data will inform potential implementation targets and tailoring of strategies that will help schools overcome barriers to implementation and ultimately improve the services and outcomes for children with ASD.
Collapse
Affiliation(s)
- Jill Locke
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA.
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Steven Marcus
- Department of Social Policy and Practice, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Aubyn Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St, Bldg. 29, St. 100, Seattle, WA, 98115, USA
| | - Carolyn Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Frances Barg
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall, Seattle, WA, 98195, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| |
Collapse
|
42
|
Stadnick N, Chlebowski C, Baker-Ericzén M, Dyson M, Garland A, Brookman-Frazee L. Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:841-851. [PMID: 27407039 DOI: 10.1177/1362361316654083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Publicly funded mental health services are critical in caring for children with autism spectrum disorder. Accurate identification of psychiatric comorbidity is necessary for effective mental health treatment. Little is known about psychiatric diagnosis for this population in routine mental health care. This study (1) examined correspondence between psychiatric diagnoses reported by mental health clinicians and those derived from a structured diagnostic interview and (2) identified predictors of agreement between clinician-reported and diagnostic interview-derived diagnoses in a sample of 197 children aged 4-14 years with autism spectrum disorder receiving mental health services. Data were drawn from a randomized effectiveness trial conducted in publicly funded mental health services. Non-autism spectrum disorder diagnoses were assessed using an adapted version of the Mini-International Neuropsychiatric Interview, parent version. Cohen's kappa was calculated to examine agreement between Mini-International Neuropsychiatric Interview, parent version and clinician-reported diagnoses of comorbid conditions. Children met criteria for an average of 2.83 (standard deviation = 1.92) Mini-International Neuropsychiatric Interview, parent version diagnoses. Agreement was poor across all diagnostic categories (κ values: 0.06-0.18). Logistic regression identified child gender and clinical characteristics as significant predictors of agreement for specific diagnoses. Results underscore the need for training mental health clinicians in targeted assessment of specific psychiatric disorders and prioritizing treatment development and testing for specific diagnoses to improve care for children with autism spectrum disorder served in publicly funded mental health settings.
Collapse
Affiliation(s)
- Nicole Stadnick
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA
| | - Colby Chlebowski
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA
| | - Mary Baker-Ericzén
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA.,4 Rady Children's Hospital, San Diego, USA
| | - Margaret Dyson
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,4 Rady Children's Hospital, San Diego, USA
| | - Ann Garland
- 2 Child and Adolescent Services Research Center, San Diego, USA.,5 University of San Diego, USA
| | - Lauren Brookman-Frazee
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA
| |
Collapse
|
43
|
Stadnick N, Brookman-Frazee L, Williams KN, Cerda G, Akshoomoff N. A Pilot Study Examining the Use of the Autism Diagnostic Observation Schedule in Community-Based Mental Health Clinics. RESEARCH IN AUTISM SPECTRUM DISORDERS 2015; 20:39-46. [PMID: 26379765 PMCID: PMC4566166 DOI: 10.1016/j.rasd.2015.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Community-based mental health (CMH) services play an important, but relatively understudied role in the identification and treatment of youth with autism spectrum disorder (ASD) who may be receiving care for other psychiatric conditions. Little is known about the role of standardized ASD assessment measures administered by providers working in generalist community-based mental health (CMH) settings. This pilot study extracted data from three CMH clinics to examine the use of the Autism Diagnostic Observation Schedule (ADOS) by 17 CMH providers who received ASD assessment training with 62 youth (Mean = 10.69 years) referred for an ASD diagnostic evaluation. Results indicated that 57% of youths assessed ultimately received an ASD diagnosis. All cases given a final ASD diagnosis were classified as "Autism" or "ASD" on the ADOS. Seventy percent of youth who did not receive a final ASD diagnosis were classified as "Non-Spectrum" on the ADOS. In these false positive cases, report narratives indicated that social communication difficulties identified on the ADOS were explained by symptoms of other mental health conditions (e.g., ADHD, anxiety). Future research is needed to examine the utility of the ADOS when used by CMH providers to facilitate CMH capacity to identify ASD.
Collapse
Affiliation(s)
- Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Gabrielle Cerda
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Natacha Akshoomoff
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
44
|
Therapist perspectives on training in a package of evidence-based practice strategies for children with autism spectrum disorders served in community mental health clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 41:114-25. [PMID: 23086499 DOI: 10.1007/s10488-012-0441-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASDs) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD.
Collapse
|
45
|
Stadnick NA, Stahmer A, Brookman-Frazee L. Preliminary Effectiveness of Project ImPACT: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program. J Autism Dev Disord 2015; 45:2092-104. [PMID: 25633920 PMCID: PMC4494791 DOI: 10.1007/s10803-015-2376-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is a pilot study of the effectiveness of Project ImPACT, a parent-mediated intervention for ASD delivered in a community program. The primary aim was to compare child and parent outcomes between the intervention group and a community comparison for 30 young children with ASD at baseline and 12 weeks. The secondary aim was to identify parent factors associated with changes in child outcomes. Results indicated significant improvement in child communication skills and a strong trend for parent intervention adherence for the intervention group from baseline to 12 weeks. Higher baseline parenting stress was negatively related to child social gains from baseline to 12 weeks. Findings provide further support for delivering parent-mediated interventions in community settings to children with ASD.
Collapse
Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA,
| | | | | |
Collapse
|
46
|
Bader SH, Barry TD. A longitudinal examination of the relation between parental expressed emotion and externalizing behaviors in children and adolescents with autism spectrum disorder. J Autism Dev Disord 2015; 44:2820-31. [PMID: 24854330 DOI: 10.1007/s10803-014-2142-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study explored the longitudinal relation between parental expressed emotion, a well-established predictor of symptom relapse in various other disorders (e.g., schizophrenia) with externalizing behaviors in 84 children, ages 8-18 (at Time 2), with autism spectrum disorder (ASD). It was found that parental expressed emotion, specifically criticism/hostility at Time 1, significantly related to a change in externalizing behaviors from Time 1 to Time 2, even after controlling for Time 1 family income, ASD symptom severity, parental distress, and parenting practices. That is, higher levels of parental criticism/hostility at Time 1 predicted higher levels of child externalizing behaviors at Time 2. However, the reverse was not found. This finding of a unidirectional relation has important clinical implications.
Collapse
|
47
|
Wood JJ, McLeod BD, Klebanoff S, Brookman-Frazee L. Toward the implementation of evidence-based interventions for youth with autism spectrum disorders in schools and community agencies. Behav Ther 2015; 46:83-95. [PMID: 25526837 DOI: 10.1016/j.beth.2014.07.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
Abstract
Evidence-based interventions (EBIs) for youth with autism spectrum disorders (ASD) are rarely found in community settings where most youth with ASD receive services. Implementation research designed to help bridge this gap is needed. However, efforts to implement EBIs in community settings face a number of barriers. The main purpose of this article is to illustrate how making EBIs more flexible and integrative may help improve their utility and may increase their uptake by stakeholders in community mental health and school settings. We conclude with an example of a modular, stepped-care program that might help bridge the science-practice gap in the ASD field by combining elements of a number of existing EBIs into a single, flexible intervention.
Collapse
|
48
|
Nair MKC, Russell PSS, George B, Prasanna GL, Mini AO, Leena ML, Russell S, Minju KA. CDC Kerala 8: Effectiveness of a clinic based, low intensity, early intervention for children with autism spectrum disorder in India: a naturalistic observational study. Indian J Pediatr 2014; 81 Suppl 2:S110-4. [PMID: 25366289 DOI: 10.1007/s12098-014-1601-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To document the effectiveness of low intensity, clinic based intervention models for Autism Spectrum Disorders (ASD) in countries with low disability resources. METHODS Thirty-nine participants with a mean (SD) of 36.03(11.15) mo were assessed before and after intervention with Childhood Autism rating scale (CARS), and at baseline with the Denver Developmental Screening Test for quantifying the effectiveness of the clinic-based intervention in ameliorating autism symptoms and studying the effect of developmental disability respectively. Developmental therapists in the clinic gave low-intensity group intervention for 45-60 min to the child through mother and encouraged to continue the training, for 3-4 h, at home to address the specific goals in the three ASD symptom clusters. Most of the children were also placed in play-schools. Follow-up support was given either on a weekly, fortnightly or monthly basis. Data was analyzed using appropriate bivariate and multivariate techniques. RESULTS There was amelioration in the severity of autism after intervention, which was statistically and clinically significant. Intervention was useful to help children with mild to severe autism. CONCLUSIONS Low-intensity, clinic-based intervention can be effectively used in situation where there is paucity of disability resources.
Collapse
Affiliation(s)
- M K C Nair
- Child Development Centre, Thiruvananthapuram Medical College, Thiruvananthapuram, 695011, Kerala, India,
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Brignell A, Morgan AT, Woolfenden S, Williams K. How relevant is the framework being used with autism spectrum disorders today? INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:43-49. [PMID: 24313935 DOI: 10.3109/17549507.2013.861870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Camarata (2014) provides a comprehensive summary of the current state of the research on early identification and intervention for children with autism spectrum disorders (ASD). Extending on the foundations provided by Camarata, this commentary discusses the value of a diagnosis of ASD and questions whether there is sufficient evidence on which to base continuing calls for early identification and ASD-specific intervention. Gaps are highlighted in the evidence base, suggestions made about how to fill those gaps, and an alternative framework is proposed for achieving best outcomes for children with early developmental problems of the type seen in ASD and their families.
Collapse
|
50
|
Stadnick NA, Drahota A, Brookman-Frazee L. Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics. JOURNAL OF CHILD AND FAMILY STUDIES 2013; 22:414-422. [PMID: 24019736 PMCID: PMC3765032 DOI: 10.1007/s10826-012-9594-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5-13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children's therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents' perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.
Collapse
Affiliation(s)
- Nicole A. Stadnick
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA. Child and Adolescent Services Research Center, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Amy Drahota
- Child and Adolescent Services Research Center, Rady Children’s Hospital-San Diego, San Diego, CA, USA. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, Rady Children’s Hospital-San Diego, San Diego, CA, USA. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| |
Collapse
|