Therapist Perspectives on Training in a Package of Evidence-Based Practice Strategies for Children with Autism Spectrum Disorders Served in Community Mental Health Clinics

Drahota, Amy; Stadnick, Nicole A.; Brookman‐Frazee, Lauren

doi:10.1007/s10488-012-0441-9

Cited by 28 publications

(31 citation statements)

References 38 publications

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“…These findings are highly consistent with qualitative studies of therapist perceptions of implementing structured practice changes (e.g., Chung, Mikesell, & Miklowitz, 2014; Drahota, Stadnick, & Brookman-Frazee, 2014) and engagement strategies (Staudt et al, 2011). It is also notable that technology was a barrier to implementation (e.g., challenges with webinar technology; malfunctioning DVD players).…”

Section: Discussionsupporting

confidence: 82%

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.

Haine‐Schlagel¹,

Mechammil²,

Brookman‐Frazee³

2017

Psychological Services

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Client engagement in services is a critical element of effective community-based child and family mental health service delivery. Caregiver engagement is particularly important, as caregivers often serve as gatekeepers to child mental health care and typically must consent for services, facilitate service attendance, and are often the target of intervention themselves. Unfortuntately, caregiver engagement has been identified as a significant challenge in community-based child mental health services. To address this gap, the Parent And Caregiver Active Participation Toolkit (PACT), which includes therapist training and participation tools for caregivers and therapists, was developed. Stakeholders’ perspectives regarding the delivery of interventions designed to improve the quality and effectiveness of community-based care are essential to understanding the implementation of such interventions in routine service settings. As such, this mixed methods study examined the perspectives of 12 therapists, eight caregivers, and six program managers who participated in a community-based randomized pilot study of PACT. Therapists, caregivers, and program managers agreed that PACT was acceptable, appropriate, and feasible to use in community settings and that both changes in therapist practices and caregiver participation resulted from implementing PACT. Some variable perceptions in the utility of the therapist training components were identified, as well as barriers and facilitators of PACT implementation. Results expand the parent pilot study’s findings as well as complement and expand the literature on training community providers in evidence-based practices.

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Section: Discussionsupporting

confidence: 82%

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.

Haine‐Schlagel¹,

Mechammil²,

Brookman‐Frazee³

2017

Psychological Services

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“…The AIM HI protocol was developed based on a systematic needs assessment of the clinical needs of children with ASD receiving MH services and the training needs of MH therapists. 9 The purpose of the current cluster randomized controlled community effectiveness trial was to build on the promising findings from a pilot study supporting the feasibility of training MH therapists and positive changes in child behaviors [31][32][33] by assessing the effectiveness of training therapists in AIM HI on changes in child behaviors across 18 months and examining potential moderators (child characteristics) and mediators (therapist fidelity) of intervention effects.…”

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confidence: 99%

Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services

et al. 2019

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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.

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“…Few studies have systematically examined the mechanisms of action of leader-level interventions and none in ASD [ 98 , 114 , 115 ]. Consistent with RDoC, TEAMS targets potential mechanisms of behavior change at leader and provider levels.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials

Brookman‐Frazee

Stahmer

2018

Implementation Sci

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BackgroundThe 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.MethodsA 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.DiscussionThis 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 registrationThis study is registered with Clinicaltrials.gov (NCT03380078). Registered 20 December 2017, retrospectively registered.

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Therapist Perspectives on Training in a Package of Evidence-Based Practice Strategies for Children with Autism Spectrum Disorders Served in Community Mental Health Clinics

Cited by 28 publications

References 38 publications

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.

Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services

Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials

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