Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery

Autism ◽  
2021 ◽  
pp. 136236132110016
Author(s):  
Eliana Hurwich-Reiss ◽  
Colby Chlebowski ◽  
Teresa Lind ◽  
Kassandra Martinez ◽  
Karin M Best ◽  
...  
Keyword(s):  
Mental Health ◽  
Autism Spectrum Disorder ◽  
Usual Care ◽  
Teaching Strategies ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Intervention Strategies ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Active Teaching

This study identified patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder within publicly funded mental health services and compared patterns for therapists delivering usual care to those trained in AIM HI (“An Individualized Mental Health Intervention for ASD”). Data were drawn from a randomized community effectiveness trial and included a subsample of 159 therapists (86% female) providing outpatient or school-based psychotherapy. Therapist strategies were measured via observational coding of psychotherapy session recordings. Exploratory factor analysis used to examine patterns of strategy delivery showed that among therapists in the usual care condition, strategies loaded onto the single factor, General Strategies, whereas for therapists in the AIM HI training condition, strategies grouped onto two factors, Autism Engagement Strategies and Active Teaching Strategies. Among usual care therapists, General Strategies were associated with an increase in child behavior problems, whereas for AIM HI therapists, Active Teaching Strategies were associated with reductions in child behavior problems over 18 months. Results support the effectiveness of training therapists in evidence-based interventions to increase the specificity of strategies delivered to children with autism spectrum disorder served in publicly funded mental health settings. Findings also support the use of active teaching strategies in reducing challenging behaviors. Lay abstract This study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI (“An Individualized Mental Health Intervention for ASD”), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, Autism Engagement Strategies and Active Teaching Strategies, while strategies used by usual care therapists grouped onto a broader single factor, General Strategies. Among usual care therapists, General Strategies were related to an increase in child behavior problems, whereas for AIM HI therapists, Active Teaching Strategies were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.

scholarly journals Emergent life events in the delivery of a caregiver-mediated evidence-based intervention for children with autism spectrum disorder in publicly funded mental health services

Autism ◽  
2020 ◽  
Vol 24 (5) ◽  
pp. 1286-1299
Author(s):  
Teresa Lind ◽  
Anna S Lau ◽  
Christopher Gomez ◽  
Adriana Rodriguez ◽  
Karen Guan ◽  
...  
Keyword(s):  
Mental Health ◽  
Autism Spectrum Disorder ◽  
Life Events ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Health Intervention ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Mental Health Intervention ◽  
Therapy Sessions

Mental health clinicians often report significant challenges when delivering evidence-based interventions in community settings, particularly when unexpected client stressors (or emergent life events) interfere with the therapy process. The current study sought to extend the study of emergent life events to children with autism spectrum disorder by examining the occurrence and impact of emergent life events in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with autism spectrum disorder, An Individualized Mental Health Intervention for ASD (AIM HI). Participants included 38 child–clinician dyads enrolled in a community effectiveness trial of An Individualized Mental Health Intervention for ASD. Video recordings of 100 therapy sessions were coded for caregiver-reported emergent life events and clinician adherence to the Individualized Mental Health Intervention for ASD protocol. Results indicated that mild to severe emergent life events were reported in 36% of sessions, and were reported for 58% of children at some point during treatment. Greater number of child comorbid diagnoses and less clinician experience were both significantly associated with a higher number of caregiver-reported emergent life events. There was no significant link between emergent life events and clinician adherence to the Individualized Mental Health Intervention for ASD protocol. Findings offer implications for evidence-based intervention implementation, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of evidence-based interventions. Lay abstract Mental health clinicians often report significant challenges when delivering evidence-based interventions (EBI) in community settings, particularly when unexpected client stressors (or emergent life events; ELEs) interfere with the therapy process. The current study sought to extend the study of ELEs to children with Autism Spectrum Disorder (ASD) by examining the occurrence and impact of ELEs in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with ASD. This intervention was An Individualized Mental Health Intervention for children with ASD (referred to as AIM HI). Participants included 38 clinicians and child clients who were enrolled in a community effectiveness trial of AIM HI. Video recordings of 100 therapy sessions were coded for caregiver-reported ELEs and also how well clinicians adhered to the AIM HI protocol. Results indicated that mild to severe ELEs were reported in 36% of therapy sessions, and were reported for 58% of children at some point during the intervention. Children who had a greater number of diagnoses (in addition to the autism diagnosis) tended to have more ELEs. In addition, clinicians with less years of experience tended to have sessions with more ELEs. There was no significant link between ELEs and how well clinicians adhered to the AIM HI protocol. Findings offer implications for the implementation of EBI, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of EBIs.

Revisiting an RCT study of a parent education program for Latinx parents in the United States: Are treatment effects maintained over time?

Autism ◽  
2021 ◽  
pp. 136236132110331
Author(s):  
Weiwen Zeng ◽  
Sandy Magaña ◽  
Kristina Lopez ◽  
Yue Xu ◽  
J Marisol Marroquín
Keyword(s):  
Autism Spectrum Disorder ◽  
Parent Education ◽  
Education Program ◽  
Child Outcomes ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Communication Impairments ◽  
Parent Education Program

This study examined maintenance of treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder using a behavior maintenance framework. In a two-site randomized waitlist-control study, we compared differences in parent and child outcomes across three timepoints using linear mixed models to determine whether outcomes observed at 4 months after baseline (Time 2) were maintained for an additional 4-month period (Time 3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder. Results showed that at Time 3, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. Site-specific treatment differences were found in outcomes such as parent-reported empowerment and child social communication impairments. Findings suggest that the intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation. Lay abstract Background: We conducted a follow-up investigation of a two-site randomized controlled trial in the United States. We examined whether the treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder were maintained over time. Methods: Using linear mixed models, we compared differences in parent and child outcomes across three timepoints: baseline, 4 months after baseline (Time 2), and 8 months after baseline (T3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder. Results: After intervention at both Time 2 and Time 3 in both sites, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. We also found that there were treatment differences across the two study sites in several outcomes. Implications: The intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation.

scholarly journals SMARTer Approach to Personalizing Intervention for Children With Autism Spectrum Disorder

2018 ◽  
Vol 61 (11) ◽  
pp. 2629-2640 ◽  
Author(s):  
Connie Kasari ◽  
Alexandra Sturm ◽  
Wendy Shih
Keyword(s):  
Autism Spectrum Disorder ◽  
Research Methods ◽  
Social Communication ◽  
Empirical Studies ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Current Status ◽  
Evidence Based ◽  
Targeted Interventions

Purpose This review article introduces research methods for personalization of intervention. Our goals are to review evidence-based practices for improving social communication impairment in children with autism spectrum disorder generally and then how these practices can be systematized in ways that personalize intervention, especially for children who respond slowly to an initial evidence-based practice. Method The narrative reflects on the current status of modular and targeted interventions on social communication outcomes in the field of autism research. Questions are introduced regarding personalization of interventions that can be addressed through research methods. These research methods include adaptive treatment designs and the Sequential Multiple Assignment Randomized Trial. Examples of empirical studies using research designs are presented to answer questions of personalization. Conclusion Bridging the gap between research studies and clinical practice can be advanced by research that attempts to answer questions pertinent to the broad heterogeneity in children with autism spectrum disorder, their response to interventions, and the fact that a single intervention is not effective for all children. Presentation Video https://doi.org/10.23641/asha.7298021

scholarly journals Renaming schizophrenia: 5 × 5

2018 ◽  
Vol 28 (03) ◽  
pp. 254-257 ◽  
Author(s):  
Sinan Guloksuz ◽  
Jim van Os
Keyword(s):  
Mental Health ◽  
Autism Spectrum Disorder ◽  
Well Being ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Long Run ◽  
The Social ◽  
Technical Features ◽  
In The Beginning

AbstractThere had been a long way to go before we felt comfortable about even discussing the issues revolving around the concept of ‘schizophrenia’, let alone reckoning on mere semantic revision. In this editorial, we aim to extend our discussion on the reasons behind the slow death of the concept of ‘schizophrenia’ and the benefits of changing the name and embracing a spectrum approach with an umbrella psychosis spectrum disorder (PSD) category (similar to autism spectrum disorder) that goes further than a mere semantic revision. We attempted to cover the topic of the renaming by providing five most pertinent points categorised under five domains: reasons, signals, challenges, promises and steps for the change. Admittedly, even a modest revision, such as classifying all psychotic disorder categories under an umbrella category of PSD, and abolishing the term schizophrenia requires careful deliberation and some effort in the beginning, but the revision is well worth the effort considering the benefits in the long run. Renaming a particular form of mental suffering should be accompanied by a broader debate of the entire diagnosis-evidence-based-practice (EBP)-symptom-reduction model as the normative factor driving the content and organisation of mental health services that may be detached from patients’ needs and reality, overlooks the trans-syndromal structure of mental difficulties, appraises the significance of the technical features over the relational and ritual components of care, and underestimates the lack of EBP group-to-individual generalisability. Individuals may make great strides in attaining well-being by accommodating to living with mental vulnerabilities through building resilience in the social and existential domains. Changing the name and the concept of ‘schizophrenia’, which goes beyond a mere semantic revision, may become the first step that allows catalysation of the process of modernising psychiatric science and services worldwide.

Sensory processing in children with autism spectrum disorder and the mental health of primary caregivers

2019 ◽  
Vol 41 (4) ◽  
pp. 341-351 ◽  
Author(s):  
Kanae Suzuki ◽  
Shu Takagai ◽  
Masatsugu Tsujii ◽  
Hiroyuki Ito ◽  
Tomoko Nishimura ◽  
...  
Keyword(s):  
Mental Health ◽  
Autism Spectrum Disorder ◽  
Sensory Processing ◽  
Primary Caregivers ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder

scholarly journals When Will He Talk? An Evidence-Based Tutorial for Measuring Progress Toward Use of Spoken Words in Preverbal Children With Autism Spectrum Disorder

2021 ◽  
Vol 30 (1) ◽  
pp. 1-18
Author(s):  
Jena McDaniel ◽  
C. Melanie Schuele
Keyword(s):  
Autism Spectrum Disorder ◽  
Progress Monitoring ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Therapeutic Setting ◽  
Children With Asd ◽  
Spoken Words ◽  
Sampling Procedures

Purpose Professionals face substantial challenges determining whether and when children with autism spectrum disorder (ASD) who are not yet using spoken words will use spoken language as their primary means of communication. This tutorial provides speech-language pathologists with practical guidance on how to measure expressive language predictors for progress monitoring and making intervention decisions for children with ASD who are preverbal. Method This tutorial is a repackaging effort that seeks to make the research accessible to clinicians wishing to implement evidence-based practice. Results We describe intentional communication, consonant inventory in communication acts, and responding to joint attention as particularly valuable prelinguistic skills to measure. We explain how and when to efficiently assess progress using published assessments periodically and using brief (5-min) communication samples for more frequent progress monitoring. Conclusions Communication samples can be used to show how a child performs within a therapeutic setting during teaching (treatment data) and outside of the therapeutic setting (generalization probe data). Both types of data are critical for determining whether the child is exhibiting progress and which aspects of intervention are facilitating progress toward use of spoken words. These recommendations also balance the evidence for best practices for progress monitoring and the demands on clinicians' time and effort. To encourage the measurement of prelinguistic skills of children with ASD who are preverbal in clinical practice, we include (a) example data collection documents, (b) examples with hypothetical data and interpretation, and (c) guidance on communication sampling procedures. Supplemental Material https://doi.org/10.23641/asha.13557836

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