Measuring the Impact of Training Community Mental Health Providers to Deliver a Package of Evidence-Based Strategies for ASD on Provider Behavior and Attitudes

Background: Publicly-funded community and school-based mental health (MH) programs play an important role in caring for school-age children with autism spectrum disorders (ASD). Previous research indicates that MH therapists in routine care have limited ASD training and do not deliver strategies consistent with evidence-based practices (EBP). AIM HI (“An Individualized Mental Health Intervention for ASD”), a clinical intervention and corresponding training model designed to be delivered by community MH providers with limited ASD experience, was developed to address this gap. AIM HI is a package of EBP strategies that targets challenging behaviors in children with ASD ages 5-13. The training model consists of a workshop and 6 months of consultation.

Objectives: This presentation will report preliminary data collected to evaluate the impact of EBP training for community MH providers on attitudes and practice. Data were collected as part of an ongoing large-scale community effectiveness trial of AIM HI. 

Methods: Participants include the first two cohorts of MH providers recruited from 17 MH programs randomized to immediate AIM HI training/implementation (INT; n=59) or to a wait-list control/usual care condition (UC; n=23). Multiple methods and informants were used to measure provider delivery of EBP strategies in treatment including observational (based on videos of therapy sessions coded by blind coders), therapist self-report, and caregiver report. Therapists also reported on their own perceptions of their knowledge and confidence regarding serving children with ASD.

Results: Of the 59 therapists enrolled in the training condition, 100% attended the introductory workshop and 81% (n=48) were considered to have completed the training (attendance at >80% of consultations). Group differences emerged between UC providers (n=23) and INT providers who completed AIM HI training (n=48) when comparing therapist report of delivery of specific EBP strategies. INT therapists reported significantly higher use of EBP intervention strategies (t=2.7 p=.008) than UC therapists. Caregivers also reported higher therapist use of EBP strategies (t=4.1, p<.001) by INT therapists as compared to therapists delivering UC. Differences were also found in therapist report of changes in their knowledge and confidence related to serving children with ASD. Specifically, INT therapists reported significant increases in both their knowledge about ASD (t=-10.8, p<.001) and their confidence in (t=-8.8, p<.001) working with an ASD population from baseline to 6 months.  UC therapists reported a slight increase in knowledge (t=-3.12, p=.005) but no change in their confidence from baseline to 6 months (t=-.223, p=.826) regarding their perceptions of their ability to work with ASD clients. Lastly, average ratings of EBP strategy use rated by blind observers were significantly higher for INT therapists compared to UC therapists.

Conclusions: Preliminary data indicate that therapist participation in AIM HI training results in changes in MH providers’ attitudes and behavior and increased use of EBP intervention strategies based on blind observer, therapist and parent report. Research on efforts to implement evidence-based strategies in community care settings has the potential to improve care for children with ASD served in MH service settings.