Implementing Evidence-Based Strategies In Community Mental Health Clinics: An Individualized Mental Health Intervention for School-Age Children with Autism Spectrum Disorders

Background: The community mental health (CMH) system plays an important role in caring for school-age children with ASD and a significant minority of children served in the CMH system have ASD. Unfortunately, CMH therapists are not trained to address the complex needs of children with ASD, particularly behavior problems, and both parents and therapists are highly frustrated with the quality of CMH care. AIM HI (An Individualized Mental Health Intervention for Children with ASD) was developed with input from community providers and parents to improve CMH services for children with ASD. AIM HI is a package of parent-mediated and child-focused evidence-based practice (EBP) strategies, based on the principles of applied behavior analysis, designed to reduce behavior problems in children with ASD ages 5 to 13 served in CMH clinics.

Objectives: To examine (1) the feasibility and acceptability of implementing the AIM HI in CMH clinics, (2) therapist fidelity, and (3) changes in child behaviors after receiving AIM HI.

Methods: Thirteen therapists/ family dyads from 3 CMH clinics participated in the study. Therapist participants represented multiple mental health disciplines: 39% MFT, 39% Psychology, and 23% Social Work. Children were 100% male and their ages ranged from 5 to 12 years (M=9.7; SD=2.2). Family race/ ethnicity included, 70% White, 15% Hispanic, and 15% Other/ Mixed.  Child ASD diagnoses were 46% Asperger’s Disorder, 39% PDD-NOS, and 15% Autistic Disorder. Sixty-nine percent had a non-ASD co-occurring psychiatric diagnosis (39% ADHD, 23% Anxiety Disorder, 15% Disruptive Behavior Disorder, 8% Mood Disorder). After initial training through an introductory workshop, therapists delivered AIM HI for approximately five months with participating families while receiving bi-weekly consultations with AIM HI developers.  

Results: Feasibility of Implementing AIM HI in CMH Clinics: Attendance at AIM HI trainings was very high and all therapists indicated that they perceived the training and intervention as useful in their work with children with ASD. Further, parent participation was high (M = 93% of sessions were attended by parents; SD = 0.10; Range = 73-100%). Therapist Fidelity: 100% of therapists were observed to use the AIM HI intervention materials and follow the intervention protocol and deliver AIM HI with fidelity. Child Outcomes: Clinically significant improvements in child problem behaviors were observed (i.e., d=.56 on the Competing Behavior Total Scale of the Social Skills Improvement System Rating Scales (SSIS). The greatest changes were seen on the Hyperactivity (d=1.02) and Internalizing subscales (d=.52). Further, 85% of children were within the clinical range in Hyperactivity at baseline while only 31% were in the clinical range after 5 months of AIM HI treatment, supporting the clinical significance of the changes. Effect sizes observed in this study are significantly larger than those observed from historical comparison group from the same clinics.

Conclusions: Results from mixed quantitative and qualitative data suggest that the training and intervention model are feasible to implement in CMH settings and improvements in child behaviors are observed. This study provides preliminary support for the use of packages of EBPs strategies tailored for delivery in specific community service settings.