Enhancing Provider Training in Integrated Mental Health Care for ASD: Perspectives from Primary Care Providers and Leaders

Background: Children with autism spectrum disorder (ASD) have high rates of co-occurring psychiatric symptoms or diagnoses (e.g., Joshi et al., 2010) that necessitate mental health care. However, there are often challenges in timely identification of mental health comorbidities and linkage to services, resulting in high rates of unmet mental health needs (Farmer et al., 2014). Pediatric primary care is well-positioned to screen for and link children with ASD to needed mental health services earlier (Asarnow et al., 2015). However, these integrated care procedures need to be tailored for children with ASD to facilitate access to and receipt of mental health care. Detailed information from pediatric primary care stakeholders related to mental health screening and referral practices and perceived training needs to improve this process are needed for successful tailoring and implementation of integrated care for children with ASD.

Objectives: In this qualitative study, the perspectives of primary care providers and organizational leaders regarding the current infrastructure and needs of primary care providers to enhance integrated mental health care for ASD were examined.

Methods: Data were drawn from the first phase of a larger implementation study that will adapt and implement an integrated care model for children with ASD and co-occurring mental health concerns. Focus groups and key informant interviews were conducted with 12 pediatric primary care leaders and providers from two large health care organizations in Southern California that provide primary care to children with ASD. Participants were asked about current mental health screening and linkage procedures and how they modify these procedures for their patients with ASD.

Results: Discovery-oriented qualitative analyses revealed preliminary themes about provider experiences in mental health screening and referral with children with ASD. Primary care providers confirmed that the majority of their school-age patients with ASD exhibit symptoms of co-occurring psychiatric conditions, notably disruptive behaviors and anxiety. However, there is a paucity of standard mental health screeners administered to school-age children, placing the burden on caregivers or providers to identify and express psychiatric concerns about the child. Primary care providers often spend significantly more time (compared to patients without ASD) supporting caregivers to follow through on a mental health referral. The reasons for this are multifactorial but due, in part, to provider perception that caregivers may not view mental health care as a top priority or distinct from other recommended or ongoing treatment services (e.g., applied behavior analysis, educational supports).

Conclusions: These initial findings confirm the need for tailored integrated mental health care procedures for children with ASD. Further, findings highlight potential targets for provider training including selecting and using efficient and effective mental health screening tools and strategies to engage and empower caregivers to facilitate access to mental health services. Qualitative data from an additional 40 primary care providers and leaders will be analyzed and integrated. Further implications for integrated care provider training and research will be discussed.