Identifying Clinician Barriers to Quality Mental Health Treatment for Adults with Autism

Background: The number of adults diagnosed with autism is growing. More than half have a co-occurring psychiatric disorder, with anxiety and depression being the most common (Buck et al., 2014). In the general population, especially for those with public insurance, these disorders are typically treated at local community mental health centers (CMHCs). Many adults with autism would benefit from mental health treatment, but do not access these services, often because there are few clinicians trained to work with them. There is limited literature exploring this topic, and examining clinician perspectives on training needs would shed light on specific strategies to increase the quality services available to adults with autism. This study is the first to directly interview mental health clinicians on their experiences and needs in regards to treating adults with autism.

Objectives: This community partnered study aims to identify the barriers clinicians in CMHCs face in providing quality services to adults with autism. These results will directly inform the development of a training program for CMHC clinicians.

Methods: To date, 28 clinicians (86% female, 76% white) from six CMHCs have completed a semi-structured interview. Participants were psychotherapists, case managers and intake coordinators. The interview contained questions about their knowledge of autism symptoms in adults, experience with and confidence in treating adults with autism, prior education and training related to adults with autism, and recommendations for topics that related training should address. All interviews were audio recorded and transcribed professionally for analysis. The analysis will be guided by grounded theory.

Results: Data collection and analyses are ongoing and will be completed by February 2018. While some clinicians noted that they had provided services to a handful of adults with autism, many did not have any experience treating this population. Most participants had no training or education in treating adults with autism and could only describe a few autism symptoms. Many clinicians were open to working with adults with autism, but lacked confidence to provide proper treatment due to inadequate knowledge about effective strategies for this population. For example, one clinician noted during her experience providing therapy to an adult with autism, “I was asking him the wrong questions or I was saying things in a way that I wasn't communicating or getting through to him. So it was challenging for me and…probably frustrating for the client.”

Conclusions: Many CMHC clinicians do not have the confidence or skills to effectively address the needs of adults with autism. Clinicians could be better equipped to do so with the right training. From their perspective, priority training needs include a deeper understanding of core autism symptoms and how those affect the therapeutic relationship, along with direction on modifying treatment strategies for adults with autism. Clinicians would be interested in participating in an interactive training program, preferably with involvement from adults with autism, role-play exercises, discussion of actual cases, and ongoing consultation. Clinician training would increase their competence and confidence to provide needed services that will enhance the quality of life of adults with autism.