Examining the Sustained Use of a Cognitive Behavioral Therapy Program for Youth with Autism Spectrum Disorder and Co-Occurring Anxiety

Background: Children and adolescents with autism spectrum disorder (ASD) are at high risk for developing co-occurring anxiety. In response to this concern, researchers have adapted cognitive behavior therapy (CBT) for youth with ASD. Results of a number of randomized controlled trials have demonstrated significant reductions in youth anxiety following CBT participation when it is delivered within controlled research settings. Although promising, only a handful of studies have examined the effectiveness of CBT programs when implemented within community settings and even fewer have examined the sustained use of CBT programs in community settings after implementation efforts have ended.

Objectives: The present study is a follow-up to an initial NIH-funded implementation trial that examined both implementation outcomes and youth treatment outcomes in response to an evidence-based, group CBT program for youth with ASD and co-occurring anxiety (i.e., Facing Your Fears (FYF); Reaven et al., 2018). This study aims to understand: 1) the percentage of clinicians who continue to use FYF four years following the implementation trial; 2) adaptations that have been made to FYF in order to sustain its fit within community settings; and 3) factors that influence clinicians’ sustained use of FYF.

Methods: 34 clinicians working with youth with ASD (Mean age = 34 years; 94% female, 88% White) initially implemented FYF across four university clinics as part of the initial implementation trial (Reaven et al., 2018). A comprehensive, mixed-method survey will be sent to clinicians asking them whether they still use FYF in any capacity, in addition to questions regarding: 1) adaptations they have made to FYF (Stirman et al., 2017); 2) barriers and facilitators to the sustained use of FYF; and 3) strategies used to train new clinicians in using FYF. Participants will also complete quantitative measures of CBT knowledge, attitudes towards evidence based practices (EBPAS; Aarons, 2004), and organizational cultural and climate (ORC; Lehman et al., 2002).

Results: Based on well-established frameworks of sustainability (Chambers, Glasgow, & Stange, 2013), we expect that providers who continue to use FYF have made a number of adaptations to the program to support its fit within their community setting (e.g., adaptations to program length, session duration, and core components implemented; Stirman et al., 2017). We also expect that providers will identify key factors that influence their sustained use of FYF, including their attitudes, self-efficacy, organizational climate, and external funding.

Conclusions: Results from the present study will be critically important to better understand the barriers and facilitators to the sustained use of EBPs for ASD in community settings. Doing so will address critical gaps within the ASD field, as the absence of sustained EBP use may signal gaps in proactive implementation efforts and/or the fit of EBPs within community settings on a long-term basis.