The Impact of Training Community Mental Health Providers to Deliver a Mental Health Intervention for Children with ASD on Caregiver Outcomes
Objectives: Test the effectiveness of training therapists to deliver the AIM HI intervention on associated caregiver outcomes over 18 months.
Methods: A total of 202 client/therapist dyads were enrolled in the trial. Children were 84% male (M age =9.13 years). Caregivers were 94% female and 52% Hispanic; 30% identified Spanish as preferred language. Therapists were 86% female and 48% were MFTs. Session-level therapist fidelity was collected over the 6 month training period during which video recordings of 1,153 psychotherapy sessions were coded for adherence to AIM HI active teaching strategies. Data collected at baseline, 6 months (post), and 12 and 18 month follow up included caregiver reported outcomes using the Parenting Sense of Competence scale (PSOC) and the Caregiver Strain Questionnaire (CGSQ).
Results: Multilevel analyses of caregiver outcomes showed significant group X Time interactions for linear (B = 3.52p = .009) and quadratic (B = -.94p =.029) trajectories of Parenting Sense of Competence Scale. The increases in PSOC over 18 months were greater when therapists receive AIM HI training, but decelerated over time. There were no significant differences in linear (B=1.55, p=.106) or quadratic (B=-.381, p =.178) trajectories by group for the PSOC. Results indicate child clinical and parent sociodemographic characteristics moderated outcomes. The effects of the AIM HI intervention on reducing caregiver strain were stronger for families with children with higher cognitive abilities, as measured by the WASI-II. Caregiver preferred language was a moderator of PSOC outcomes as AIM HI moderated increases in parental feeling of competence for English speaking caregivers, but not caregivers who identified Spanish as a preferred language.
Conclusions: Findings build on initial child outcome findings and add to the empirical support for the effectiveness of AIM HI when delivered by community mental health providers. Moderation analyses provide important information for refinement of the intervention and are consistent with current work developing a toolkit to supplement the AIM HI intervention for Latinx families.