The Impact of Training Community Mental Health Providers to Deliver a Mental Health Intervention for Children with ASD on Caregiver Outcomes

Background: Publicly-funded mental health (MH) services play an important role in caring for school-age children with ASD. AIM HI (“An Individualized Mental Health Intervention for ASD,” Brookman-Frazee and Drahota, 2010) is a package of parent mediated and child-focused behavioral strategies designed to reduce challenging behaviors for children with ASD in MH settings. The current study examined the impact of training community therapists to deliver AIM HI. Data were drawn from a large-scale randomized community effectiveness trial of AIM HI conducted in 29 publicly-funded outpatient and school-based MH programs from 2012-2017. Initial examination of parent report of child outcomes (ECBI) indicate statistically significant GroupXTime interactions for the ECBI Intensity and Problem scales, with significantly larger decline in ECBI Intensity in the AIM HI group relative to the UC group.Therapist fidelity mediated these intervention effects (Brookman-Frazee et al., under review). The current study was designed to expand on these child outcomes to look at caregiver outcomes for caregivers involved in the AIM HI with their child and a participating therapist.

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.