Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services: A Cluster Randomized Clinical Trial
Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services: A Cluster Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2019.0011
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发表时间：
2019-06-01
期刊：
影响因子：
25.8
通讯作者：
Ganger, William
中科院分区：
文献类型：
--
作者：
Brookman-Frazee, Lauren;Roesch, Scott;Ganger, William
重要性公共资助的心理健康服务在解决自闭症谱系障碍（ASD）儿童共同发生的心理健康问题方面发挥着重要作用;然而，治疗师报告缺乏有效服务于这一复杂人群的培训。目的探讨在ASD个体化心理健康干预（AIM HI）中对社区治疗师进行18个月ASD儿童挑战行为培训的有效性，并确定干预效果的调节因子和中介因子。研究设计、环境和实验对象：2012年至2017年在南加州29个公共资助的门诊和学校心理健康项目中进行的随机分组试验。程序随机接受即时AIM HI培训或提供常规护理，然后接受AIM HI培训。治疗师参与者是从注册的项目中招募的，儿童参与者是从参与者治疗师的病例中招募的。分析了202名5至13岁ASD儿童的数据。干预AIM HI方案是一套以父母为中介和以儿童为中心的策略，旨在减少5至13岁ASD儿童的挑战性行为。它的目的是提供公共资助的精神卫生服务的基础上，治疗师的培训需求和儿童临床需求的系统评估。治疗师培训和咨询过程需要大约6个月，包括一个介绍性研讨会，11个结构化的咨询会议，因为治疗师提供AIM HI与当前客户，以及来自培训师的特定案例的绩效反馈。主要结果和措施儿童参与者的挑战性行为进行了评估，使用Eyberg儿童行为量表（ECBI）和社会技能改善系统（SSIS）的竞争问题行为量表的基础上，在基线和6个月的时间间隔为18个月。使用意向治疗模型分析结局。结果共有202名ASD儿童（平均[SD]年龄，9.1 [2.4]岁; 170名[84.2%]男性; 121名[59.9%]拉丁裔）符合条件，入组并纳入分析。观察到ECBI强度（B=-0.38; P= 0.02）和ECBI问题（B=-1.00; P= 0.005）量表的组间时间相互作用具有统计学显著性，AIM HI组的ECBI强度评分下降幅度显著更大（B=-1.36; P
ImportancePublicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. ObjectiveTo test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. Design, Setting, and ParticipantsCluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. InterventionsThe AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. Main Outcomes and MeasuresChild participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. ResultsIn total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B=-0.38; P=.02) and ECBI Problem (B=-1.00; P=.005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B=-1.36; P